Promising New Prognostic Score for High-Risk DLBCL

A novel prognostic score may be better able to identify patients with diffuse large B-cell lymphoma (DLBCL) at high-risk for reduced progression-free survival (PFS) and overall survival (OS) compared with existing scores, according to research (abstract 347) presented at the 2018 American Society of Hematology (ASH) Annual Meeting & Exposition, held December 1–4 in San Diego.

DLBCL is a heterogeneous group of aggressive B-cell lymphomas. In most patients, a regimen of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is highly successful. However, between 20% and 40% of patients don’t respond to this regimen, underscoring the importance of identifying such individuals as candidates for alternative treatment options, including new schemes, approaches, and agents.

While the International Prognostic Index (IPI) is a reliable indicator, it misses very high-risk patients. Bento and colleagues aimed to develop a user-friendly, readily available prognostic score using easily attainable complete blood cell (CBC) counts to improve detection in such patients.

“Low absolute lymphocyte count and high levels of blood monocytes have shown to be unfavorable risk factors. The red cell distribution width (RDW) has been associated with aging and active inflammatory processes and beta-2-microglobulin (B2M) with tumor load and proliferation as well as comorbidities such as kidney failure. All these variables are easily obtainable at the time of diagnosis,” the study authors wrote.

The researchers retrospectively mined a Spanish national database for 992 DLBCL patients with a median follow-up of 55 months. According to the results of a multivariate analysis, they identified age, Eastern Cooperative Oncology Group (ECOG) score, stage, bulky mass, beta-2-microglobulin (B2M), red cell distribution width, and lymphocytes/monocytes ratio as independent variables for PFS. These variables were then utilized to develop a novel prognostic score.

The 9-point, age-categorized prognostic score that the investigators created outperformed the revised IPI (R-IPI) and other scores in high-risk assessment for both PFS and OS. Specifically, the new score identified a high-risk subgroup, with a 5-year PFS of 20% vs 47% for R-IPI and 38% for NCCN-IPI, and a 5-year-OS of 26% vs 59% for R-IPI and 46% for NCCN-IPI.

“This is a score that can be easily calculated and might help with refining prognostication of patients with DLBCL,” said Stefan K. Barta, MD, MS, an associate professor at the Perelman School of Medicine at the University of Pennsylvania.