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Prepublished online as a Blood First Edition Paper on April 3, 2003; DOI 10.1182/blood-2002-12-3837.
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Blood, 15 September 2003, Vol. 102, No. 6, pp. 1989-1996
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Age-adjusted International Prognostic Index predicts autologous stem cell transplantation outcome for patients with relapsed or primary refractory diffuse large B-cell lymphoma
Paul A. Hamlin,
Andrew D. Zelenetz,
Tarun Kewalramani,
Jing Qin,
Jaya M. Satagopan,
David Verbel,
Ariela Noy,
Carol S. Portlock,
David J. Straus,
Joachim Yahalom,
Stephen D. Nimer, and
Craig H. Moskowitz
From the Lymphoma and Hematology Services, Division of Hematologic Oncology, Department of Medicine; Department of Biostatistics; and the Department of Radiation Oncology, Memorial Hospital, Memorial Sloan-Kettering Cancer Center, New York, NY.
Second-line chemotherapy followed by high-dose therapy (HDT) with autologous stem cell transplantation (ASCT) cures less than half of the patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL). Prognostic models capable of predicting outcome are essential. In 3 sequential clinical trials, conducted from January 1993 to August 2000, we treated 150 patients with relapsed or primary refractory DLBCL with ifosfamide, carboplatin, and etoposide (ICE) chemotherapy followed by HDT/ASCT for patients with chemosensitive disease. We evaluated the age-adjusted International Prognostic Index at the initiation of second-line therapy (sAAIPI) as a predictor of progression-free survival (PFS) and overall survival (OS). At a median follow-up of 4 years, the PFS and OS are 28% and 34% by intention to treat and 39% and 45% for only those patients with chemosensitive disease. Three risk groups with different PFS and OS were identified by the sAAIPI: low risk (0 factors), 70% and 74%; intermediate risk (1 factor), 39% and 49%; and high risk (2 or 3 factors), 16% and 18% (P < .001 for both PFS and OS). The sAAIPI also predicts the PFS and OS for patients with ICEchemosensitive disease: low risk, 69% and 83%; intermediate risk, 46% and 55%; and high risk, 25% and 26% (P < .001 PFS and OS). The sAAIPI predicts outcome for patients with relapsed or primary refractory DLBCL in both intent-to-treat and chemosensitive populations. This powerful prognostic instrument should be used to evaluate new treatment approaches and to compare results of different regimens.
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