Personalized risk prediction for event-free survival at 24 months in patients with diffuse large b-cell lymphoma.
Fiche publication
Date publication
octobre 2015
Auteurs
Membres identifiés du Cancéropôle Est :
Dr BOLOGNA Serge
Tous les auteurs :
Maurer MJ, Jais JP, Ghesquieres H, Witzig TE, Hong F, Haioun C, Thompson CA, Thieblemont C, Micallef IN, Porrata LF, Ribrag V, Nowakowski GS, Casanovas O, Bologna S, Morschhauser F, Morrison VA, Peterson BA, Macon WR, Copie-Bergman C, Feldman AL, Syrbu SI, Kurtin PJ, Gascoyne RD, Li H, Allmer C, Kahl BS, Ansell SM, Slager SL, Link BK, Salles G, Habermann TM, Tilly H, Cerhan JR
Lien Pubmed
Résumé
We recently defined event-free survival at 24 months (EFS24) as a clinically relevant outcome for patients with DLBCL. Patients who fail EFS24 have very poor overall survival, while those who achieve EFS24 have a subsequent overall survival equivalent to that of the age- and sex-matched general population. Here, we develop and validate a clinical risk calculator (IPI24) for EFS24. Model building was performed on a discovery dataset of 1348 patients with DLBCL and treated with anthracycline-based immunochemotherapy. A multivariable model containing age, Ann Arbor stage, normalized serum LDH, ALC, ECOG performance status, bulky disease and sex was identified. The model was then applied to an independent validation dataset of 1177 DLBCL patients. The IPI24 score estimates the probability of failing to achieve the EFS24 endpoint for an individual patient. The IPI24 model showed superior discriminatory ability (c-statistic=0.671) in the validation dataset compared to the IPI (c-statistic=0.649) or the NCCN-IPI (c-statistic=0.657). After recalibration of the model on the combined dataset, the median predicted probability of failing to achieve EFS24 was 36% (range, 12% to 88%), and the IPI24 showed an EFS24 gradient in all IPI groups. The IPI24 also identified a significant percentage of patients with high risk disease, with over 20% of patients having a 50% or higher risk of failing to achieve EFS24. The IPI24 provides an individual patient level probability of achieving the clinically relevant EFS24 endpoint. It can be utilized via electronic apps. This article is protected by copyright. All rights reserved.
Référence
Am J Hematol. 2015 Oct 22