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An enhanced International Prognostic Index (NCCN-IPI) for patients with diffuse large B-cell lymphoma treated in the rituximab era
The International Prognostic Index (IPI) has been the basis for determining prognosis in patients with aggressive non-Hodgkin lymphoma (NHL) for the past 20 years. Using raw clinical data from the National Comprehensive Cancer Network (NCCN) database collected during the rituximab era, we built an e...
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Published in: | Blood 2014-02, Vol.123 (6), p.837-842 |
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creator | Zhou, Zheng Sehn, Laurie H. Rademaker, Alfred W. Gordon, Leo I. LaCasce, Ann S. Crosby-Thompson, Allison Vanderplas, Ann Zelenetz, Andrew D. Abel, Gregory A. Rodriguez, Maria A. Nademanee, Auayporn Kaminski, Mark S. Czuczman, Myron S. Millenson, Michael Niland, Joyce Gascoyne, Randy D. Connors, Joseph M. Friedberg, Jonathan W. Winter, Jane N. |
description | The International Prognostic Index (IPI) has been the basis for determining prognosis in patients with aggressive non-Hodgkin lymphoma (NHL) for the past 20 years. Using raw clinical data from the National Comprehensive Cancer Network (NCCN) database collected during the rituximab era, we built an enhanced IPI with the goal of improving risk stratification. Clinical features from 1650 adults with de novo diffuse large B-cell lymphoma (DLBCL) diagnosed from 2000-2010 at 7 NCCN cancer centers were assessed for their prognostic significance, with statistical efforts to further refine the categorization of age and normalized LDH. Five predictors (age, lactate dehydrogenase (LDH), sites of involvement, Ann Arbor stage, ECOG performance status) were identified and a maximum of 8 points assigned. Four risk groups were formed: low (0-1), low-intermediate (2-3), high-intermediate (4-5), and high (6-8). Compared with the IPI, the NCCN-IPI better discriminated low- and high-risk subgroups (5-year overall survival [OS]: 96% vs 33%) than the IPI (5 year OS: 90% vs 54%), respectively. When validated using an independent cohort from the British Columbia Cancer Agency (n = 1138), it also demonstrated enhanced discrimination for both low- and high-risk patients. The NCCN-IPI is easy to apply and more powerful than the IPI for predicting survival in the rituximab era.
•The clinically based NCCN-IPI is a robust prognostic tool for the rituximab era that better discriminates low- and high-risk DLBCL patients compared with the IPI.•The NCCN-IPI outperforms the IPI by refined categorization of age and LDH, and the identification of disease involvement at specific extranodal sites. |
doi_str_mv | 10.1182/blood-2013-09-524108 |
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•The clinically based NCCN-IPI is a robust prognostic tool for the rituximab era that better discriminates low- and high-risk DLBCL patients compared with the IPI.•The NCCN-IPI outperforms the IPI by refined categorization of age and LDH, and the identification of disease involvement at specific extranodal sites.