A modified scoring of the NCCN- IPI is more accurate in the elderly and is improved by albumin and β2-microglobulin.

The International Prognostic Index ( IPI) has been used for decades in diffuse large B-cell lymphoma ( DLBCL). A retrospective cancer registry analysis in North America showed significantly improved results when an enhanced IPI, the National Comprehensive Cancer Network ( NCCN)- IPI was applied. This novel score puts more weight on age and high levels of lactate dehydrogenase ( LDH). Nevertheless, it remains unclear if these results can be extrapolated to the general population. This retrospective bi-centre analysis included 499 unselected DLBCL patients who were treated with rituximab and anthracycline-based chemoimmunotherapy between 2004 and 2013. In our cohort, the NCCN- IPI was more accurate in identifying patients at low or high risk, despite older age, and more patients with increased LDH. Nevertheless, a modified scoring of the risk factors was required to more accurately identify elderly patients with a very favourable diagnosis, suggesting an impaired value of the original NCCN- IPI in the elderly. Serum β2-microglobulin and albumin were retained as independent prognostic factors for survival in a multivariate analysis. Our data confirm, for the first time, the superior prognostic power of the NCCN- IPI in an unselected, middle-European cohort. We furthermore propose a modified NCCN- IPI for more accurate prognostication in the elderly. Albumin and β2-microglobulin levels are likely to add significant information to the NCCN- IPI. [ABSTRACT FROM AUTHOR]