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Early risk stratification for diffuse large B-cell lymphoma integrating interim Deauville score and International Prognostic Index

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Abstract

The aim of this study was to evaluate the prognostic relevance of early risk stratification in diffuse large B-cell lymphoma (DLBCL) using interim Deauville score on positron emission tomography-computed tomography (PET-CT) scan and baseline International Prognostic Index (IPI). This retrospective study included 220 patients (median age, 64 years; men, 60%) diagnosed with DLBCL between 2007 and 2016 at our institution, treated with rituximab-based chemotherapy. Interim PET-CT was performed after three cycles of immuno-chemotherapy. Interim Deauville score was assessed as 4 or 5 in 49 patients (22.3%), and 94 patients (42.7%) had high-intermediate or high-risk IPI scores. In multivariate analysis, interim Deauville score (1–3 and 4–5) and baseline IPI (low/low-intermediate and high-intermediate/high) were independently associated with progression-free survival (for Deauville score, hazard ratio [HR], 1.00 vs. 2.96 [95% confidence interval (CI), 1.83–4.78], P < 0.001; for IPI, HR, 1.00 vs. 4.84 [95% CI, 2.84–8.24], P < 0.001). We stratified patients into three groups: low-risk (interim Deauville scores 1–3 and low/low-intermediate IPI), intermediate-risk (Deauville scores 1–3 with high-intermediate/high IPI or Deauville scores 4–5 with low/low-intermediate IPI), and high-risk (Deauville scores 4–5 and high-intermediate/high IPI). This early risk stratification showed a strong association with progression-free survival (HR, 1.00 vs. 3.98 [95% CI 2.10–7.54] vs. 13.97 [95% CI 7.02–27.83], P < 0.001). Early risk stratification using interim Deauville score and baseline IPI predicts the risk of disease progression or death in patients with DLBCL. Our results provide guidance with interim PET-driven treatment intensification strategies.

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Author notes

  1. Sung Kyun Yim, Ho-Young Yhim, and Yeon-Hee Han contributed equally to this work as co-first authors.

Authors and Affiliations

  1. Department of Internal Medicine, Chonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, Republic of Korea

    Sung Kyun Yim, Ho-Young Yhim, So-Yeon Jeon, Na-Ri Lee, Eun-Kee Song & Jae-Yong Kwak

  2. Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea

    Ho-Young Yhim, So-Yeon Jeon, Na-Ri Lee, Eun-Kee Song, Hwan-Jeong Jeong & Jae-Yong Kwak

  3. Department of Nuclear Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea

    Yeon-Hee Han & Hwan-Jeong Jeong

  4. College of Nursing, Chonbuk National University, Jeonju, Republic of Korea

    Hee Sun Kim

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Contributions

H.-Y.Y., S.K.Y., H.-Y.H., and J.-Y.K. contributed to the study inception and design; H.-Y.Y., S.K.Y., Y.-H.H., H.S.K., and J.-Y.K. contributed to the statistical analysis and interpretation; H.-Y.Y., S.K.Y., S.-Y.J., N.-R.L., E.-K.S., and J.-Y.K. enrolled patients into the study and collected the data; H.-Y.Y. and S.K.Y. contributed to writing the first draft of the manuscript; Y.-H.H. and H.-J.J. analyzed the PET-CT results; and all authors critically revised the manuscript and approved the submitted version of the manuscript.

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Correspondence to Jae-Yong Kwak.

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The authors declare that they have no conflict of interest.

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All procedures performed in this study involving human participants have been approved by the institutional review board (IRB) of Chonbuk National University Hospital and have been performed in accordance with the ethical standards of the IRB and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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The IRB granted a waiver of written informed consent because this study was a retrospective analysis involving no more than minimal risk for the subjects.

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Yim, S.K., Yhim, HY., Han, YH. et al. Early risk stratification for diffuse large B-cell lymphoma integrating interim Deauville score and International Prognostic Index. Ann Hematol 98, 2739–2748 (2019). https://doi.org/10.1007/s00277-019-03834-4

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