What are the prognostic factors in advanced stage diffuse large cell lymphoma?

Updated: Jun 12, 2019
  • Author: Shipra Gandhi, MBBS; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

The International Non-Hodgkin Lymphoma Prognostic Factors Project developed a predictive model of outcome for aggressive non-Hodgkin lymphoma (NHL); ie, stage II bulky or stage III or IV. [20] The specific 5 pretreatment characteristics that independently were statistically significant for higher-risk disease were as follows:

  • Age older than 60 years

  • Tumor stage III or IV (advanced)

  • More than 1 extranodal site involved by disease

  • Patient performance status of 2 or more

  • LDH elevation above the reference range

Based on these 5 characteristics, patients were stratified into 4 categories, as follows:

  • Low-risk patients - 0 or 1 adverse factor.

  • Low-risk to intermediate-risk patients - 2 factors.

  • High-risk to intermediate-risk patients - 3 factors.

  • High-risk patients - 4 or 5 factors.

When patient outcomes were analyzed by risk stratification, they had different outcomes with regard to complete response, disease-free survival, and overall survival. For example, patients with a low risk had a complete response rate of 87% and a 5-year survival rate of 73%, as compared with a complete response rate of 44% and a 5-year survival rate of 26% in the high-risk group.

Subsequent studies have confirmed the reproducibility of the IPI for predicting clinical outcome for patients with diffuse large cell lymphoma. Currently, poor-risk patients (despite achieving complete response) may be considered for aggressive therapy with high-dose chemotherapy and peripheral stem cell/bone marrow transplantation in first remission.


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