Reassessment of the prognostic value of the International Prognostic Index and the revised International Prognostic Index in patients with diffuse large B-cell lymphoma: A multicentre study

Huang,Hong-Hui; Xiao,Fei; Chen,Fang-Yuan; Wang,Ting; Li,Jun-Min; Wang,Jian‑Min; Cao,Jun-Ning; Wang,Chun; Zou,Shan-Hua

doi:10.3892/etm.2012.607

Reassessment of the prognostic value of the International Prognostic Index and the revised International Prognostic Index in patients with diffuse large B-cell lymphoma: A multicentre study

Authors:
- Hong-Hui Huang
- Fei Xiao
- Fang-Yuan Chen
- Ting Wang
- Jun-Min Li
- Jian‑Min Wang
- Jun-Ning Cao
- Chun Wang
- Shan-Hua Zou
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Affiliations: Department of Hematology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China , Department of Hematology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China , Department of Hematology, Changhai Hospital, Second Military Medical University, Shanghai, P.R. China, Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China, Department of Hematology, Shanghai First People's Hospital affiliated to Shanghai Jiaotong University, Shanghai, P.R. China, Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
Published online on: June 12, 2012 https://doi.org/10.3892/etm.2012.607
Pages: 475-480

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Abstract

The International Prognostic Index (IPI) is a widely accepted model that is used to predict the prognosis of patients with diffuse large B‑cell lymphoma (DLBCL) who are treated using chemotherapy. However, the prognostic value of the IPI has been a focal point of debate in the immunochemotherapy era. The aim of this study was to reassess the value of the IPI and revised IPI (R-IPI) in a Chinese population. A multicentre retrospective analysis of DLBCL patients who were treated with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP)-like chemotherapy alone or chemotherapy plus rituximab (R-CHOP-like) was performed. The prognostic values of IPI and R-IPI at the time of diagnosis with respect to overall survival (OS) and progression-free survival (PFS) were evaluated. Among the 438 patients in the study, 241 received a CHOP-like regimen and 197 patients received an R-CHOP‑like regimen. Although the IPI remained predictive for the CHOP-like group, it failed to distinguish between the various prognostic categories in the R-CHOP-like group. Notably, redistribution of the IPI factors into R-IPI factors identified three discrete prognostic groups with significantly different outcomes in both the CHOP-like and R-CHOP-like groups. In the R-CHOP-like group, these three risk groups, very good, good and poor, had distinctly different 3-year PFS rates of 96, 84.3 and 67.5% (P=0.001), and 3-year OS rates of 96, 87.6 and 71.1% (P=0.003), respectively. Our study demonstrates the power of the R-IPI as a simplified and more clinically relevant predictor of disease outcome than the standard IPI in DLBCL populations in the rituximab era. Therefore, the R-IPI merits further study in a larger population-based prospective study.

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