Abstract
Background: We reported that addition of rituximab (R) to chemotherapy significantly improves outcome in DLBCL patients (pt) >60 years (
Methods: We evaluated outcomes of the Intergroup study with respect to the standard IPI, R-IPI, age-adjusted (aa) IPI for evaluable pt treated with R-CHOP alone or with maintenance rituximab. We further assessed a modified IPI (mIPI) using age ≥ 70 y as a cutoff rather than age 60 y.
Results: The 267 pt in this analysis were followed for a median of 4 y. Pt characteristics were: age > 70 (48%) (median=69), male 52%, stage III/IV 75%, >1 EN site 30%, LDH elevated 60%, PS ≥2 15%. On univariate analysis all of these characteristics were significant for 3 y failure-free survival (FFS) and overall survival (OS). The IPI provided additional discrimination of risk compared to the R-IPI with significant differences in FFS and OS for 3 vs 4–5 factors. The aa-IPI defined relatively few pt as low or high risk. The impact of age was studied using a cut-off of 70 years in a modified IPI, yielding 4 risk groups as shown below.
Conclusions: For pt ≥ 60 treated with rituximab-chemotherapy the distinction between 3 vs 4,5 factors in the IPI was significant.The IPI also provided additional discrimination of risk compared to the R-IPI. In this older group of pt, use of an age cutoff ≥70 y placed more patients in the low risk category. It is of interest to apply the mIPI in other datasets with DLBCL pt >60 y.
| Group . | # Factors # . | Pt . | % 3y FFS* . | % 3y OS* . |
|---|---|---|---|---|
| *All risk groups significantly different; logrank p < 0.001 | ||||
| **95 % CI: FFS (0.46,0.66), OS (0.58,0.78) | ||||
| ***95 % CI: FFS (0.21,0.45), OS (0.31,0.55) | ||||
| L: Low, LI: Low Intermediate, HI: High Intermediate, H; High | ||||
| IPI | ||||
| L | 0–1 | 12 | 78 | 83 |
| LI | 2 | 28 | 70 | 80 |
| HI | 3 | 33 | 56** | 68** |
| H | 4–5 | 37 | 33*** | 43*** |
| R-IPI | ||||
| Very Good | 0 | 0 | - | - |
| Good | 1–2 | 40 | 72 | 81 |
| Poor | 3–5 | 60 | 46 | 57 |
| aa-IPI | ||||
| L | 0 | 12 | 78 | 83 |
| LI | 1 | 35 | 68 | 78 |
| HI | 2 | 44 | 47 | 59 |
| H | 3 | 9 | 31 | 35 |
| mIPI (age ≥ 70) | ||||
| L | 0–1 | 27 | 77 | 86 |
| LI | 2 | 28 | 62 | 74 |
| HI | 3 | 29 | 47 | 58 |
| H | 4–5 | 16 28 | 36 | |
| Group . | # Factors # . | Pt . | % 3y FFS* . | % 3y OS* . |
|---|---|---|---|---|
| *All risk groups significantly different; logrank p < 0.001 | ||||
| **95 % CI: FFS (0.46,0.66), OS (0.58,0.78) | ||||
| ***95 % CI: FFS (0.21,0.45), OS (0.31,0.55) | ||||
| L: Low, LI: Low Intermediate, HI: High Intermediate, H; High | ||||
| IPI | ||||
| L | 0–1 | 12 | 78 | 83 |
| LI | 2 | 28 | 70 | 80 |
| HI | 3 | 33 | 56** | 68** |
| H | 4–5 | 37 | 33*** | 43*** |
| R-IPI | ||||
| Very Good | 0 | 0 | - | - |
| Good | 1–2 | 40 | 72 | 81 |
| Poor | 3–5 | 60 | 46 | 57 |
| aa-IPI | ||||
| L | 0 | 12 | 78 | 83 |
| LI | 1 | 35 | 68 | 78 |
| HI | 2 | 44 | 47 | 59 |
| H | 3 | 9 | 31 | 35 |
| mIPI (age ≥ 70) | ||||
| L | 0–1 | 27 | 77 | 86 |
| LI | 2 | 28 | 62 | 74 |
| HI | 3 | 29 | 47 | 58 |
| H | 4–5 | 16 28 | 36 | |
Disclosure: No relevant conflicts of interest to declare.
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