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Early risk stratification for diffuse large B-cell lymphoma integrating interim Deauville score and International Prognostic Index
- Source :
- Annals of Hematology. 98:2739-2748
- Publication Year :
- 2019
- Publisher :
- Springer Science and Business Media LLC, 2019.
-
Abstract
- 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.
- Subjects :
- Adult
Male
Oncology
medicine.medical_specialty
Multivariate analysis
Risk Assessment
Disease-Free Survival
03 medical and health sciences
0302 clinical medicine
International Prognostic Index
hemic and lymphatic diseases
Interim
Internal medicine
Humans
Medicine
Aged
Retrospective Studies
Aged, 80 and over
business.industry
Hazard ratio
Retrospective cohort study
Hematology
General Medicine
Middle Aged
medicine.disease
Confidence interval
Survival Rate
Positron-Emission Tomography
030220 oncology & carcinogenesis
Risk stratification
Female
Lymphoma, Large B-Cell, Diffuse
Rituximab
business
Diffuse large B-cell lymphoma
030215 immunology
Subjects
Details
- ISSN :
- 14320584 and 09395555
- Volume :
- 98
- Database :
- OpenAIRE
- Journal :
- Annals of Hematology
- Accession number :
- edsair.doi.dedup.....b2005769ad1fc032118ecdddb8284fa4