Stelitano C, Baldini L, Pieresca C, Callea V, Angrilli F, Clò V, Partesotti G, Merli F, Cavanna L, Morabito F, Federico M, Brugiatelli M, Silingardi V
Dipartimento di Emato-Oncologia, Azienda Ospedaliera Bianchi-Melacrino-Morelli, 89100 Reggio Calabria, Italy. morctmo@tin. it.
Haematologica. 2000 Feb;85(2):154-9.
The subset of non-follicular non-Hodgkin's lymphoma (NHL) includes patients with varied prognoses, thus suitable for different therapeutic approaches. The International Prognostic Index (IPI), originally proposed for aggressive NHL, has been demonstrated to be of prognostic relevance also in follicular NHL. The main aim of the study was to validate the IPI in this histologic category; in addition, the specific prognostic classification, currently employed in the Gruppo Italiano per lo Studio dei Linfomi (GISL) prospective therapeutic trials and based on different features, more similar to those applied to chronic lymphocytic leukemia, was analyzed.
The present series consists of 137 evaluable patients affected by Working Formulation group A NHL out of 256 cases referred to the GISL Registry. The retrospective prognostic study included the evaluation by both univariate and multivariate analyses of overall survival, response to therapy and response duration. The IPI was applied as originally proposed. The GISL definition of indolent and aggressive disease at diagnosis was based on the presence of B symptoms, bulky disease, anemia and thrombocytopenia.
The distribution of patients in IPI risk groups was rather unbalanced with 18%, 47%, 28% and 7% of cases classified as low (L), intermediate-low (IL), intermediate-high (IH) and high (H) risk, respectively. The median overall survival was not reached in either L or IL risk groups, and was 84.1 and 7.4 months for IH and H risk groups, respectively (p=0. 0005). A simplified IPI model was designed merging patients in both intermediate risk groups and the statistical difference of survival retained its significance. GISL prognostic stratification was demonstrated to have a significant association with survival, with a median survival of 71.3 months in aggressive disease and a median survival not reached at 152 months in indolent disease. Both the simplified IPI model and the GISL risk definition retained their significance in multivariate analysis for overall survival, while for response to therapy only the simplified IPI model resulted to be of statistical significance. In addition, the GISL prognostic stratification identified patients with different outcomes within the IPI intermediate risk group, with a median survival of 70.2 months for patients with aggressive disease wheras the median survival for those with indolent disease was not reached. Finally, a prognostic score resulting from the integration of the simplified IPI and the GISL system was statistically validated.
The retrospective analysis of this series demonstrates the validity of the IPI in non-follicular indolent NHL and the usefulness of integrating the IPI parameters with disease specific prognostic variables.
非滤泡性非霍奇金淋巴瘤（NHL）亚组患者的预后各不相同，因此适合采用不同的治疗方法。最初针对侵袭性NHL提出的国际预后指数（IPI），已被证明在滤泡性NHL中也具有预后相关性。本研究的主要目的是在这一组织学类型中验证IPI；此外，还分析了目前在意大利淋巴瘤研究组（GISL）前瞻性治疗试验中使用的、基于不同特征且更类似于用于慢性淋巴细胞白血病的特定预后分类。
本系列研究包括GISL登记处登记的256例患者中的137例可评估的、符合工作分类A组NHL的患者。这项回顾性预后研究包括通过单因素和多因素分析评估总生存期、治疗反应和反应持续时间。IPI按最初提出的方法应用。GISL对惰性和侵袭性疾病的诊断定义基于B症状、大包块病、贫血和血小板减少症的存在。
患者在IPI风险组中的分布相当不均衡，分别有18%、47%、28%和7%的病例被分类为低（L）、中低（IL）、中高（IH）和高（H）风险。L组和IL组的总生存期均未达到中位数，IH组和H组的总生存期分别为84.1个月和7.4个月（p = 0.0005）。设计了一个简化的IPI模型，将两个中风险组合并，生存的统计学差异仍然显著。GISL预后分层被证明与生存有显著关联，侵袭性疾病的中位生存期为71.3个月，惰性疾病的中位生存期在152个月时未达到。简化的IPI模型和GISL风险定义在总生存期的多因素分析中均保持其显著性，而对于治疗反应，只有简化的IPI模型具有统计学意义。此外，GISL预后分层在IPI中风险组内识别出了不同预后的患者，侵袭性疾病患者的中位生存期为70.2个月，而惰性疾病患者的中位生存期未达到。最后，对简化的IPI和GISL系统整合得出的预后评分进行了统计学验证。
本系列的回顾性分析证明了IPI在非滤泡性惰性NHL中的有效性，以及将IPI参数与疾病特异性预后变量相结合的有用性。
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