Division of Hematology and Medical Oncology, Department of Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan, Republic of China.
Ann Hematol. 2013 Nov;92(11):1513-20. doi: 10.1007/s00277-013-1807-0. Epub 2013 Jun 18.
Several revisions of International Prognostic Index (IPI) have been proposed for patients with diffuse large B-cell lymphoma (DLBCL) after the introduction of rituximab. Expanding evidence suggests that baseline absolute lymphocyte count (ALC) is also an independent factor for outcome prediction. We investigated the optimal prognostic model for these patients in the rituximab era. The study enrolled 274 consecutive patients with DLBCL receiving first-line cyclophosphamide, doxorubicin, vincristine, and prednisone based chemotherapy with rituximab between 2003 and 2009. Five factors within IPI and ALC were entered for Cox regression analysis. Overall survival (OS) and progression-free survival were calculated for different risk groups of models. Efficacy of models was compared by the value of Akaike information criterion (AIC). Revised IPI (R-IPI) and ALC/R-IPI, but not IPI, were informative to discriminate between different risk groups. In multivariate analysis for individual factors of the prognostic models, performance status >1 [odds ratio (OR) 3.59], Ann Arbor stage III or IV (OR 2.24), and ALC <1 × 10⁹/L (OR, 2.75) remained significant. Another modified score based on the three factors divided patients into four risk groups and the 3-year OS rate was 93, 77, 39, and 13 %, respectively. By comparing AIC values in the Cox proportional hazards model, the modified three-factor model was the superior prognostic model followed by established ALC/R-IPI, R-IPI, and standard IPI. In conclusion, the addition of the novel factor, ALC, interacts with other established factors in outcome prediction for DLBCL. Development of a new score is needed for a better risk stratification in the rituximab era and would be helpful in the design of future clinical trials. The proposed three-factor model should be validated in large-scale studies.
几种修订的国际预后指数（IPI）已经被提出，用于弥漫性大 B 细胞淋巴瘤（DLBCL）患者在利妥昔单抗引入后。不断增加的证据表明，基线绝对淋巴细胞计数（ALC）也是一个独立的预后预测因素。我们研究了在利妥昔单抗时代这些患者的最佳预后模型。这项研究纳入了 274 例连续接受一线环磷酰胺、阿霉素、长春新碱和泼尼松的 DLBCL 患者，这些患者接受了利妥昔单抗治疗，时间是在 2003 年至 2009 年。对 IPI 和 ALC 中的五个因素进行 Cox 回归分析。为不同风险组的模型计算总生存率（OS）和无进展生存率。通过 Akaike 信息准则（AIC）值比较模型的疗效。修订后的 IPI（R-IPI）和 ALC/R-IPI，但不是 IPI，对不同风险组具有信息性。在预后模型的个体因素的多变量分析中，表现状态 >1[比值比（OR）3.59]、Ann Arbor 分期 III 或 IV（OR 2.24）和 ALC <1×10⁹/L（OR，2.75）仍然显著。另一个基于这三个因素的修改后的评分将患者分为四个风险组，3 年 OS 率分别为 93%、77%、39%和 13%。通过比较 Cox 比例风险模型中的 AIC 值，修改后的三因素模型是优越的预后模型，其次是已建立的 ALC/R-IPI、R-IPI 和标准 IPI。总之，新的因素 ALC 的加入与其他已建立的因素在 DLBCL 的预后预测中相互作用。在利妥昔单抗时代，需要开发一个新的评分来进行更好的风险分层，这将有助于未来临床试验的设计。所提出的三因素模型应在大规模研究中验证。
