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Relapsed/Refractory International Prognostic Index (R/ R‐IPI ): An international prognostic calculator for relapsed/refractory diffuse large B‐cell lymphoma
Author(s) -
Maurer Matthew J.,
Jakobsen Lasse H.,
Mwangi Raphael,
Schmitz Norbert,
Farooq Umar,
Flowers Cristopher R.,
Nully Brown Peter,
Thompson Carrie A.,
Frederiksen Henrik,
Cunningham David,
Jørgensen Judit,
Poeschel Viola,
Nowakowski Grzegorz,
Seymour John F.,
Merli Francesco,
Haioun Corinne,
Ghesquieres Hervé,
Ziepert Marita,
Tilly Hervé,
Salles Gilles,
Shi Qian,
ElGalaly Tarec C.,
Habermann Thomas M.
Publication year - 2021
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.26149
Subject(s) - medicine , oncology , concordance , diffuse large b cell lymphoma , clinical endpoint , progression free survival , lymphoma , international prognostic index , clinical trial , chemotherapy
Abstract 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.