title: Prognostic factors in patients with diffuse large B cell lymphoma: Before and after the introduction of rituximab.
abstract: This study attempted to evaluate the usefulness of the International Prognostic Index (IPI) as a prognostic model in patients treated with R-CHOP (rituximab, cyclophosphamide, vincristine, adriamycin and prednisolone) chemotherapy. We compared 279 patients with DLBCL. Among them, 183 received CHOP while 96 received R-CHOP. Results showed that there were no statistically significant differences between the two groups of patients in terms of both the patient and the lymphoma characteristics. The estimated 2-year survival was significantly higher among patients treated with R-CHOP compared to CHOP alone (85.6% vs. 64.7%, P = 0.004). Both the IPI and age-adjusted IPI were less useful as prognostic models in patients receiving R-CHOP compared to CHOP. In the multivariate analysis, age >or= 60, elevated serum LDH, low serum albumin and advanced stages of disease were each independently associated with decreased survival in patients treated with CHOP. In contrast, among those treated with R-CHOP, only male sex and advanced stage of disease were each independently associated with decreased survival. Using these two factors, patients treated with R-CHOP could be separated into three prognostic groups with 5-year estimated survival ranging from 47% to 100% (P < 0.0001). In summary, we can conclude that with the significant improvement in survival following the use of rituximab, the relevance of previously recognized prognostic factors has to be reassessed and re-evaluated.
authors.affiliation: Department of Medical Oncology, National Cancer Centre, Singapore.
authors.forename: Lynette
authors.initials: L
authors.lastname: Ngo
authors.forename: Siew-Wan
authors.initials: SW
authors.lastname: Hee
authors.forename: Lay-Cheng
authors.initials: LC
authors.lastname: Lim
authors.forename: Miriam
authors.initials: M
authors.lastname: Tao
authors.forename: Richard
authors.initials: R
authors.lastname: Quek
authors.forename: Swee-Peng
authors.initials: SP
authors.lastname: Yap
authors.forename: Er-Li
authors.initials: EL
authors.lastname: Loong
authors.forename: Ivy
authors.initials: I
authors.lastname: Sng
authors.forename: Tan Leonard
authors.initials: TL
authors.lastname: Hwan-Cheong
authors.forename: Mei-Kim
authors.initials: MK
authors.lastname: Ang
authors.forename: Joanne
authors.initials: J
authors.lastname: Ngeow
authors.forename: Chee-Kian
authors.initials: CK
authors.lastname: Tham
authors.forename: Min-Han
authors.initials: MH
authors.lastname: Tan
authors.forename: Soon-Thye
authors.initials: ST
authors.lastname: Lim
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D011379:Prognosis; D012189:Retrospective Studies; D000069283:Rituximab; D012737:Sex Factors; D016019:Survival Analysis; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone