title: Delineating outcomes of patients with diffuse large b cell lymphoma using the national comprehensive cancer network-international prognostic index and positron emission tomography-defined remission status; a population-based analysis.
abstract: The recently devised National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) appears superior to the revised IPI (R-IPI) in delineating outcome in diffuse large B-cell lymphoma. We examined the outcome of a population-based cohort of 223 consecutive patients treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) or R-CHOP-like immuno-chemotherapy between January 2005 and December 2011 by both the NCCN-IPI and R-IPI, and further stratified outcome by the achievement of both computerized tomography (CT) and positron emission tomography (PET)-CT complete remission (CR), with the latter reassessed using blinded central review by an independent nuclear medicine and radiology specialist. The NCCN-IPI was superior to the R-IPI in identifying patients at very high risk of systemic and/or central nervous system relapse. Notably, both the NCCN-IPI and the R-IPI remained strongly predictive of relapse irrespective of CT or PET-defined remission status following R-CHOP. Patients with high-risk NCCN-IPI scores (≥6) have a dismal outcome following R-CHOP therapy regardless of PET-defined response to R-CHOP. Moreover, such patients appear refractory to salvage chemotherapy and thus require alternative therapeutic approaches, although age and performance status may, for many patients, preclude the safe delivery of a primary intensified regimen. By contrast, patients with NCCN-IPI 1-5 who achieve PET-CR following R-CHOP have excellent outcomes and may merit reduced follow up frequency.
authors.affiliation: Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Bishton
authors.affiliation: Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Hughes
authors.affiliation: Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Faith
authors.initials: F
authors.lastname: Richardson
authors.affiliation: Department of Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Eleanor
authors.initials: E
authors.lastname: James
authors.affiliation: Department of Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Eric
authors.initials: E
authors.lastname: Bessell
authors.affiliation: Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Vishakha
authors.initials: V
authors.lastname: Sovani
authors.affiliation: Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Ganatra
authors.affiliation: Department of Medicine, Kings Mill Hospital, Sutton-in-Ashfield, UK.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Haynes
authors.affiliation: Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Andrew K
authors.initials: AK
authors.lastname: McMillan
authors.affiliation: Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Fox
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: DLBCL; NCCN-IPI; PET-CT