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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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Submitted August 10, 2006
Accepted October 13, 2006
Revised International Prognostic Index (R-IPI) is a better predictor of outcome than the Standard IPI for patients with DLBCL treated with R-CHOP
Laurie H Sehn*, Brian Berry, Mukesh Chhanabhai, Catherine Fitzgerald, Karamjit Gill, Paul Hoskins, Richard Klasa, Kerry J Savage, Tamara Shenkier, Judy Sutherland, Randy D Gascoyne, and Joseph M Connors
Division of Medical Oncology & the Dept of Pathology, BC Cancer Agency, Vancouver, Canada
* Corresponding author; email: lsehn{at}bccancer.bc.ca.
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 groups 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 immuno-chemotherapy. While the IPI remains predictive, it only identifies two 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 three distinct prognostic groups with a very good (4-year PFS 94%, OS 94%), good (4-year PFS 80%, OS 79%) and poor (4-year PFS 53%, OS 55%) outcome, respectively (p<0.0001). 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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