Validation of the NCCN-IPI for diffuse large B-cell lymphoma (DLBCL): the addition of beta(2)-microglobulin yields a more accurate GELTAMO-IPI
Por:
Montalban, C, Diaz-Lopez, A, Dlouhy, I, Rovira, J, Lopez-Guillmermo, A, Alonso, S, Martin, A, Sancho, JM, Garcia, O, Sanchez, JM, Rodriguez, M, Novelli, S, Salar, A, Gutierrez, A, Rodriguez-Salazar, MJ, Bastos, M, Dominguez, JF, Fernandez, R, de Villambrosia, SG, Queizan, JEA, Cordoba, R, de Ona, R, Lopez-Hernandez, A, Freue, JM, Garrote, H, Lopez, L, Martin-Moreno, AM, Rodriguez, J, Abraira, V, Garcia, JF
Publicada:
1 mar 2017
Resumen:
The study included 1848 diffuse large B-cell lymphoma (DLBCL) patients treated with chemotherapy/rituximab. The aims were to validate the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) and explore the effect of adding high Beta-2 microglobulin (beta 2M), primary extranodal presentation and intense treatment to the NCCN-IPI variables in order to develop an improved index. Comparing survival curves, NCCN-IPI discriminated better than IPI, separating four risk groups with 5-year overall survival rates of 93%, 83%, 67% and 49%, but failing to identify a true high-risk population. For the second aim the series was split into training and validation cohorts: in the former the multivariate model identified age, lactate dehydrogenase, Eastern Cooperative Oncology Group performance status, Stage III-IV, and beta M-2 as independently significant, whereas the NCCN-IPI-selected extranodal sites, primary extranodal presentation and intense treatments were not. These results were confirmed in the validation cohort. The Grupo Espanol de Linfomas/Trasplante de Medula osea (GELTAMO)-IPI developed here, with 7 points, significantly separated four risk groups (0, 1-3, 4 or >= 5 points) with 11%, 58%, 17% and 14% of patients, and 5-year overall survival rates of 93%, 79%, 66% and 39%, respectively. In the comparison GELTAMO IPI discriminated better than the NCCN-IPI. In conclusion, GELTAMO-IPI is more accurate than the NCCN-IPI and has statistical and practical advantages in that the better discrimination identifies an authentic high-risk group and is not influenced by primary extranodal presentation or treatments of different intensity.
Filiaciones:
Montalban, C:
MD Anderson Canc Ctr, Dept Haematol, Madrid, Spain
Rovira, J:
Fdn Jimenez Diaz, Dept Haematol, Madrid, Spain
Lopez-Guillmermo, A:
MD Anderson Canc Ctr, Dept Translat Res, Madrid, Spain
Hosp Clin Barcelona, Dept Haematol, Barcelona, Spain
Hosp Univ Vall Hebron, Dept Haematol, Barcelona, Spain
Martin, A:
Univ Hosp, Dept Haematol, Salamanca, Spain
Garcia, O:
Hosp Clin Barcelona, Dept Haematol, Barcelona, Spain
Sanchez, JM:
MD Anderson Canc Ctr, Dept Translat Res, Madrid, Spain
Hosp Virgen Roci, Dept Haematol, Seville, Spain
Hosp Univ Ramon y Cajal, IRYCIS, Madrid, Spain
Rodriguez, M:
Hosp Clin Barcelona, Dept Haematol, Barcelona, Spain
Hosp Mar, Dept Haematol, Barcelona, Spain
MD Anderson Canc Ctr, Dept Biobank, Madrid, Spain
Novelli, S:
MD Anderson Canc Ctr, Dept Translat Res, Madrid, Spain
Univ Hosp, Dept Haematol, Salamanca, Spain
Hosp Mar, Dept Haematol, Barcelona, Spain
Hosp Univ Son Espases, Dept Haematol, Palma de Mallorca, Spain
MD Anderson Canc Ctr, Dept Biobank, Madrid, Spain
Salar, A:
Hosp Univ Canarias, Dept Haematol, Santa Cruz, CA USA
Hosp Gregorio Marain, Dept Haematol, Madrid, Spain
Hosp Univ Marque Valdecilla, Dept Haematol, Santander, Spain
Hosp Univ Vall Hebron, Dept Haematol, Barcelona, Spain
Gutierrez, A:
IBSAL, Salamanca, Spain
MD Anderson Canc Ctr, Dept Biobank, Madrid, Spain
Rodriguez-Salazar, MJ:
Hosp Gregorio Marain, Dept Haematol, Madrid, Spain
Fdn Jimenez Diaz, Dept Haematol, Madrid, Spain
Bastos, M:
Univ Hosp, Dept Haematol, Salamanca, Spain
Dominguez, JF:
Hosp Mar, Dept Haematol, Barcelona, Spain
Hosp Gregorio Marain, Dept Haematol, Madrid, Spain
Fernandez, R:
Hosp Univ Ramon y Cajal, IRYCIS, Madrid, Spain
de Villambrosia, SG:
Hosp Virgen Roci, Dept Haematol, Seville, Spain
Fdn Jimenez Diaz, Dept Haematol, Madrid, Spain
Hosp Univ Vall Hebron, Dept Haematol, Barcelona, Spain
MD Anderson Canc Ctr, Dept Pathol, Madrid, Spain
Queizan, JEA:
Hosp Univ Son Espases, Dept Haematol, Palma de Mallorca, Spain
Hosp Univ Canarias, Dept Haematol, Santa Cruz, CA USA
Cordoba, R:
IBSAL, Salamanca, Spain
de Ona, R:
Hosp Gregorio Marain, Dept Haematol, Madrid, Spain
Hosp Germans Trias Pujol, Dept Haematol, ICO IJC, Badalona, Spain.
Hosp Univ 12 de Octubre, Dept Haematol, Madrid, Spain.
Hosp Santa Creu St Pau, Dept Haematol, Barcelona, Spain.
Hosp Cabuen, Dept Haematol, Madrid, Spain.
Hosp Gen Segovia, Haematol, Segovia, Spain.
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