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Prognosis of aggressive lymphomas: a study of five prognostic models with
patients included in the LNH-84 regimen
B Coiffier and E Lepage
Hematology Department, Centre Hospitalier Lyon-Sud, France.
Four prognostic models described for aggressive malignant lymphomas and the
classical Ann Arbor staging system were used to compare the survival of 737
patients treated with the LNH-84 regimen. The aim of the study was to
determine the optimal prognostic system at the time of diagnosis. Three
institutions have described these models after multivariate analyses: the
Dana Farber Cancer Institute (DFCI1 and DFCI2), the MD Anderson Hospital
(MDAH), and the Memorial Sloan- Kettering Cancer Center (MSKCC). The models
were constructed with the following variables: performance status, LDH
level, and tumor extension. The latter is the most difficult to assess: it
was considered as the number of extranodal sites and the diameter of the
largest mass in DFCI1, stage and the diameter of the largest mass in DFCI2,
the number of extranodal and extensive nodal sites in MDAH, and the number
of nodal sites and their localization in MSKCC. Univariate studies with
LNH-84 regimen patients showed all these variables to have major prognostic
significance (logrank tests: P less than 10(-4)). All five prognostic
systems divided patients into three subgroups: good, intermediate, and poor
prognosis. Logrank analyses of survival showed highly significant
differences (X2 greater than 90 and P less than 10(- 6)) between the
subgroups. No gross difference was found between the models, and none was
better than the others. A new, internationally accepted prognostic system
for the expression and comparison of treatment results in aggressive
malignant lymphomas should include major univariate prognostic parameters
and must be reliable and easy to use in clinical practice. Until such time,
stage or LDH level are the best alternatives.
Volume 74,
Issue 2,
pp. 558-564,
08/01/1989
Copyright © 1989 by The American Society of Hematology
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