[International prognostic index in diffuse B large cell lymphosarcoma].

AIM

To evaluate efficacy of the International Prognostic Index (IPI) in relation to diffuse B-large cell lymphosarcoma (BLCLS), to identify significant prognostic factors.

MATERIAL AND METHODS

The trial enrolled 121 patients (67 males and 54 females, mean age 54 years) suffering from BLCLS with involvement of the lymph nodes, spleen, tonsils. The diagnosis was made according to WHO criteria. 83 patients (29 with local lesion of lymph nodes, 10 with primary lesion of the tonsils, 9 with primary lesion of the spleen and 35 with generalized lesion) received polychemotherapy (PCT): CHOP-21, R-CHOP-21. Patients with primary splenic lesion have undergone splenectomy followed by CHOP-21 PCT, radiotherapy on the splenic region and that of regional lymph nodes. Radiation therapy was also given to patients with stage I-II, 38 patients received NHL-BFM-90 PCT.

RESULTS

In distribution of patients into prognosis groups according to IPI 5-year event-free survival on CHOP-21 and R-CHOP-21 therapy was 83% in the group of low risk, 79% in the group of low/intermediate risk, 52% in the group of high/intermediate risk, 34% in the group of a high risk. However, there were poor outcomes in the group of low risk (recurrence, resistance) and long-term persistent remissions in high risk groups. Frequency and duration of complete remissions depended on location of the primary lesion. Five-year event-free survival in patients with solitary lesion of the peripheral lymph nodes on CHOP-21, R-CHOP-21 in spite of their size (bulky) and high concentration of lactate dehydrogenase) was 97% while in tonsillar lesion (according to IPI all the patients entered groups of low and low/intermediate risk) - 50%. All the patients with primary splenic lesion according to IPI had high risk but after splenectomy and PCT (CHOP-21, R-CHOP-21) followed by radiotherapy they demonstrated 100% 5-year event-free survival (follow-up since 1998).

CONCLUSION

Determination of prognosis groups in BLCLS is not valid as such distribution gives no grounds for choice of adequate therapy. A decisive prognostic factor is now site of the lesion.