</description><identifier>ISSN: 0006-4971</identifier><identifier>EISSN: 1528-0020</identifier><identifier>DOI: 10.1182/blood-2013-09-524108</identifier><identifier>PMID: 24264230</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Antibodies, Monoclonal, Murine-Derived - therapeutic use ; Antineoplastic Agents - therapeutic use ; Clinical Trials and Observations ; Cohort Studies ; Female ; Follow-Up Studies ; Humans ; International Agencies ; Lymphoma, Large B-Cell, Diffuse - drug therapy ; Male ; Middle Aged ; Practice Guidelines as Topic ; Prognosis ; Program Development ; Rituximab</subject><ispartof>Blood, 2014-02, Vol.123 (6), p.837-842</ispartof><rights>2014 American Society of Hematology</rights><rights>2014 by The American Society of Hematology 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c463t-7d8e0fad402833fb999e73842204a5db7c31384d72801b653f653aa25549444e3</citedby><cites>FETCH-LOGICAL-c463t-7d8e0fad402833fb999e73842204a5db7c31384d72801b653f653aa25549444e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0006497120360432$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,3549,27924,27925,45780</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24264230$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zhou, Zheng</creatorcontrib><creatorcontrib>Sehn, Laurie H.</creatorcontrib><creatorcontrib>Rademaker, Alfred W.</creatorcontrib><creatorcontrib>Gordon, Leo I.</creatorcontrib><creatorcontrib>LaCasce, Ann S.</creatorcontrib><creatorcontrib>Crosby-Thompson, Allison</creatorcontrib><creatorcontrib>Vanderplas, Ann</creatorcontrib><creatorcontrib>Zelenetz, Andrew D.</creatorcontrib><creatorcontrib>Abel, Gregory A.</creatorcontrib><creatorcontrib>Rodriguez, Maria A.</creatorcontrib><creatorcontrib>Nademanee, Auayporn</creatorcontrib><creatorcontrib>Kaminski, Mark S.</creatorcontrib><creatorcontrib>Czuczman, Myron S.</creatorcontrib><creatorcontrib>Millenson, Michael</creatorcontrib><creatorcontrib>Niland, Joyce</creatorcontrib><creatorcontrib>Gascoyne, Randy D.</creatorcontrib><creatorcontrib>Connors, Joseph M.</creatorcontrib><creatorcontrib>Friedberg, Jonathan W.</creatorcontrib><creatorcontrib>Winter, Jane N.</creatorcontrib><title>An enhanced International Prognostic Index (NCCN-IPI) for patients with diffuse large B-cell lymphoma treated in the rituximab era</title><title>Blood</title><addtitle>Blood</addtitle><description>The International Prognostic Index (IPI) has been the basis for determining prognosis in patients with aggressive non-Hodgkin lymphoma (NHL) for the past 20 years. Using raw clinical data from the National Comprehensive Cancer Network (NCCN) database collected during the rituximab era, we built an enhanced IPI with the goal of improving risk stratification. Clinical features from 1650 adults with de novo diffuse large B-cell lymphoma (DLBCL) diagnosed from 2000-2010 at 7 NCCN cancer centers were assessed for their prognostic significance, with statistical efforts to further refine the categorization of age and normalized LDH. Five predictors (age, lactate dehydrogenase (LDH), sites of involvement, Ann Arbor stage, ECOG performance status) were identified and a maximum of 8 points assigned. Four risk groups were formed: low (0-1), low-intermediate (2-3), high-intermediate (4-5), and high (6-8). Compared with the IPI, the NCCN-IPI better discriminated low- and high-risk subgroups (5-year overall survival [OS]: 96% vs 33%) than the IPI (5 year OS: 90% vs 54%), respectively. When validated using an independent cohort from the British Columbia Cancer Agency (n = 1138), it also demonstrated enhanced discrimination for both low- and high-risk patients. The NCCN-IPI is easy to apply and more powerful than the IPI for predicting survival in the rituximab era.
