Department of Internal Medicine, Chonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, Republic of Korea.
Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea.
Ann Hematol. 2019 Dec;98(12):2739-2748. doi: 10.1007/s00277-019-03834-4. Epub 2019 Nov 11.
The aim of this study was to evaluate the prognostic relevance of early risk stratification in diffuse large B-cell lymphoma (DLBCL) using interim Deauville score on positron emission tomography-computed tomography (PET-CT) scan and baseline International Prognostic Index (IPI). This retrospective study included 220 patients (median age, 64 years; men, 60%) diagnosed with DLBCL between 2007 and 2016 at our institution, treated with rituximab-based chemotherapy. Interim PET-CT was performed after three cycles of immuno-chemotherapy. Interim Deauville score was assessed as 4 or 5 in 49 patients (22.3%), and 94 patients (42.7%) had high-intermediate or high-risk IPI scores. In multivariate analysis, interim Deauville score (1-3 and 4-5) and baseline IPI (low/low-intermediate and high-intermediate/high) were independently associated with progression-free survival (for Deauville score, hazard ratio [HR], 1.00 vs. 2.96 [95% confidence interval (CI), 1.83-4.78], P < 0.001; for IPI, HR, 1.00 vs. 4.84 [95% CI, 2.84-8.24], P < 0.001). We stratified patients into three groups: low-risk (interim Deauville scores 1-3 and low/low-intermediate IPI), intermediate-risk (Deauville scores 1-3 with high-intermediate/high IPI or Deauville scores 4-5 with low/low-intermediate IPI), and high-risk (Deauville scores 4-5 and high-intermediate/high IPI). This early risk stratification showed a strong association with progression-free survival (HR, 1.00 vs. 3.98 [95% CI 2.10-7.54] vs. 13.97 [95% CI 7.02-27.83], P < 0.001). Early risk stratification using interim Deauville score and baseline IPI predicts the risk of disease progression or death in patients with DLBCL. Our results provide guidance with interim PET-driven treatment intensification strategies.
本研究旨在评估使用正电子发射断层扫描-计算机断层扫描（PET-CT）扫描时的早期 Deauville 评分和基线国际预后指数（IPI）对弥漫性大 B 细胞淋巴瘤（DLBCL）的预后相关性。本回顾性研究纳入了 2007 年至 2016 年间在我院诊断为 DLBCL 的 220 例患者（中位年龄 64 岁；男性占 60%），这些患者均接受了基于利妥昔单抗的化疗。免疫化疗 3 个周期后进行了中期 PET-CT。49 例患者（22.3%）的中期 Deauville 评分为 4 或 5，94 例患者（42.7%）具有高-中危或高危 IPI 评分。多变量分析显示，中期 Deauville 评分（1-3 和 4-5）和基线 IPI（低/低-中危和高-中危/高危）与无进展生存期独立相关（对于 Deauville 评分，风险比[HR]，1.00 比 2.96[95%置信区间（CI），1.83-4.78]，P<0.001；对于 IPI，HR，1.00 比 4.84[95%CI，2.84-8.24]，P<0.001）。我们将患者分为三组：低危组（中期 Deauville 评分 1-3 分且基线 IPI 为低/低-中危）、中危组（中期 Deauville 评分 1-3 分但 IPI 为高-中危/高危或中期 Deauville 评分 4-5 分且基线 IPI 为低/低-中危）和高危组（中期 Deauville 评分 4-5 分且基线 IPI 为高-中危/高危）。这种早期风险分层与无进展生存期具有很强的相关性（HR，1.00 比 3.98[95%CI 2.10-7.54]比 13.97[95%CI 7.02-27.83]，P<0.001）。使用中期 Deauville 评分和基线 IPI 的早期风险分层可预测 DLBCL 患者疾病进展或死亡的风险。我们的研究结果为基于中期 PET 的治疗强化策略提供了指导。
