The utility of International Prognostic index (IPI) in the era of immunochemotherapy could not be determined by the available randomized trials. Recently, the study of British Columbia group suggested that a revised IPI (R-IPI) which redistributed the IPI factors into 3 distinct prognostic groups provided a more clinically useful prediction of outcome for patients with diffuse large B-cell lymphoma (DLBCL). We investigated the clinical outcomes of R-CHOP chemotherapy in patients with DLBCL for determining which has a more differential potential of predicting the prognosis among R-IPI or standard IPI.
Patients and Methods: We analyzed a total of 348 patients with newly diagnosed DLBCL from National University Hospitals of Southern Korea (NUHSK) between September 2002 and July 2008. R-CHOP conducted standard doses of chemotherapy and rituximab (375 mg/m2) administered a 21-day interval. The limited-stage patients were treated with 3rd or 4th chemotherapy followed by involved field radiation therapy (IFRT) and the advanced-stage patients were treated with six to eight cycles of chemotherapy.
Results: The median age was 61 years (range, 18–85) with 51.6% of patients aged above 60. After a median follow-up of 25 months (range, 2-66.8), 280 patients (80.5%) were alive and 76 patients (21.8%) had relapsed or progressed. 16 patients (4.6%) underwent autologous stem cell transplantation (ASCT). The 4-year probability of overall survival (OS) and progression-free survival (PFS) were 73.7 ± 3.4 % and 69.1 ± 3.6 %, respectively (Fig. 1A). The distribution of patients and 4-year OS rates according to IPI factors were followings; 16.7% patients had zero risk factor with 95.4%, 33.9% patients had 1 factor with 90.0%, 19.3% patients had 2 factors with 69.9%, 19.0% patients had 3 factors with 55.7%, 10.3% patients had 4 factors with 28.4% and 0.9% patients had 5 factors without reached 4-year OS rates (Fig. 1B). Both standard IPI and revised IPI showed a significant potential as prognostic variable in OS and PFS. However, the standard IPI distinguished clinical outcomes between patients with 3 risk factors and patients with 4–5 risk factors. In addition, there was no survival difference between patients with zero risk factor and patients with 1 risk factor (Fig. 2).
Conclusion: The standard IPI had more differentiation potency in predicting prognosis than R-IPI in patients with DLBCL treated with R-CHOP chemotherapy.
Disclosures: No relevant conflicts of interest to declare.