•The clinically based NCCN-IPI is a robust prognostic tool for the rituximab era that better discriminates low- and high-risk DLBCL patients compared with the IPI.•The NCCN-IPI outperforms the IPI by refined categorization of age and LDH, and the identification of disease involvement at specific extranodal sites.</description><subject>Adult</subject><subject>Aged</subject><subject>Antibodies, Monoclonal, Murine-Derived - therapeutic use</subject><subject>Antineoplastic Agents - therapeutic use</subject><subject>Clinical Trials and Observations</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>International Agencies</subject><subject>Lymphoma, Large B-Cell, Diffuse - drug therapy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Practice Guidelines as Topic</subject><subject>Prognosis</subject><subject>Program Development</subject><subject>Rituximab</subject><issn>0006-4971</issn><issn>1528-0020</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><recordid>eNp9kUtvVCEUx4nR2LH6DYxhqQv08LqPjUk78TFJU7vQNeHCuXMxd2DCZWq79ZNLHa26cUEIOfwf8CPkOYfXnHfizTCn5JkALhn0TAvFoXtAVlyLjgEIeEhWANAw1bf8hDxZlq8AXEmhH5MToUSjhIQV-X4WKcbJRoeebmLBHG0JKdqZXuW0jWkpwdWBxxv68nK9vmSbq80rOqZM9_UixrLQb6FM1IdxPCxIZ5u3SM-Zw3mm8-1uP6WdpSWjLTUhRFompDmUw03Y2YFitk_Jo9HOCz77tZ-SL-_ffV5_ZBefPmzWZxfMqUYW1voOYbRegeikHIe-77GVnRIClNV-aJ3k9ehb0QEfGi3HuqwVWqteKYXylLw9-u4Pww69q92znc0-1yL51iQbzL-TGCazTddGa9HKvqkG6mjgclqWjOO9loO5Y2J-MjF3TAz05sikyl78nXsv-g3hTzGsr78OmM3i6s9WIiGjK8an8P-EH4HpnxA</recordid><startdate>20140206</startdate><enddate>20140206</enddate><creator>Zhou, Zheng</creator><creator>Sehn, Laurie H.</creator><creator>Rademaker, Alfred W.</creator><creator>Gordon, Leo I.</creator><creator>LaCasce, Ann S.</creator><creator>Crosby-Thompson, Allison</creator><creator>Vanderplas, Ann</creator><creator>Zelenetz, Andrew D.</creator><creator>Abel, Gregory A.</creator><creator>Rodriguez, Maria A.</creator><creator>Nademanee, Auayporn</creator><creator>Kaminski, Mark S.</creator><creator>Czuczman, Myron S.</creator><creator>Millenson, Michael</creator><creator>Niland, Joyce</creator><creator>Gascoyne, Randy D.</creator><creator>Connors, Joseph M.</creator><creator>Friedberg, Jonathan W.</creator><creator>Winter, Jane N.</creator><general>Elsevier Inc</general><general>American Society of Hematology</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>20140206</creationdate><title>An enhanced International Prognostic Index (NCCN-IPI) for patients with diffuse large B-cell lymphoma treated in the rituximab era</title><author>Zhou, Zheng ; Sehn, Laurie H. ; Rademaker, Alfred W. ; Gordon, Leo I. ; LaCasce, Ann S. ; Crosby-Thompson, Allison ; Vanderplas, Ann ; Zelenetz, Andrew D. ; Abel, Gregory A. ; Rodriguez, Maria A. ; Nademanee, Auayporn ; Kaminski, Mark S. ; Czuczman, Myron S. ; Millenson, Michael ; Niland, Joyce ; Gascoyne, Randy D. ; Connors, Joseph M. ; Friedberg, Jonathan W. ; Winter, Jane N.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c463t-7d8e0fad402833fb999e73842204a5db7c31384d72801b653f653aa25549444e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Antibodies, Monoclonal, Murine-Derived - therapeutic use</topic><topic>Antineoplastic Agents - therapeutic use</topic><topic>Clinical Trials and Observations</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>International Agencies</topic><topic>Lymphoma, Large B-Cell, Diffuse - drug therapy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Practice Guidelines as Topic</topic><topic>Prognosis</topic><topic>Program Development</topic><topic>Rituximab</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zhou, Zheng</creatorcontrib><creatorcontrib>Sehn, Laurie H.</creatorcontrib><creatorcontrib>Rademaker, Alfred W.</creatorcontrib><creatorcontrib>Gordon, Leo I.</creatorcontrib><creatorcontrib>LaCasce, Ann S.</creatorcontrib><creatorcontrib>Crosby-Thompson, Allison</creatorcontrib><creatorcontrib>Vanderplas, Ann</creatorcontrib><creatorcontrib>Zelenetz, Andrew D.