リツキシマブ併用化学療法を受けたびまん性大細胞型B細胞リンパ腫における改訂国際予後指標の有用性

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Background: Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease that presents with various clinical features. The international prognostic index (IPI) was established as a simple scoring system to predict the prognosis of DLBCL patients. However, IPI was unsuitable as a prognostic indicator for DLBCL patients treated with rituximab-based chemotherapy. The revised IPI (R-IPI) is proposed to predict the prognosis of DLBCL patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy.,Purpose: The present study aimed to validate the usefulness of R-IPI as a predictor of prognosis in DLBCL patients.,Materials and Methods: We reviewed the clinical records of CD20-positive DLBCL patients treated with R-CHOP or R-CHOP-like therapy between December 2001 and March 2012 at the Department of Hematology, Tokyo Women's Medical University Hospital. Clinical data were retrospectively analyzed, and the usefulness of the IPI and R-IPI were assessed. The Kaplan-Meyer method was used for the estimations of overall survival (OS) and progression-free survival (PFS).,Results: A total of 177 DLBLC patients were treated with R-CHOP or R-CHOP-like therapies during the study period. The characteristics of the study group were as follows: proportion of male patients, 53.7% (n = 95); median age, 69 years (range: 17-89 years); proportion of patients aged ?61 years, 70.6% (n = 125); proportion of patients with performance status ?2, 14.1% (n = 25); proportion of patients with increased lactate dehydrogenase levels, 63.3% (n = 112); proportion of patients with ?2 extranodal lesions, 24.9% (n = 44); and proportion of patients with stage III-IV disease, 46.9% (n = 83). The median observation period was 33 months (range: 0-124 months); overall response rate, 89.5% (n = 136), with complete response in 84.2% of patients (n = 128); and 5-year PFS and 5-year OS rates, 61.2% and 76.9%, respectively. The IPI could not distinguish between the 4 risk groups (IPI 5-year PFS: low 84.1%, low-intermediate 54.2%, high-intermediate 34.7%, high 46.7%; IPI 5-year OS: low 89.1%, low-intermediate 84.4%, high-intermediate 66.8%, high 51.9%). However, the R-IPI could distinguish between 3 separate risk groups (5-year PFS: very good 95.0%, good 66.1%, and poor 39.7%; R-IPI 5-year OS: very good 95.0%, good 85.5%, and poor 58.6%).,Conclusions: Our findings showed that the R-IPI might be more useful than the IPI for predicting the prognosis of DLBCL patients treated with R-CHOP therapy.
2013-03-31

リツキシマブ併用化学療法を受けたびまん性大細胞型B細胞リンパ腫における改訂国際予後指標の有用性

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