title: Age-adjusted International Prognostic Index predicts autologous stem cell transplantation outcome for patients with relapsed or primary refractory diffuse large B-cell lymphoma.
abstract: Second-line chemotherapy followed by high-dose therapy (HDT) with autologous stem cell transplantation (ASCT) cures less than half of the patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL). Prognostic models capable of predicting outcome are essential. In 3 sequential clinical trials, conducted from January 1993 to August 2000, we treated 150 patients with relapsed or primary refractory DLBCL with ifosfamide, carboplatin, and etoposide (ICE) chemotherapy followed by HDT/ASCT for patients with chemosensitive disease. We evaluated the age-adjusted International Prognostic Index at the initiation of second-line therapy (sAAIPI) as a predictor of progression-free survival (PFS) and overall survival (OS). At a median follow-up of 4 years, the PFS and OS are 28% and 34% by intention to treat and 39% and 45% for only those patients with chemosensitive disease. Three risk groups with different PFS and OS were identified by the sAAIPI: low risk (0 factors), 70% and 74%; intermediate risk (1 factor), 39% and 49%; and high risk (2 or 3 factors), 16% and 18% (P <.001 for both PFS and OS). The sAAIPI also predicts the PFS and OS for patients with ICEchemosensitive disease: low risk, 69% and 83%; intermediate risk, 46% and 55%; and high risk, 25% and 26% (P <.001 PFS and OS). The sAAIPI predicts outcome for patients with relapsed or primary refractory DLBCL in both intent-to-treat and chemosensitive populations. This powerful prognostic instrument should be used to evaluate new treatment approaches and to compare results of different regimens.
authors.affiliation: Lymphoma and Hematology Services, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Box 350, 1275 York Ave, New York, NY, 10021.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Hamlin
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Zelenetz
authors.forename: Tarun
authors.initials: T
authors.lastname: Kewalramani
authors.forename: Jing
authors.initials: J
authors.lastname: Qin
authors.forename: Jaya M
authors.initials: JM
authors.lastname: Satagopan
authors.forename: David
authors.initials: D
authors.lastname: Verbel
authors.forename: Ariela
authors.initials: A
authors.lastname: Noy
authors.forename: Carol S
authors.initials: CS
authors.lastname: Portlock
authors.forename: David J
authors.initials: DJ
authors.lastname: Straus
authors.forename: Joachim
authors.initials: J
authors.lastname: Yahalom
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Nimer
authors.forename: Craig H
authors.initials: CH
authors.lastname: Moskowitz
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000627:therapeutic use; D016393:Lymphoma, B-Cell / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D033581:Stem Cell Transplantation; D015996:Survival Rate; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D005047:Etoposide; D016190:Carboplatin; D007069:Ifosfamide