</creatorcontrib><creatorcontrib>Abel, Gregory A.</creatorcontrib><creatorcontrib>Rodriguez, Maria A.</creatorcontrib><creatorcontrib>Nademanee, Auayporn</creatorcontrib><creatorcontrib>Kaminski, Mark S.</creatorcontrib><creatorcontrib>Czuczman, Myron S.</creatorcontrib><creatorcontrib>Millenson, Michael</creatorcontrib><creatorcontrib>Niland, Joyce</creatorcontrib><creatorcontrib>Gascoyne, Randy D.</creatorcontrib><creatorcontrib>Connors, Joseph M.</creatorcontrib><creatorcontrib>Friedberg, Jonathan W.</creatorcontrib><creatorcontrib>Winter, Jane N.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Blood</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zhou, Zheng</au><au>Sehn, Laurie H.</au><au>Rademaker, Alfred W.</au><au>Gordon, Leo I.</au><au>LaCasce, Ann S.</au><au>Crosby-Thompson, Allison</au><au>Vanderplas, Ann</au><au>Zelenetz, Andrew D.</au><au>Abel, Gregory A.</au><au>Rodriguez, Maria A.</au><au>Nademanee, Auayporn</au><au>Kaminski, Mark S.</au><au>Czuczman, Myron S.</au><au>Millenson, Michael</au><au>Niland, Joyce</au><au>Gascoyne, Randy D.</au><au>Connors, Joseph M.</au><au>Friedberg, Jonathan W.</au><au>Winter, Jane N.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>An enhanced International Prognostic Index (NCCN-IPI) for patients with diffuse large B-cell lymphoma treated in the rituximab era</atitle><jtitle>Blood</jtitle><addtitle>Blood</addtitle><date>2014-02-06</date><risdate>2014</risdate><volume>123</volume><issue>6</issue><spage>837</spage><epage>842</epage><pages>837-842</pages><issn>0006-4971</issn><eissn>1528-0020</eissn><abstract>The International Prognostic Index (IPI) has been the basis for determining prognosis in patients with aggressive non-Hodgkin lymphoma (NHL) for the past 20 years. Using raw clinical data from the National Comprehensive Cancer Network (NCCN) database collected during the rituximab era, we built an enhanced IPI with the goal of improving risk stratification. Clinical features from 1650 adults with de novo diffuse large B-cell lymphoma (DLBCL) diagnosed from 2000-2010 at 7 NCCN cancer centers were assessed for their prognostic significance, with statistical efforts to further refine the categorization of age and normalized LDH. Five predictors (age, lactate dehydrogenase (LDH), sites of involvement, Ann Arbor stage, ECOG performance status) were identified and a maximum of 8 points assigned. Four risk groups were formed: low (0-1), low-intermediate (2-3), high-intermediate (4-5), and high (6-8). Compared with the IPI, the NCCN-IPI better discriminated low- and high-risk subgroups (5-year overall survival [OS]: 96% vs 33%) than the IPI (5 year OS: 90% vs 54%), respectively. When validated using an independent cohort from the British Columbia Cancer Agency (n = 1138), it also demonstrated enhanced discrimination for both low- and high-risk patients. The NCCN-IPI is easy to apply and more powerful than the IPI for predicting survival in the rituximab era.
•The clinically based NCCN-IPI is a robust prognostic tool for the rituximab era that better discriminates low- and high-risk DLBCL patients compared with the IPI.•The NCCN-IPI outperforms the IPI by refined categorization of age and LDH, and the identification of disease involvement at specific extranodal sites.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24264230</pmid><doi>10.1182/blood-2013-09-524108</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Adult Aged Antibodies, Monoclonal, Murine-Derived - therapeutic use Antineoplastic Agents - therapeutic use Clinical Trials and Observations Cohort Studies Female Follow-Up Studies Humans International Agencies Lymphoma, Large B-Cell, Diffuse - drug therapy Male Middle Aged Practice Guidelines as Topic Prognosis Program Development Rituximab |
title | An enhanced International Prognostic Index (NCCN-IPI) for patients with diffuse large B-cell lymphoma treated in the rituximab era |
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