Relapsed/Refractory International Prognostic Index (R/R-IPI): An international prognostic calculator for relapsed/refractory diffuse large B-cell lymphoma.
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols
/ therapeutic use
Cohort Studies
Combined Modality Therapy
Disease Progression
Drug Resistance, Neoplasm
Female
Humans
Immunotherapy
Kaplan-Meier Estimate
Lymphoma, Large B-Cell, Diffuse
/ drug therapy
Male
Middle Aged
Mobile Applications
Models, Theoretical
Point-of-Care Systems
Prognosis
Recurrence
Risk
Severity of Illness Index
Smartphone
Treatment Outcome
Journal
American journal of hematology
ISSN: 1096-8652
Titre abrégé: Am J Hematol
Pays: United States
ID NLM: 7610369
Informations de publication
Date de publication:
01 05 2021
01 05 2021
Historique:
revised:
26
02
2021
received:
15
02
2021
accepted:
28
02
2021
pubmed:
5
3
2021
medline:
14
5
2021
entrez:
4
3
2021
Statut:
ppublish
Résumé
Disease progression after frontline therapy for Diffuse large B-cell lymphoma (DLBCL) is a clinically significant event. Patients who experience early progression or have refractory disease have especially poor outcomes. Simple, clinically applicable prognostic tools are needed for selecting patients for consideration for novel therapies and prognostication in the relapsed/refractory (R/R) setting. Model building was performed in patients from the Surrogate endpoints in aggressive lymphoma (SEAL) consortium with disease progression after frontline immunochemotherapy. The primary endpoint was overall survival (OS) measured from date of progression. Validation was performed in the University of Iowa/Mayo Clinic SPORE Molecular Epidemiology Resource (MER) and Danish National Lymphoma Register (LYFO) cohorts. Model performance was assessed using time-dependent concordance indices (c-statistic) and calibration with metrics evaluated at 2 years from progression. Note, 1234 of 5112 patients treated with frontline immunochemotherapy in the SEAL consortium developed progressive disease. Time to progression on immunochemotherapy and age at progression were strongly associated with post-progression OS (both p < 0.001). A prognostic model was developed incorporating spline fit for both variables. The model had good concordance in the discovery (0.67) and validation sets (LYFO c = 0.64, MER c = 0.68) with generally good calibration. Time to progression on frontline therapy is strongly associated with post-progression OS in DLBCL. We developed and validated a simple to apply clinical prognostic tool in the R/R setting. The useful prediction of expected outcomes in R/R DLBCL and can inform treatment decisions such as considerations for CAR-T therapy as well as trial designs. The model is available in smartphone-based point of care applications.
Identifiants
pubmed: 33661547
doi: 10.1002/ajh.26149
pmc: PMC8763015
mid: NIHMS1768328
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Validation Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
599-605Subventions
Organisme : NCI NIH HHS
ID : Lymphoma Epidemiology of Outcomes U01CA195568
Pays : United States
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Organisme : NCI NIH HHS
ID : P50 CA097274
Pays : United States
Organisme : NCI NIH HHS
ID : U01 CA195568
Pays : United States
Organisme : NCI NIH HHS
ID : University of Iowa/Mayo Clinic SPORE P50CA097274
Pays : United States
Informations de copyright
© 2021 Wiley Periodicals LLC.
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