title: A diachronic-comparative analysis for the identification of the most powerful prognostic index for localized diffuse large B-cell lymphoma.
abstract: BACKGROUND
  In the rituximab era, the conventional International Prognostic index (IPI) lost at least in part its predictive power, while the National Comprehensive Cancer Network-IPI (NCCN-IPI) seems to be a new and valid prognosticator. However, it has not yet been evaluated in patients with localized disease and it has not been compared with the modified IPI (mIPI) of the pre-rituximab era. In order to evaluate the different prognosticators and to assess the importance of rituximab and radiotherapy (RT), we carried out the so far largest retrospective analysis of patients with localized diffuse large B-cell lymphoma (DLBCL).
  
  
  METHODS
  We retrospectively assessed clinical and therapeutical data of 1405 patients treated in from 1987 to 2012 in 10 cancer centers in Italy and 1 in Austria.
  
  
  RESULTS
  All patients underwent an anthracycline containing polychemotherapy and 254 additional rituximab. The median follow-up was 5.7 years (range 0.1-23 years). The 5-year overall survival (OS) was 75%, being significantly superior in those who underwent additional rituximab, while RT consolidation did not improve the outcome of those who received immunochemotherapy. Patients with extranodal disease benefited from the addition of rituximab, while RT did not improve OS of the immunochemotherapy subgroup. In the pre-rituximab era, the mIPI showed a better performance than the others. In rituximab-treated patients, the NCCN-IPI had the highest discriminant value and the 5-years OS varied significantly (P < 0.001) between the three risk groups and was 98% in low-risk patients, 82% in those with a low-intermediate risk and 57% among high-intermediate and high-risk cases.
  
  
  CONCLUSIONS
  The NCCN-IPI is so far the best prognosticator for patients with localized DLBCL who underwent R-CHOP(-like). The addition of rituximab is indispensable regardless of the risk category and site of involvement, while the addition of RT should be reserved to those cases who are ineligible to rituximab.
authors.affiliation: Division of Hematology, Hospital of Bolzano, Bolzano, Italy; Department of Hematology and Oncology, University Hospital Innsbruck, Austria. Electronic address: m.mian@webmaxxi.eu.
authors.forename: M
authors.initials: M
authors.lastname: Mian
authors.affiliation: Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena.
authors.forename: L
authors.initials: L
authors.lastname: Marcheselli
authors.affiliation: USC Hematology, A.O. Papa Giovanni XXIII, Bergamo.
authors.forename: A
authors.initials: A
authors.lastname: Rossi
authors.affiliation: Department of Hematology, Ospedale San Bortolo, Vicenza.
authors.forename: C
authors.initials: C
authors.lastname: Visco
authors.affiliation: Division of Hematology 2, Azienda Ospedaliera Città Della Salute e Della Scienza, Turin.
authors.forename: A
authors.initials: A
authors.lastname: Chiappella
authors.affiliation: Division of Hematology and Bone Marrow Transplantation, Azienda Ospedaliero-Universitaria Udine, Udine.
authors.forename: S
authors.initials: S
authors.lastname: Volpetti
authors.affiliation: Division of Hematology and Bone Marrow Transplantation, Azienda Ospedaliero-Universitaria Udine, Udine.
authors.forename: F
authors.initials: F
authors.lastname: Zaja
authors.affiliation: Department of Medical Oncology, University of Messina, Messina.
authors.forename: P
authors.initials: P
authors.lastname: Mondello
authors.affiliation: Department of Hematology and Oncology, University Hospital Innsbruck, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Fiegl
authors.affiliation: Division of Hematology, Hospital of Bolzano, Bolzano, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Billio
authors.affiliation: Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena.
authors.forename: M
authors.initials: M
authors.lastname: Federico
authors.affiliation: Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena.
authors.forename: S
authors.initials: S
authors.lastname: Luminari
authors.affiliation: USC Hematology, A.O. Papa Giovanni XXIII, Bergamo.
authors.forename: A
authors.initials: A
authors.lastname: Rambaldi
authors.affiliation: Department of Medical Oncology and Hematology, Humanitas Cancer Center, Bergamo, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Cortelazzo
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
keywords: IPI; NCCN-IPI; localized; lymphoma; rituximab