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Risk classification as the basis for clinical staging of diffuse large-
cell lymphoma derived from 10-year survival data
WS Velasquez, S Jagannath, SL Tucker, LM Fuller, LB North, JR Redman, F Swan, FB Hagemeister, P McLaughlin and F Cabanillas
Department of Hematology, University of Texas, M.D. Anderson Cancer Center,
Houston 77030.
Two hundred and fifty previously untreated adult patients with diffuse
large-cell lymphomas were treated with a chemotherapy combination of
cyclophosphamide, adriamycin, vincristine, prednisone, and low-dose
bleomycin (CHOP-Bleo) with or without radiotherapy between 1974 and 1984.
The 10-year survival rates for patients with Ann Arbor stages II, III, or
IV disease of 55%, 42%, and 40%, respectively, were not significantly
different. However, the survival rate of 76% for patients with stage I
disease was clearly better. Factors more indicative of prognosis than
stage, as found by univariant analysis, were tumor burden, serum lactic
dehydrogenase level (LDH), age, and constitutional symptoms. From these, a
multivariant analysis selected tumor burden, LDH level, and age as major
independent factors for predicting survival (P less than .001). A
prognostic risk model constructed on the basis of tumor burden and LDH
levels identified four distinct risk groups (A, B, C, D) with 10-year
survival rates of 85%, 66%, and 43% for A, B, and C. No patient in group D
survived 10 years. These risk groups also had a strong correlation with
complete remission rates and with relapse rates. Thus this model proved
more effective for identifying patient populations according to their
expected responses, durations of remission, and survivals than the Ann
Arbor staging system. Detailed information supporting the use of this
system for predicting prognosis and for treatment selection for patients
with diffuse large-cell lymphomas is provided.
Volume 74,
Issue 2,
pp. 551-557,
08/01/1989
Copyright © 1989 by The American Society of Hematology
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