title: A new prognostic score for AIDS-related lymphomas in the rituximab-era.
abstract: While the International Prognostic Index is commonly used to predict outcomes in immunocompetent patients with aggressive B-cell non-Hodgkin lymphomas, HIV-infection is an important competing risk for death in patients with AIDS-related lymphomas. We investigated whether a newly created prognostic score (AIDS-related lymphoma International Prognostic Index) could better assess risk of death in patients with AIDS-related lymphomas. We randomly divided a dataset of 487 patients newly diagnosed with AIDS-related lymphomas and treated with rituximab-containing chemoimmunotherapy into a training (n=244) and validation (n=243) set. We examined the association of HIV-related and other known risk factors with overall survival in both sets independently. We defined a new score (AIDS-related lymphoma International Prognostic Index) by assigning weights to each significant predictor [age-adjusted International Prognostic Index, extranodal sites, HIV-score (composed of CD4 count, viral load, and prior history of AIDS)] with three risk categories similar to the age-adjusted International Prognostic Index (low, intermediate and high risk). We compared the prognostic value for overall survival between AIDS-related lymphoma International Prognostic Index and age-adjusted International Prognostic Index in the validation set and found that the AIDS-related lymphoma International Prognostic Index performed significantly better in predicting risk of death than the age-adjusted International Prognostic Index (P=0.004) and better discriminated risk of death between each risk category (P=0.015 vs. P=0.13). Twenty-eight percent of patients were defined as low risk by the ARL-IPI and had an estimated 5-year overall survival (OS) of 78% (52% intermediate risk, 5-year OS 60%; 20% high risk, 5-year OS 50%).
authors.affiliation: Fox Chase Cancer Center, Philadelphia, PA, USA Stefan.Barta@fccc.ed.
authors.forename: Stefan K
authors.initials: SK
authors.lastname: Barta
authors.affiliation: Albert Einstein Cancer Center, Bronx, NY, USA.
authors.forename: Xiaonan
authors.initials: X
authors.lastname: Xue
authors.affiliation: Albert Einstein Cancer Center, Bronx, NY, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Wang
authors.affiliation: University of Arkansas, Little Rock, AR, USA.
authors.forename: Jeannette Y
authors.initials: JY
authors.lastname: Lee
authors.affiliation: University of California, San Francisco, CA, USA.
authors.forename: Lawrence D
authors.initials: LD
authors.lastname: Kaplan
authors.affiliation: ICO-Hospital Germans Trias i Pujol, Jose Carreras Research Institute and PETHEMA Group, Badalona, Spain.
authors.forename: Josep-Maria
authors.initials: JM
authors.lastname: Ribera
authors.affiliation: ICO-Hospital Germans Trias i Pujol, Jose Carreras Research Institute and PETHEMA Group, Badalona, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Oriol
authors.affiliation: National Cancer Institute, Aviano, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Spina
authors.affiliation: National Cancer Institute, Aviano, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Tirelli
authors.affiliation: Hopital Antoine Beclere, Clamart, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Boue
authors.affiliation: National Cancer Institute, Bethesda, MD, USA.
authors.forename: Wyndham H
authors.initials: WH
authors.lastname: Wilson
authors.affiliation: University Hospital Cologne, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Wyen
authors.affiliation: National Cancer Institute, Bethesda, MD, USA.
authors.forename: Kieron
authors.initials: K
authors.lastname: Dunleavy
authors.affiliation: Memorial-Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA.
authors.forename: Ariela
authors.initials: A
authors.lastname: Noy
authors.affiliation: Albert Einstein Cancer Center, Bronx, NY, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Sparano
mesh_terms: D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D000069283:Rituximab; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab