The National Comprehensive Cancer Network international prognostic index (NCCN-IPI) may be superior to other tools for predicting 2-year progression-free survival in patients with diffuse large B cell lymphoma (DLBCL), according to an article recently published in Hematology.

“However, the prognostic model for DLBCL patients treated with R-CHOP requires updating or integrating biomarkers to improve discrimination to the acceptable level (c-index 0.7),” the authors wrote.

The researchers compared 3 tools for predicting prognosis: the international prognostic index (IPI), revised IPI (R-IPI), and the NCCN-IPI. These tools showcased concordance indices of 0.6104, 0.6004, and 0.6216, respectively.

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Although both the NCCN-IPI and the R-IPI exhibited calibration plots with the optimal agreement, the NCCN-IPI had a superior absolute difference in survival (ADS) of 52%, compared to the R-IPI at 42%. The IPI, on the other hand, displayed miscalibrations and an ADS of 25%. The overall 2-year progression-free survival of this cohort was 63%.

This observational study included 292 patients previously diagnosed with de novo DLBCL. Median age was 63 years. All received treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), including those over 80 years of age who received R-mini-CHOP. Most participants (67%) had high levels of lactic dehydrogenase (LDH), 59% had disease stages 3 or 4, and 65% were nongerminal center B cell subtypes.

During the course of treatment, most patients (n=184) had a complete response, while 48 had a partial response, 31 experienced progressive diseases, 28 had refractory DLBCL, and 6 died. At the end of the follow-up period, the overall outcomes were 241 complete responses, 131 disease progressions, 81 refractory cases, 35 relapses, and 96 deaths.

Although these results translate into a better understanding of achieving a more accurate prognosis prediction in patients with DLBCL treated with R-CHOP, there are still some gaps remaining.

“Suggestions for future external validation in the developing country setting are recruiting participants from a multicenter study, prospective data collection, PET-CT staging and response assessment, and the addition of baselines B2M or other potential biomarkers,” the authors concluded.


Warnnissorn N, Kanitsap N, Niparuck P, et al. External validation and comparison of IPI, R-IPI, and NCCN-IPI in diffuse large B-cell lymphoma patients treated with R-CHOP to predict 2-year progression-free survival. Hematology. Published online November 22, 2022. doi:10.1080/16078454.2022.2147916.