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Prepublished online as a Blood First Edition Paper on April 3, 2003; DOI 10.1182/blood-2002-12-3837.
Submitted December 19, 2002
Accepted March 20, 2003
The age-adjusted international prognostic index predicts autologous stem cell transplant (ASCT) 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*
Department of Medicine - Lymphoma Service, Memorial Hospital, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Medicine - Hematology Service, Memorial Hospital, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
Department of Radiation Oncology, Memorial Hospital, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
Department of Biostatistics, Memorial Hospital, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
* Corresponding author; email: moskowic{at}mskcc.org.
Second-line chemotherapy followed by high dose therapy (HDT) with autologous stem cell transplantation (ASCT) cures less than half of patients with relapsed or refractory diffuse large B cell lymphoma (DLBCL). Prognostic models capable of predicting outcome are essential. In three sequential clinical trials, conducted from 1/93 to 8/00, 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 followup 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<0.001 for both PFS and OS). The sAAIPI also predicts the PFS and OS for patients with ICE chemosensitive disease: low risk 69% and 83%; intermediate risk 46% and 55%; and high risk 25% and 26% (p<0.001 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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