title: Outcome prediction of diffuse large B-cell lymphomas associated with hepatitis C virus infection: a study on behalf of the Fondazione Italiana Linfomi.
abstract: A specific prognostication score for hepatitis C virus-positive diffuse large B-cell lymphomas is not available. For this purpose, the Fondazione Italiana Linfomi (FIL, Italian Lymphoma Foundation) carried out a multicenter retrospective study on a large consecutive series of patients with hepatitis C virus-associated diffuse large B-cell lymphoma to evaluate the prognostic impact of clinical and virological features and to develop a specific prognostic score for this subset of patients. All prognostic evaluations were performed on 535 patients treated with an anthracycline-based induction regimen (with rituximab in 255 cases). Severe hepatotoxicity was observed in 14% of patients. The use of rituximab was not associated with increased rate of severe hepatotoxicity. Three-year overall survival and progression-free survival were 71% and 55%, respectively. At multivariate analysis, ECOG performance status of 2 or over, serum albumin below 3.5 g/dL and HCV-RNA viral load over 1000 KIU/mL retained prognostic significance. We combined these 3 factors in a new "HCV Prognostic Score" able to discriminate 3 risk categories with different overall and progression-free survival (low=0; intermediate=1; high-risk ≥2 factors; P<0.001). This score retained prognostic value in the subgroups of patients treated with and without rituximab (P<0.001). The new score performed better than the International Prognostic Index at multivariate analysis and Harrel C-statistic. With the use of three readily available factors (performance status, albumin level and HCV-RNA viral load), the new "HCV Prognostic Score" is able to identify 3 risk categories with different survival, and may be a useful tool to predict the outcome of hepatitis C virus-associated diffuse large B-cell lymphomas.
authors.affiliation: luca.arcaini@unipv.it.
authors.forename: Michele
authors.initials: M
authors.lastname: Merli
authors.forename: Carlo
authors.initials: C
authors.lastname: Visco
authors.forename: Michele
authors.initials: M
authors.lastname: Spina
authors.forename: Stefano
authors.initials: S
authors.lastname: Luminari
authors.forename: Virginia Valeria
authors.initials: VV
authors.lastname: Ferretti
authors.forename: Manuel
authors.initials: M
authors.lastname: Gotti
authors.forename: Sara
authors.initials: S
authors.lastname: Rattotti
authors.forename: Valeria
authors.initials: V
authors.lastname: Fiaccadori
authors.forename: Chiara
authors.initials: C
authors.lastname: Rusconi
authors.forename: Clara
authors.initials: C
authors.lastname: Targhetta
authors.forename: Caterina
authors.initials: C
authors.lastname: Stelitano
authors.forename: Alessandro
authors.initials: A
authors.lastname: Levis
authors.forename: Achille
authors.initials: A
authors.lastname: Ambrosetti
authors.forename: Davide
authors.initials: D
authors.lastname: Rossi
authors.forename: Luigi
authors.initials: L
authors.lastname: Rigacci
authors.forename: Alfonso Maria
authors.initials: AM
authors.lastname: D'Arco
authors.forename: Pellegrino
authors.initials: P
authors.lastname: Musto
authors.forename: Annalisa
authors.initials: A
authors.lastname: Chiappella
authors.forename: Luca
authors.initials: L
authors.lastname: Baldini
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bonfichi
authors.forename: Luca
authors.initials: L
authors.lastname: Arcaini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006526:Hepatitis C / Q000150:complications* / Q000821:virology; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D063868:Patient Outcome Assessment; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult