title: A clinically based prognostic index for diffuse large B-cell lymphoma with a cut-off at 70 years of age significantly improves prognostic stratification: population-based analysis from the Danish Lymphoma Registry.
abstract: The introduction of rituximab and generally improved health among elderly patients have increased the survival of patients with diffuse large B-cell lymphoma (DLBCL). The International Prognostic Index (IPI) from 1992 is based on pre-rituximab data from clinical trials including several lymphoma subtypes. We applied IPI factors to a population-based rituximab-treated cohort of 1990 patients diagnosed 2000-2010 and explored new factors and the optimal prognostic age cut-off for DLBCL. Multivariate-analyses (MVA) confirmed the prognostic value of all IPI factors except the presence of > 1 extranodal lesion. The optimal age cut-off was 70 years. In a MVA of albumin, lymphocyte count, sex, immunoglobulin G, bulky disease, hemoglobin and B-symptoms, only albumin was prognostic. We propose: (1) a modified DLBCL prognostic index (DLBCL-PI) including: age (70 years), performance status (PS), lactate dehydrogenase (LDH), stage and albumin level, and (2) a separate age-adjusted DLBCL-PI for patients ≤ 70 years including PS, LDH, albumin level and > 1 extranodal lesion, however excluding stage.
authors: a Department of Hematology , Herlev , Denmark.
authors: Anne O
authors: AO
authors: Gang
authors: b Department of Hematology , Copenhagen , Denmark.
authors: Michael
authors: M
authors: Pedersen
authors: c Department of Hematology , Aarhus , Denmark.
authors: Francesco
authors: F
authors: d'Amore
authors: d Department of Hematology , Roskilde , Denmark.
authors: Lars M
authors: LM
authors: Pedersen
authors: e Department of Hematology , Odense , Denmark.
authors: Bo A
authors: BA
authors: Jensen
authors: f Department of Hematology , Ålborg , Denmark.
authors: Paw
authors: P
authors: Jensen
authors: g Department of Pathology , Odense , Denmark.
authors: Michael B
authors: MB
authors: Møller
authors: h Department of Hematology , Esbjerg , Denmark.
authors: Hans T
authors: HT
authors: Mourits-Andersen
authors: i Department of Hematology , Holstebro , Denmark.
authors: Robert S
authors: RS
authors: Pedersen
authors: a Department of Hematology , Herlev , Denmark.
authors: Tobias W
authors: TW
authors: Klausen
authors: b Department of Hematology , Copenhagen , Denmark.
authors: Peter
authors: P
authors: de N Brown
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003718:Denmark; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data*; D033581:Stem Cell Transplantation / Q000379:methods*; D055815:Young Adult
keywords: Diffuse large B-cell lymphoma; prognostic index; rituximab; treatment