title: Validation of the NCCN-IPI for diffuse large B-cell lymphoma (DLBCL): the addition of β2-microglobulin yields a more accurate GELTAMO-IPI.
abstract: The study included 1848 diffuse large B-cell lymphoma (DLBCL)patients treated with chemotherapy/rituximab. The aims were to validate the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) and explore the effect of adding high Beta-2 microglobulin (β2M), primary extranodal presentation and intense treatment to the NCCN-IPI variables in order to develop an improved index. Comparing survival curves, NCCN-IPI discriminated better than IPI, separating four risk groups with 5-year overall survival rates of 93%, 83%, 67% and 49%, but failing to identify a true high-risk population. For the second aim the series was split into training and validation cohorts: in the former the multivariate model identified age, lactate dehydrogenase, Eastern Cooperative Oncology Group performance status, Stage III-IV, and β2M as independently significant, whereas the NCCN-IPI-selected extranodal sites, primary extranodal presentation and intense treatments were not. These results were confirmed in the validation cohort. The Grupo Español de Linfomas/Trasplante de Médula ósea (GELTAMO)-IPI developed here, with 7 points, significantly separated four risk groups (0, 1-3, 4 or ≥5 points) with 11%, 58%, 17% and 14% of patients, and 5-year overall survival rates of 93%, 79%, 66% and 39%, respectively. In the comparison GELTAMO IPI discriminated better than the NCCN-IPI. In conclusion, GELTAMO-IPI is more accurate than the NCCN-IPI and has statistical and practical advantages in that the better discrimination identifies an authentic high-risk group and is not influenced by primary extranodal presentation or treatments of different intensity.
authors.affiliation: Department of Haematology, MD Anderson Cancer Centre, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Montalbán
authors.affiliation: Department of Translational Research, MD Anderson Cancer Centre, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Díaz-López
authors.affiliation: Department of Haematology, Hospital Clinic, Barcelona, Spain.
authors.forename: Ivan
authors.initials: I
authors.lastname: Dlouhy
authors.affiliation: Department of Haematology, Hospital Clinic, Barcelona, Spain.
authors.forename: Jordina
authors.initials: J
authors.lastname: Rovira
authors.affiliation: Department of Haematology, Hospital Clinic, Barcelona, Spain.
authors.forename: Armando
authors.initials: A
authors.lastname: Lopez-Guillermo
authors.affiliation: Department of Haematology, Hospital Universitario and IBSAL, Salamanca, Spain.
authors.forename: Sara
authors.initials: S
authors.lastname: Alonso
authors.affiliation: Department of Haematology, Hospital Universitario and IBSAL, Salamanca, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Martín
authors.affiliation: Department of Haematology, Hospital Germans Trias i Pujol, ICO-IJC, Badalona, Spain.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Sancho
authors.affiliation: Department of Haematology, Hospital Germans Trias i Pujol, ICO-IJC, Badalona, Spain.
authors.forename: Olga
authors.initials: O
authors.lastname: García
authors.affiliation: Department of Haematology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Sánchez
authors.affiliation: Department of Haematology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Mario
authors.initials: M
authors.lastname: Rodríguez
authors.affiliation: Department of Haematology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain.
authors.forename: Silvana
authors.initials: S
authors.lastname: Novelli
authors.affiliation: Department of Haematology, Hospital del Mar, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Salar
authors.affiliation: Department of Haematology, Hospital Universitari Son Espases, Palma de Mallorca (IdISPa), Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gutiérrez
authors.affiliation: Department of Haematology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Rodríguez-Salazar
authors.affiliation: Department of Haematology, Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: Mariana
authors.initials: M
authors.lastname: Bastos
authors.affiliation: Department of Haematology, Hospital Virgen del Rocío, Sevilla, Spain.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Domínguez
authors.affiliation: Department of Haematology, Hospital de Cabueñes, Gijón, Spain.
authors.forename: Rubén
authors.initials: R
authors.lastname: Fernández
authors.affiliation: Department of Haematology, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
authors.forename: Sonia
authors.initials: S
authors.lastname: Gonzalez de Villambrosia
authors.affiliation: Department of Haematology, Hospital General de Segovia, Segovia, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: Queizan
authors.affiliation: Department of Haematology, Fundación Jimenez Díaz, Madrid, Spain.
authors.forename: Raul
authors.initials: R
authors.lastname: Córdoba
authors.affiliation: Department of Haematology, MD Anderson Cancer Centre, Madrid, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: de Oña
authors.affiliation: Department of Haematology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: López-Hernandez
authors.affiliation: Department of Translational Research, MD Anderson Cancer Centre, Madrid, Spain.
authors.forename: Julian M
authors.initials: JM
authors.lastname: Freue
authors.affiliation: Department of Translational Research, MD Anderson Cancer Centre, Madrid, Spain.
authors.forename: Heidys
authors.initials: H
authors.lastname: Garrote
authors.affiliation: Department of Translational Research, MD Anderson Cancer Centre, Madrid, Spain.
authors.forename: Lourdes
authors.initials: L
authors.lastname: López
authors.affiliation: Department of Biobank, MD Anderson Cancer Centre, Madrid, Spain.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Martin-Moreno
authors.affiliation: Department of Haematology, MD Anderson Cancer Centre, Madrid, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Rodriguez
authors.affiliation: Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.
authors.forename: Víctor
authors.initials: V
authors.lastname: Abraira
authors.affiliation: Department of Translational Research, MD Anderson Cancer Centre, Madrid, Spain.|Department of Pathology, MD Anderson Cancer Centre, Madrid, Spain.
authors.forename: Juan F
authors.initials: JF
authors.lastname: García
authors.affiliation: Department of Translational Research, MD Anderson Cancer Centre, Madrid, Spain.|Department of Pathology, MD Anderson Cancer Centre, Madrid, Spain.
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015415:Biomarkers; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D016403:Lymphoma, Large B-Cell, Diffuse / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012074:Remission Induction; D015203:Reproducibility of Results; D016896:Treatment Outcome; D001613:beta 2-Microglobulin / Q000097:blood*
chemical_list: D015415:Biomarkers; D001613:beta 2-Microglobulin
keywords: 
  DLBCL
  ; prognostic scores; risk assessment