Korean J Intern Med.  2010 Sep;25(3):301-308. 10.3904/kjim.2010.25.3.301.

Modified Number of Extranodal Involved Sites as a Prognosticator in R-CHOP-Treated Patients with Disseminated Diffuse Large B-Cell Lymphoma

• Yoo C
• Kim S
• Sohn BS
• Kim JE
• Yoon DH
• Huh J
• Lee DH
• Kim SW
• Lee JS
• Suh C

• KMID: 1776612
• DOI: http://doi.org/10.3904/kjim.2010.25.3.301

Abstract

BACKGROUND/AIMS
Rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy (R-CHOP) has improved survival in patients with diffuse large B-cell lymphoma (DLBCL) and weakened the prognostic power of the international prognostic index (IPI). We evaluated the efficacy of the IPI and revised IPI (R-IPI) in patients with DLBCL who were treated with R-CHOP, focusing on extranodal site number (ENS) because extranodal involvement occurs frequently in Koreans.
METHODS
A total of 126 R-CHOP-treated patients with stage III/IV DLBCL were analyzed. We performed a retrospective analysis of the clinicopathologic factors and verified the predictive power of the standard IPI and R-IPI. Various numbers of extranodal sites were analyzed for further stratification, and we set the extranodal site-modified IPI (E-IPI) as the IPI when the number of extranodal sites was stratified as < 3 vs. > or = 3.
RESULTS
A univariate analysis showed that ENS was associated with complete response (CR, p = 0.04), event-free survival (EFS, p = 0.01), and overall survival (OS, p < 0.001) when the ENS cut-off was set at > or = 3. A multivariate analysis revealed that an ENS > or = 3 remained associated with EFS (p < 0.01; hazard ratio [HR], 2.60; 95% confidence interval [CI], 1.29 to 5.26) and OS (p < 0.01; HR, 3.52; 95% CI, 1.68 to 7.35). The IPI was effective for determining prognosis in terms of OS (p = 0.04) but not EFS (p = 0.17). The R-IPI was effective in terms of both variables (p = 0.02 and 0.04, respectively), as was the E-IPI (p = 0.01 and 0.001, respectively).
CONCLUSIONS
An ENS < 3 vs. > or = 3, rather than the original < 2 vs. > or = 2, was the most significant prognostic factor for EFS and OS. All three indices were predictive, but only the E-IPI identified the high-risk group of R-CHOP-treated Korean patients with disseminated DLBCL.

Keyword

Prognosis; Lymphoma, large B-cell, diffuse; Rituximab; Extranodal

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Antibodies, Monoclonal/*administration & dosage
Antineoplastic Combined Chemotherapy Protocols/*administration & dosage
Cyclophosphamide/administration & dosage
Doxorubicin/administration & dosage
Female
Humans
Korea
Lymphoma, Large B-Cell, Diffuse/*drug therapy/*pathology
Male
Middle Aged
Prednisone/administration & dosage
Prognosis
Retrospective Studies
Vincristine/administration & dosage
Young Adult