Prognostic models for diffuse large B-cell lymphoma in the rituximab era: a never-ending story.
BACKGROUND
Improved treatment have modified survival outcome in patients with diffuse large B-cell lymphoma (DLBCL) and altered the importance of previously recognized prognostic markers.


METHODS
To evaluate International Prognostic Index (IPI) score before and after rituximab introduction and to validate the absolute lymphocyte count (ALC)/revised International Prognostic Index (R-IPI) model, we carried out a retrospective analysis on a total of 831 patients with DLBCL.


RESULTS
Our results show that IPI lost its discriminating power with the introduction of rituximab. The analysis of our second set allowed us to validate the ALC/R-IPI model. The R-IPI and ALC/R-IPI could still be used for designing clinical trials, but both have difficulty recognizing a high percentage of poor prognosis patients, though it remains an important goal of a good prognostic model considering the modest impact of salvage treatments on survival.


CONCLUSIONS
A new model on the basis of significant variables in the rituximab era and built on a large database of patients treated with rituximab is urgently needed. As prognostic models are changing with the efficacy and mechanisms of action of treatment utilized, looking for a new prognostic score is a never-ending story in which researchers are trying to hit a continuously moving target.
Bari
A
A
Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena.
Marcheselli
L
L
Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena.
Sacchi
S
S
Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena. Electronic address: stefano.sacchi@unimo.it.
Marcheselli
R
R
Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena.
Pozzi
S
S
Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena.
Ferri
P
P
Department of Public Health Sciences, University of Modena and Reggio Emilia, Modena.
Balleari
E
E
Department of Internal Medicine, University of Genoa, Genoa.
Musto
P
P
Unit of Hematology and Stem Cell Transplantation, IRCCS-CROB, Oncology Referral Center of Basilicata, Rionero in Vulture, Potenza.
Neri
S
S
Unit of Hematology, Papardo Hospital, Messina.
Aloe Spiriti
M A
MA
Department of Hematology, AO Sant'Andrea, La Sapienza University, Rome, Italy.
Cox
M C
MC
Department of Hematology, AO Sant'Andrea, La Sapienza University, Rome, Italy.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018655:Lymphocyte Count; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D000069283:Rituximab; D015996:Survival Rate; D055815:Young Adult
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab