THE REVISED INTERNATIONAL PROGNOSTIC INDEX IS MORE USEFUL IN COMBINATION WITH SERUM INTERLEUKIN-2 RECEPTOR LEVEL FOR DETERMINING THE PROGNOSIS IN DIFFUSE LARGE B-CELL LYMPHOMA
(Abstract release date: 05/19/16)
EHA Library. Kuwahara S. 06/09/16; 134579; PB1679
Dr. Saeko Kuwahara
Contributions
Contributions
Abstract
Abstract: PB1679
Type: Publication Only
Background
The current standard of care for diffuse large B-cell lymphoma (DLBCL) is rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). The International Prognostic Index (IPI) was developed to predict the outcome prior to the availability of rituximab. The addition of rituximab to CHOP dramatically improved clinical outcomes in patients with DLBCL. Therefore, some major modifications to the IPI have been reevaluated in the rituximab era. The revised IPI (R-IPI), a clinical tool used to predict patient outcome, has been implemented and validated; however, it has not been established for general practical use. Serum soluble interleukin-2 receptor (IL-2R) level has been identified as a marker of poor outcome in patients with DLBCL.
Aims
In this study, we analyzed to determine whether incorporation of serum IL-2R level into the factors of R-IPI allow for wider differentiation of outcomes.
Methods
The clinical records of 227 consecutive patients in our center with DLBCL diagnosed between 2003 and 2013 who received rituximab were retrospectively analyzed. Data for IPI factors (age >60 years, stage III/IV disease, elevated serum lactate dehydrogenase level, Eastern Cooperative Oncology Group performance status ≥2, and >1 extranodal site of disease) and serum IL-2R level upon diagnosis were collected retrospectively. The normal upper limit of serum IL-2R level was set at 519 U/mL using an enzyme immunoassay system. The R-IPI segregated patients into 3 outcome groups. A combination of R-IPI and serum IL-2R level identified 6 groups. The survival period was calculated from treatment initiation and estimated using Kaplan-Meier method. Death from any cause or relapse was defined as an event. Survival was compared between risk groups using the log-rank test. This study was conducted in accordance with the Declaration of Helsinki and its amendments. The protocol was approved by the Ethics Committee of the Japanese Red Cross Kyoto Daiichi Hospital.
Results
A total of 227 patients with DLBCL were enrolled, and 54 patients had normal serum IL-2R levels, on the basis of which, 12 were categorized as a very good prognostic group, 39 a good prognostic group, and 3 a poor prognostic group according to the R-IPI; similarly 173 patients had elevated serum IL-2R levels, on the basis of which, 4 were categorized as a very good prognostic group, 81 a good prognostic group, and 88 a poor prognostic group. With a median observation period of 39 months (range, 1 - 205), the 3-year overall survival (OS) was 72.9% for all patients. and 100%, 94.4%, and 100% for 3 prognostic groups of patients with normal serum IL-2R levels, according to the R-IPI. Similarly, the 3-year OS for patients with elevated serum IL-2R level was 100%, 81.7%, and 68.7%, respectively (p=.002). Moreover, 12 patients with a very good prognostic group per the R-IPI showed favorable prognoses regardless of serum IL-2R level (100% 3-year OS). However, serum IL-2R level significantly differed between with good and poor prognostic groups. According to the serum IL-2R level, 3-year OS was 94.4%, and 81.7%, respectively, for patients with the good prognostic group (p=.02) and 100% and 60.5%, respectively, for those with the poor prognostic group (p=.02).
Conclusion
A new scoring system is needed for better risk stratification and establishing the appropriate therapeutic strategy in the rituximab era. R-IPI is a useful prognostic marker, particularly in patients with elevated serum IL-2R levels. The combination of serum IL-2R level with R-IPI might provide a more precise risk stratification and serve as a useful prognostic predictor in DLBCL patients to identify candidates for experimental therapy other than R-CHOP.
Session topic: E-poster
Keyword(s): CHOP, Diffuse large B cell lymphoma, Prognostic factor, Rituximab
Type: Publication Only
Background
The current standard of care for diffuse large B-cell lymphoma (DLBCL) is rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). The International Prognostic Index (IPI) was developed to predict the outcome prior to the availability of rituximab. The addition of rituximab to CHOP dramatically improved clinical outcomes in patients with DLBCL. Therefore, some major modifications to the IPI have been reevaluated in the rituximab era. The revised IPI (R-IPI), a clinical tool used to predict patient outcome, has been implemented and validated; however, it has not been established for general practical use. Serum soluble interleukin-2 receptor (IL-2R) level has been identified as a marker of poor outcome in patients with DLBCL.
Aims
In this study, we analyzed to determine whether incorporation of serum IL-2R level into the factors of R-IPI allow for wider differentiation of outcomes.
Methods
The clinical records of 227 consecutive patients in our center with DLBCL diagnosed between 2003 and 2013 who received rituximab were retrospectively analyzed. Data for IPI factors (age >60 years, stage III/IV disease, elevated serum lactate dehydrogenase level, Eastern Cooperative Oncology Group performance status ≥2, and >1 extranodal site of disease) and serum IL-2R level upon diagnosis were collected retrospectively. The normal upper limit of serum IL-2R level was set at 519 U/mL using an enzyme immunoassay system. The R-IPI segregated patients into 3 outcome groups. A combination of R-IPI and serum IL-2R level identified 6 groups. The survival period was calculated from treatment initiation and estimated using Kaplan-Meier method. Death from any cause or relapse was defined as an event. Survival was compared between risk groups using the log-rank test. This study was conducted in accordance with the Declaration of Helsinki and its amendments. The protocol was approved by the Ethics Committee of the Japanese Red Cross Kyoto Daiichi Hospital.
Results
A total of 227 patients with DLBCL were enrolled, and 54 patients had normal serum IL-2R levels, on the basis of which, 12 were categorized as a very good prognostic group, 39 a good prognostic group, and 3 a poor prognostic group according to the R-IPI; similarly 173 patients had elevated serum IL-2R levels, on the basis of which, 4 were categorized as a very good prognostic group, 81 a good prognostic group, and 88 a poor prognostic group. With a median observation period of 39 months (range, 1 - 205), the 3-year overall survival (OS) was 72.9% for all patients. and 100%, 94.4%, and 100% for 3 prognostic groups of patients with normal serum IL-2R levels, according to the R-IPI. Similarly, the 3-year OS for patients with elevated serum IL-2R level was 100%, 81.7%, and 68.7%, respectively (p=.002). Moreover, 12 patients with a very good prognostic group per the R-IPI showed favorable prognoses regardless of serum IL-2R level (100% 3-year OS). However, serum IL-2R level significantly differed between with good and poor prognostic groups. According to the serum IL-2R level, 3-year OS was 94.4%, and 81.7%, respectively, for patients with the good prognostic group (p=.02) and 100% and 60.5%, respectively, for those with the poor prognostic group (p=.02).
Conclusion
A new scoring system is needed for better risk stratification and establishing the appropriate therapeutic strategy in the rituximab era. R-IPI is a useful prognostic marker, particularly in patients with elevated serum IL-2R levels. The combination of serum IL-2R level with R-IPI might provide a more precise risk stratification and serve as a useful prognostic predictor in DLBCL patients to identify candidates for experimental therapy other than R-CHOP.
Session topic: E-poster
Keyword(s): CHOP, Diffuse large B cell lymphoma, Prognostic factor, Rituximab
Abstract: PB1679
Type: Publication Only
Background
The current standard of care for diffuse large B-cell lymphoma (DLBCL) is rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). The International Prognostic Index (IPI) was developed to predict the outcome prior to the availability of rituximab. The addition of rituximab to CHOP dramatically improved clinical outcomes in patients with DLBCL. Therefore, some major modifications to the IPI have been reevaluated in the rituximab era. The revised IPI (R-IPI), a clinical tool used to predict patient outcome, has been implemented and validated; however, it has not been established for general practical use. Serum soluble interleukin-2 receptor (IL-2R) level has been identified as a marker of poor outcome in patients with DLBCL.
Aims
In this study, we analyzed to determine whether incorporation of serum IL-2R level into the factors of R-IPI allow for wider differentiation of outcomes.
Methods
The clinical records of 227 consecutive patients in our center with DLBCL diagnosed between 2003 and 2013 who received rituximab were retrospectively analyzed. Data for IPI factors (age >60 years, stage III/IV disease, elevated serum lactate dehydrogenase level, Eastern Cooperative Oncology Group performance status ≥2, and >1 extranodal site of disease) and serum IL-2R level upon diagnosis were collected retrospectively. The normal upper limit of serum IL-2R level was set at 519 U/mL using an enzyme immunoassay system. The R-IPI segregated patients into 3 outcome groups. A combination of R-IPI and serum IL-2R level identified 6 groups. The survival period was calculated from treatment initiation and estimated using Kaplan-Meier method. Death from any cause or relapse was defined as an event. Survival was compared between risk groups using the log-rank test. This study was conducted in accordance with the Declaration of Helsinki and its amendments. The protocol was approved by the Ethics Committee of the Japanese Red Cross Kyoto Daiichi Hospital.
