Research Papers:
Improved prognostic stratification using NCCN- and GELTAMO-international prognostic index in patients with diffuse large B-cell lymphoma
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Abstract
Junshik Hong1, Seok Jin Kim2, Myung Hee Chang3, Jeong-A Kim4, Jae-Yong Kwak5, Jin Seok Kim6, Dok Hyun Yoon7, Won Sik Lee8, Young Rok Do9, Hye Jin Kang10, Hyeon-Seok Eom11, Yong Park12, Jong-Ho Won13, Yeung-Chul Mun14, Hyo Jung Kim15, Jung Hye Kwon16, Jee Hyun Kong17, Sung Yong Oh18, Sunah Lee19, Sung Hwa Bae20, Deok-Hwan Yang21, Hyun Jung Jun22, Ho Sup Lee23, Hwan Jung Yun24, Soon Il Lee25, Min Kyoung Kim26, Jun Ho Yi27, Jae Hoon Lee28, Won Seog Kim2 and Cheolwon Suh7
1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
2Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
3Department of Hematology-Oncology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
4Department of Internal Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Seoul, South Korea
5Department of Internal Medicine, Chonbuk National University Medical School & Hospital, Jeonju, South Korea
6Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
7Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
8Department of Internal Medicine, Inje University College of Medicine, Inje University Busan Paik Hospital, Busan, South Korea
9Division of Hematology-Oncology, Department of Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
10Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
11Hematology-Oncology Clinic, National Cancer Center, Goyang, South Korea
12Department of Internal Medicine, Korea University Anam Hospital, College of Medicine, Seoul, South Korea
13Department of Internal Medicine, Soon Chun Hyang University, Seoul, South Korea
14Department of Internal Medicine, Ewha Womans University, Seoul, South Korea
15Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea
16Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul, South Korea
17Division of Hematology-Oncology, Department of Medicine, Wonju Severance Christian Hospital, Yonsei University College of Medicine, Wonju, South Korea
18Department of Internal Medicine, Dong-A University Hospital, Busan, South Korea
19Department of Internal Medicine, Daegu Fatima Hospital, Daegu, South Korea
20Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, South Korea
21Department of Hemato-Oncology, Chonnam National University Hwasun Hospital, Jeollanamdo, South Korea
22Department of Internal Medicine, Seoul Medical Center, Seoul, South Korea
23Department of Internal Medicine, Kosin University Gospel Hospital, Busan, South Korea
24Department of Hemato-Oncology, Chungnam National University Hospital, Daejeon, South Korea
25Department of Internal Medicine, Dankook University College of Medicine, Cheonan, South Korea
26Department of Medicine, Yeungnam University College of Medicine, Daegu, South Korea
27Department of Internal Medicine, Chung Ang University, Seoul, South Korea
28Department of Internal Medicine, Gachon University College of Medicine, Incheon, South Korea
Correspondence to:
Seok Jin Kim, email: [email protected]
Keywords: non-hodgkin lymphoma, diffuse large B-cell lymphoma, international prognostic index, prognosis, overall survival
Received: July 18, 2017 Accepted: August 27, 2017 Published: September 18, 2017
ABSTRACT
The National Comprehensive Cancer Network (NCCN)-International Prognostic Index (IPI) and GELTAMO (Grupo Español de Linfomas/Trasplante Autólogo de Médula Ósea)-IPI were developed to enable better risk prediction of patients with diffuse large B-cell lymphoma (DLBCL). The present study compared the effectiveness of risk prediction between IPI, NCCN-IPI, and GELTAMO-IPI in patients with DLBCL particularly in terms of determining high-risk patients. Among 439 patients who were enrolled to a prospective DLBCL cohort treated with R-CHOP immunochemotherapy, risk groups were classified according to the three IPIs and the prognostic significance of individual IPI factors and IPI models were analyzed and compared. All three IPI effectively separated the analyzed patients into four risk groups according to overall survival (OS). Estimated 5-year OS of patients classified as high-risk according to the IPI was 45.7%, suggesting that the IPI is limited in the selection of patients who are expected to have a poor outcome. In contrast, the 5-year OS of patients stratified as high-risk according to NCCN- and GELTAMO-IPI was 31.4% and 21.9%, respectively. The results indicate that NCCN- and GELTAMO-IPI are better than the IPI in predicting patients with poor prognosis, suggesting the superiority of enhanced, next-generation IPIs for DLBCL.
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