Prognostic factors in aggressive malignant lymphomas

Description and validation of a prognostic index that could identify patients requiring a more intensive therapy

Bertrand Coiffier, Christion Gisselbrecht, Julie Marie Vose, Hervé Tilly, Raoul Herbrecht, André Bosly, James Olen Armitage

Research output: Contribution to journalArticle

202 Citations (Scopus)

Abstract

The objectives of this study were to determine prognostic factors for response to treatment, freedom-from-relapse (FFR) survival, and overall survival of 737 aggressive malignant lymphoma patients treated with the doxorubicin, cyclophosphamide, vindesine, bleomycin, methylprednisolone, methotrexate with leucovorin, ifosfamide, etoposide, asparaginase, and cytarabine (LNH-84) regimen; to construct a prognostic index with factors isolated by multivariate analyses; and to validate this prognostic index with another set of patients. Complete response (CR) was reached in 75% of LNH-84 patients, and 30% of them relapsed. With a median follow-up of 36 months, median FFR survival and median overall survival were not reached. Low serum albumin level, high tumoral mass, weight loss, bone marrow involvement, ≥ 2 extranodal sites, and increased lactic dehydrogenase (LDH) level were associated with a low response rate. Advanced stage, increased LDH level, and nonlarge-cell histologic subtypes (diffuse mixed, lymphoblastic, and small non-cleaved) were statistically associated with a high relapse rate and short FFR survival. Increased LDH level, low serum albumin level, tumoral mass larger than 10 cm, ≥ 2 extranodal sites, advanced stage, and age older than 65 years were statistically associated with short overall survival. Four of these parameters, namely, LDH level, stage, number of extranodal sites, and tumoral mass, were put together to construct a prognostic index. This index partitioned LNH-84 patients into three subgroups of good, intermediate, and poor prognosis (P < .00001): CR rates of 93%, 83%, and 61%; relapse rates of 12%, 25%, and 45%; 3-year FFR survival of 87%, 73%, and 53%; and 3-year survival of 88%, 71%, and 41%, respectively. This prognostic index was applied to a test set of patients: 155 patients treated on protocols of the Nebraska Lymphoma Study Group. Using this index, these patients had 3-year FFR survival of 70%, 40%, and 22% (P = .0002) and 3-year survival of 79%, 52%, and 31 % (P = .005). In patients with aggressive lymphomas, this simple prognostic index could distinguish between patients requiring intensive treatment such as autologous bone marrow transplantation in first complete remission and those who could be treated with standard regimens.

Original languageEnglish (US)
Pages (from-to)211-219
Number of pages9
JournalJournal of Clinical Oncology
Volume9
Issue number2
DOIs
StatePublished - Jan 1 1991

Fingerprint

Lymphoma
Survival
Recurrence
Oxidoreductases
Milk
Therapeutics
Serum Albumin
Vindesine
Asparaginase
Ifosfamide
Leucovorin
Autologous Transplantation
Cytarabine
Bleomycin
Methylprednisolone
Etoposide
Bone Marrow Transplantation
Methotrexate
Doxorubicin
Cyclophosphamide

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Prognostic factors in aggressive malignant lymphomas : Description and validation of a prognostic index that could identify patients requiring a more intensive therapy. / Coiffier, Bertrand; Gisselbrecht, Christion; Vose, Julie Marie; Tilly, Hervé; Herbrecht, Raoul; Bosly, André; Armitage, James Olen.

In: Journal of Clinical Oncology, Vol. 9, No. 2, 01.01.1991, p. 211-219.

Research output: Contribution to journalArticle

@article{743aab18fdb94001894e15883a4eb341,
title = "Prognostic factors in aggressive malignant lymphomas: Description and validation of a prognostic index that could identify patients requiring a more intensive therapy",
abstract = "The objectives of this study were to determine prognostic factors for response to treatment, freedom-from-relapse (FFR) survival, and overall survival of 737 aggressive malignant lymphoma patients treated with the doxorubicin, cyclophosphamide, vindesine, bleomycin, methylprednisolone, methotrexate with leucovorin, ifosfamide, etoposide, asparaginase, and cytarabine (LNH-84) regimen; to construct a prognostic index with factors isolated by multivariate analyses; and to validate this prognostic index with another set of patients. Complete response (CR) was reached in 75{\%} of LNH-84 patients, and 30{\%} of them relapsed. With a median follow-up of 36 months, median FFR survival and median overall survival were not reached. Low serum albumin level, high tumoral mass, weight loss, bone marrow involvement, ≥ 2 extranodal sites, and increased lactic dehydrogenase (LDH) level were associated with a low response rate. Advanced stage, increased LDH level, and nonlarge-cell histologic subtypes (diffuse mixed, lymphoblastic, and small non-cleaved) were statistically associated with a high relapse rate and short FFR survival. Increased LDH level, low serum albumin level, tumoral mass larger than 10 cm, ≥ 2 extranodal sites, advanced stage, and age older than 65 years were statistically associated with short overall survival. Four of these parameters, namely, LDH level, stage, number of extranodal sites, and tumoral mass, were put together to construct a prognostic index. This index partitioned LNH-84 patients into three subgroups of good, intermediate, and poor prognosis (P < .00001): CR rates of 93{\%}, 83{\%}, and 61{\%}; relapse rates of 12{\%}, 25{\%}, and 45{\%}; 3-year FFR survival of 87{\%}, 73{\%}, and 53{\%}; and 3-year survival of 88{\%}, 71{\%}, and 41{\%}, respectively. This prognostic index was applied to a test set of patients: 155 patients treated on protocols of the Nebraska Lymphoma Study Group. Using this index, these patients had 3-year FFR survival of 70{\%}, 40{\%}, and 22{\%} (P = .0002) and 3-year survival of 79{\%}, 52{\%}, and 31 {\%} (P = .005). In patients with aggressive lymphomas, this simple prognostic index could distinguish between patients requiring intensive treatment such as autologous bone marrow transplantation in first complete remission and those who could be treated with standard regimens.",
author = "Bertrand Coiffier and Christion Gisselbrecht and Vose, {Julie Marie} and Herv{\'e} Tilly and Raoul Herbrecht and Andr{\'e} Bosly and Armitage, {James Olen}",
year = "1991",
month = "1",
day = "1",
doi = "10.1200/JCO.1991.9.2.211",
language = "English (US)",
volume = "9",
pages = "211--219",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "2",

}

TY - JOUR

T1 - Prognostic factors in aggressive malignant lymphomas

T2 - Description and validation of a prognostic index that could identify patients requiring a more intensive therapy

AU - Coiffier, Bertrand

AU - Gisselbrecht, Christion

AU - Vose, Julie Marie

AU - Tilly, Hervé

AU - Herbrecht, Raoul

AU - Bosly, André

AU - