Shi Xue, Liu Xiaoqian, Li Xiaomei, Li Yahan, Lu Dongyue, Sun Xue, Li Ying, Hu Shunfeng, Zhang Yuanfeng, Zhou Xiangxiang, Wang Xin, Chen Haiping, Fang Xiaosheng
Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, China.
Department of Hematology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.
Front Oncol. 2021 Dec 16;11:754964. doi: 10.3389/fonc.2021.754964. eCollection 2021.
The baseline International Prognostic Index (IPI) is not sufficient for the initial risk stratification of patients with diffuse large B-cell lymphoma (DLBCL) treated with R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone). The aims of this study were to evaluate the prognostic relevance of early risk stratification in DLBCL and develop a new stratification system that combines an interim evaluation and IPI. This multicenter retrospective study enrolled 314 newly diagnosed DLBCL patients with baseline and interim evaluations. All patients were treated with R-CHOP or R-CHOP-like regimens as the first-line therapy. Survival differences were evaluated for different risk stratification systems including the IPI, interim evaluation, and the combined system. When stratified by IPI, the high-intermediate and high-risk groups presented overlapping survival curves with no significant differences, and the high-risk group still had >50% of 3-year overall survival (OS). The interim evaluation can also stratify patients into three groups, as 3-year OS and progression-free survival (PFS) rates in patients with stable disease (SD) and progressive disease (PD) were not significantly different. The SD and PD patients had significantly lower 3-year OS and PFS rates than complete remission and partial response patients, but the percentage of these patients was only ~10%. The IPI and interim evaluation combined risk stratification system separated the patients into low-, intermediate-, high-, and very high-risk groups. The 3-year OS rates were 96.4%, 86.7%, 46.4%, and 40%, while the 3-year PFS rates were 87.1%, 71.5%, 42.5%, and 7.2%. The OS comparison between the high-risk group and very high-risk group was marginally significant, and OS and PFS comparisons between any other two groups were significantly different. This combined risk stratification system could be a useful tool for the prognostic prediction of DLBCL patients.
基线国际预后指数（IPI）不足以对接受R-CHOP（利妥昔单抗联合环磷酰胺、阿霉素、长春新碱和泼尼松）治疗的弥漫性大B细胞淋巴瘤（DLBCL）患者进行初始风险分层。本研究的目的是评估DLBCL早期风险分层的预后相关性，并开发一种结合中期评估和IPI的新分层系统。这项多中心回顾性研究纳入了314例有基线和中期评估的新诊断DLBCL患者。所有患者均接受R-CHOP或类似R-CHOP方案作为一线治疗。对包括IPI、中期评估和联合系统在内的不同风险分层系统评估生存差异。按IPI分层时，高中间风险组和高风险组的生存曲线重叠，无显著差异，高风险组3年总生存率（OS）仍>50%。中期评估也可将患者分为三组，因为疾病稳定（SD）和疾病进展（PD）患者的3年OS和无进展生存率（PFS）无显著差异。SD和PD患者的3年OS和PFS率显著低于完全缓解和部分缓解患者，但这些患者的比例仅约10%。IPI和中期评估联合风险分层系统将患者分为低、中、高和极高风险组。3年OS率分别为96.4%、86.7%、46.4%和40%，而3年PFS率分别为87.1%、71.5%、42.5%和