Results
A total of 227 patients with DLBCL were enrolled, and 54 patients had normal serum IL-2R levels, on the basis of which, 12 were categorized as a very good prognostic group, 39 a good prognostic group, and 3 a poor prognostic group according to the R-IPI; similarly 173 patients had elevated serum IL-2R levels, on the basis of which, 4 were categorized as a very good prognostic group, 81 a good prognostic group, and 88 a poor prognostic group. With a median observation period of 39 months (range, 1 - 205), the 3-year overall survival (OS) was 72.9% for all patients. and 100%, 94.4%, and 100% for 3 prognostic groups of patients with normal serum IL-2R levels, according to the R-IPI. Similarly, the 3-year OS for patients with elevated serum IL-2R level was 100%, 81.7%, and 68.7%, respectively (p=.002). Moreover, 12 patients with a very good prognostic group per the R-IPI showed favorable prognoses regardless of serum IL-2R level (100% 3-year OS). However, serum IL-2R level significantly differed between with good and poor prognostic groups. According to the serum IL-2R level, 3-year OS was 94.4%, and 81.7%, respectively, for patients with the good prognostic group (p=.02) and 100% and 60.5%, respectively, for those with the poor prognostic group (p=.02).
Conclusion
A new scoring system is needed for better risk stratification and establishing the appropriate therapeutic strategy in the rituximab era. R-IPI is a useful prognostic marker, particularly in patients with elevated serum IL-2R levels. The combination of serum IL-2R level with R-IPI might provide a more precise risk stratification and serve as a useful prognostic predictor in DLBCL patients to identify candidates for experimental therapy other than R-CHOP.
Session topic: E-poster
Keyword(s): CHOP, Diffuse large B cell lymphoma, Prognostic factor, Rituximab
Type: Publication Only
Background
The current standard of care for diffuse large B-cell lymphoma (DLBCL) is rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). The International Prognostic Index (IPI) was developed to predict the outcome prior to the availability of rituximab. The addition of rituximab to CHOP dramatically improved clinical outcomes in patients with DLBCL. Therefore, some major modifications to the IPI have been reevaluated in the rituximab era. The revised IPI (R-IPI), a clinical tool used to predict patient outcome, has been implemented and validated; however, it has not been established for general practical use. Serum soluble interleukin-2 receptor (IL-2R) level has been identified as a marker of poor outcome in patients with DLBCL.
Aims
In this study, we analyzed to determine whether incorporation of serum IL-2R level into the factors of R-IPI allow for wider differentiation of outcomes.
Methods
The clinical records of 227 consecutive patients in our center with DLBCL diagnosed between 2003 and 2013 who received rituximab were retrospectively analyzed. Data for IPI factors (age >60 years, stage III/IV disease, elevated serum lactate dehydrogenase level, Eastern Cooperative Oncology Group performance status ≥2, and >1 extranodal site of disease) and serum IL-2R level upon diagnosis were collected retrospectively. The normal upper limit of serum IL-2R level was set at 519 U/mL using an enzyme immunoassay system. The R-IPI segregated patients into 3 outcome groups. A combination of R-IPI and serum IL-2R level identified 6 groups. The survival period was calculated from treatment initiation and estimated using Kaplan-Meier method. Death from any cause or relapse was defined as an event. Survival was compared between risk groups using the log-rank test. This study was conducted in accordance with the Declaration of Helsinki and its amendments. The protocol was approved by the Ethics Committee of the Japanese Red Cross Kyoto Daiichi Hospital.
Results
A total of 227 patients with DLBCL were enrolled, and 54 patients had normal serum IL-2R levels, on the basis of which, 12 were categorized as a very good prognostic group, 39 a good prognostic group, and 3 a poor prognostic group according to the R-IPI; similarly 173 patients had elevated serum IL-2R levels, on the basis of which, 4 were categorized as a very good prognostic group, 81 a good prognostic group, and 88 a poor prognostic group. With a median observation period of 39 months (range, 1 - 205), the 3-year overall survival (OS) was 72.9% for all patients. and 100%, 94.4%, and 100% for 3 prognostic groups of patients with normal serum IL-2R levels, according to the R-IPI. Similarly, the 3-year OS for patients with elevated serum IL-2R level was 100%, 81.7%, and 68.7%, respectively (p=.002). Moreover, 12 patients with a very good prognostic group per the R-IPI showed favorable prognoses regardless of serum IL-2R level (100% 3-year OS). However, serum IL-2R level significantly differed between with good and poor prognostic groups. According to the serum IL-2R level, 3-year OS was 94.4%, and 81.7%, respectively, for patients with the good prognostic group (p=.02) and 100% and 60.5%, respectively, for those with the poor prognostic group (p=.02).
Conclusion
A new scoring system is needed for better risk stratification and establishing the appropriate therapeutic strategy in the rituximab era. R-IPI is a useful prognostic marker, particularly in patients with elevated serum IL-2R levels. The combination of serum IL-2R level with R-IPI might provide a more precise risk stratification and serve as a useful prognostic predictor in DLBCL patients to identify candidates for experimental therapy other than R-CHOP.
Session topic: E-poster
Keyword(s): CHOP, Diffuse large B cell lymphoma, Prognostic factor, Rituximab
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