Modified Number of Extranodal Involved Sites as a Prognosticator in R-CHOP-Treated Patients with Disseminated Diffuse Large B-Cell Lymphoma.
10.3904/kjim.2010.25.3.301
- Author:
Changhoon YOO
1
;
Shin KIM
;
Byeong Seok SOHN
;
Jeong Eun KIM
;
Dok Hyun YOON
;
Jooryung HUH
;
Dae Ho LEE
;
Sang We KIM
;
Jung Shin LEE
;
Cheolwon SUH
Author Information
1. Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Prognosis;
Lymphoma, large B-cell, diffuse;
Rituximab;
Extranodal
- MeSH:
Adolescent;
Adult;
Aged;
Aged, 80 and over;
Antibodies, Monoclonal/*administration & dosage;
Antineoplastic Combined Chemotherapy Protocols/*administration & dosage;
Cyclophosphamide/administration & dosage;
Doxorubicin/administration & dosage;
Female;
Humans;
Korea;
Lymphoma, Large B-Cell, Diffuse/*drug therapy/*pathology;
Male;
Middle Aged;
Prednisone/administration & dosage;
Prognosis;
Retrospective Studies;
Vincristine/administration & dosage;
Young Adult
- From:The Korean Journal of Internal Medicine
2010;25(3):301-308
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: Rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy (R-CHOP) has improved survival in patients with diffuse large B-cell lymphoma (DLBCL) and weakened the prognostic power of the international prognostic index (IPI). We evaluated the efficacy of the IPI and revised IPI (R-IPI) in patients with DLBCL who were treated with R-CHOP, focusing on extranodal site number (ENS) because extranodal involvement occurs frequently in Koreans. METHODS: A total of 126 R-CHOP-treated patients with stage III/IV DLBCL were analyzed. We performed a retrospective analysis of the clinicopathologic factors and verified the predictive power of the standard IPI and R-IPI. Various numbers of extranodal sites were analyzed for further stratification, and we set the extranodal site-modified IPI (E-IPI) as the IPI when the number of extranodal sites was stratified as < 3 vs. > or = 3. RESULTS: A univariate analysis showed that ENS was associated with complete response (CR, p = 0.04), event-free survival (EFS, p = 0.01), and overall survival (OS, p < 0.001) when the ENS cut-off was set at > or = 3. A multivariate analysis revealed that an ENS > or = 3 remained associated with EFS (p < 0.01; hazard ratio [HR], 2.60; 95% confidence interval [CI], 1.29 to 5.26) and OS (p < 0.01; HR, 3.52; 95% CI, 1.68 to 7.35). The IPI was effective for determining prognosis in terms of OS (p = 0.04) but not EFS (p = 0.17). The R-IPI was effective in terms of both variables (p = 0.02 and 0.04, respectively), as was the E-IPI (p = 0.01 and 0.001, respectively). CONCLUSIONS: An ENS < 3 vs. > or = 3, rather than the original < 2 vs. > or = 2, was the most significant prognostic factor for EFS and OS. All three indices were predictive, but only the E-IPI identified the high-risk group of R-CHOP-treated Korean patients with disseminated DLBCL.
