Comparison of conventional prognostic indices in patients older than 60 years with diffuse large B-cell lymphoma treated with R-CHOP in the US Intergroup Study (ECOG 4494, CALGB 9793)

Consideration of age greater than 70 years in an elderly prognostic index (E-IPI)

Ranjana H. Advani, Haiyan Chen, Thomas Matthew Habermann, Vicki A. Morrison, Edie A. Weller, Richard I. Fisher, Bruce A. Peterson, Randy D. Gascoyne, Sandra J. Horning

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

To assess if immunochemotherapy influenced the prognostic value of IPI in elderly diffuse large B-cell lymphoma (DLBCL) patients, we evaluated the performance of the standard International Prognostic Index (IPI) and following modifications: age adjusted (AA)-IPI, revised (R)-IPI, and an elderly IPI with age cut-off 70 years (E-IPI) in patients >60 years treated with RCHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone). In 267 patients, by IPI/AA-IPI 60% were high-intermediate, 53% high and 12% low risk. With R-IPI, 60% were poor risk and none very good risk. Using E-IPI, 45% were high-intermediate/high risk and 27% low risk. No differences in outcome were seen in the low/low-intermediate groups with IPI/AA-IPI. For E-IPI, failure-free survival (FFS) and overall survival (OS) were significantly different for low/low-intermediate groups. No differences were detected in the four indices with model fit/discrimination measures; however, E-IPI ranked highest. For elderly R-CHOP treated patients, distribution of IPI/AA-IPI skewed toward high/high-intermediate risk with no differences in FFS/OS between low/low-intermediate risk. In contrast, with E-IPI, more are classified as low risk with significant differences in FFS/OS for low-intermediate compared to low risk. The R-IPI does not identify a very good risk group, thus minimizing its utility in this population. The prognostic discrimination provided by the E-IPI for low and low-intermediate elderly DLBCL patients needs validation by other datasets.

Original languageEnglish (US)
Pages (from-to)143-151
Number of pages9
JournalBritish Journal of Haematology
Volume151
Issue number2
DOIs
StatePublished - Oct 2010

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Lymphoma, Large B-Cell, Diffuse
Survival
Vincristine
Prednisone
Doxorubicin
Cyclophosphamide

Keywords

  • CHOP
  • elderly
  • immunochemotherapy
  • non-Hodgkin lymphoma
  • prognostic

ASJC Scopus subject areas

  • Hematology

Cite this

Comparison of conventional prognostic indices in patients older than 60 years with diffuse large B-cell lymphoma treated with R-CHOP in the US Intergroup Study (ECOG 4494, CALGB 9793) : Consideration of age greater than 70 years in an elderly prognostic index (E-IPI). / Advani, Ranjana H.; Chen, Haiyan; Habermann, Thomas Matthew; Morrison, Vicki A.; Weller, Edie A.; Fisher, Richard I.; Peterson, Bruce A.; Gascoyne, Randy D.; Horning, Sandra J.

In: British Journal of Haematology, Vol. 151, No. 2, 10.2010, p. 143-151.

Research output: Contribution to journalArticle

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abstract = "To assess if immunochemotherapy influenced the prognostic value of IPI in elderly diffuse large B-cell lymphoma (DLBCL) patients, we evaluated the performance of the standard International Prognostic Index (IPI) and following modifications: age adjusted (AA)-IPI, revised (R)-IPI, and an elderly IPI with age cut-off 70 years (E-IPI) in patients >60 years treated with RCHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone). In 267 patients, by IPI/AA-IPI 60{\%} were high-intermediate, 53{\%} high and 12{\%} low risk. With R-IPI, 60{\%} were poor risk and none very good risk. Using E-IPI, 45{\%} were high-intermediate/high risk and 27{\%} low risk. No differences in outcome were seen in the low/low-intermediate groups with IPI/AA-IPI. For E-IPI, failure-free survival (FFS) and overall survival (OS) were significantly different for low/low-intermediate groups. No differences were detected in the four indices with model fit/discrimination measures; however, E-IPI ranked highest. For elderly R-CHOP treated patients, distribution of IPI/AA-IPI skewed toward high/high-intermediate risk with no differences in FFS/OS between low/low-intermediate risk. In contrast, with E-IPI, more are classified as low risk with significant differences in FFS/OS for low-intermediate compared to low risk. The R-IPI does not identify a very good risk group, thus minimizing its utility in this population. The prognostic discrimination provided by the E-IPI for low and low-intermediate elderly DLBCL patients needs validation by other datasets.",
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