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Blood, 1 March 2007, Vol. 109, No. 5, pp. 1857-1861.
Prepublished online as a Blood First Edition Paper on November 14, 2006; DOI 10.1182/blood-2006-08-038257.
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CLINICAL TRIALS AND OBSERVATIONS
The revised International Prognostic Index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP
Laurie H. Sehn1,
Brian Berry2,
Mukesh Chhanabhai2,
Catherine Fitzgerald1,
Karamjit Gill1,
Paul Hoskins1,
Richard Klasa1,
Kerry J. Savage1,
Tamara Shenkier1,
Judy Sutherland1,
Randy D. Gascoyne2, and
Joseph M. Connors1
1 Division of Medical Oncology and
2 Department of Pathology, British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada
Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous entity, with patients exhibiting a wide range of outcomes. The addition of rituximab to CHOP chemotherapy (R-CHOP)has led to a marked improvement in survival and has called into question the significance of previously recognized prognostic markers. Since randomized controlled trials of R-CHOP in DLBCL have included select subgroups of patients, the utility of the International Prognostic Index (IPI) has not been reassessed. We performed a retrospective analysis of patients with DLBCL treated with R-CHOP in the province of British Columbia to assess the value of the IPI in the era of immunochemotherapy. The IPI remains predictive, but it identifies only 2 risk groups. Redistribution of the IPI factors into a revised IPI (R-IPI) provides a more clinically useful prediction of outcome. The R-IPI identifies 3 distinct prognostic groups with a very good (4-year progression-free survival [PFS] 94%, overall survival [OS] 94%), good (4-year PFS 80%, OS 79%), and poor (4-year PFS 53%, OS 55%) outcome, respectively (P < .001). The IPI (or R-IPI) no longer identifies a risk group with less than a 50% chance of survival. In the era of R-CHOP treatment, the R-IPI is a clinically useful prognostic index that may help guide treatment planning and interpretation of clinical trials.
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