Clinical risk scores do not accurately identify a very high risk population with diffuse large B cell lymphoma-an analysis of 386 Portuguese patients.

A new interesting article has been published in Ann Hematol. 2019 Aug;98(8):1937-1946. doi: 10.1007/s00277-019-03676-0. Epub 2019 Apr 4. and titled:

Clinical risk scores do not accurately identify a very high risk population with diffuse large B cell lymphoma-an analysis of 386 Portuguese patients.

Authors of this article are:

Coutinho R, Lobato J, Esteves S, Cabeçadas J, Gomes da Silva M.

A summary of the article is shown below:

The identification of high-risk patients deserving alternative first-line treatments to R-CHOP is a research priority in diffuse large B cell lymphoma (DLBCL). Despite the increasing recognition of biological features underlying aggressive behavior, clinical scores remain the basis for prognostic evaluation and treatment stratification in DLBCL. We performed a retrospective analysis of patients with DLBCL uniformly treated with immunochemotherapy with the aim of assessing the discriminative power of the NCCN international prognostic index (IPI) and the GELTAMO-IPI scores in risk group stratification and compared them with the IPI. Additionally, we investigated if bulky disease, gender, beta-2 microglobulin (β2m), body mass index, and B-symptoms have independent prognostic impact. We confirmed the discriminative ability of the three prognostic scores in terms of progression-free survival and overall survival and found that the NCCN-IPI performs better in the identification of a high-risk population compared to the IPI and the GELTAMO scores. In an attempt to improve the prognostic power of the NCCN-IPI we analyzed additional clinical variables. Bulky disease and elevated β2m were found to be independent predictors of prognosis when controlling for the NCCN-IPI risk groups. However, they seem to bring no incremental power to the latter in the identification of poor outcome patients. We support the use of the NCCN-IPI for the clinical identification of high-risk patients in DLBCL. Future studies to unravel the biological heterogeneity within NCCN-IPI groups are needed to improve risk prediction and design targeted therapies for poor prognosis patients.

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This article is a good source of information and a good way to become familiar with topics such as: Adolescent;Adult;Age Factors;Aged;Aged, 80 and over;Antibodies, Monoclonal, Murine-Derived;Antineoplastic Combined Chemotherapy Protocols;Cyclophosphamide;Doxorubicin;Female;Humans;Lymphoma, Large B-Cell, Diffuse;Male;Middle Aged;Prednisone;Prognosis;Retrospective Studies;Risk Factors;Sex Factors;Survival Analysis;Vincristine;beta 2-Microglobulin.

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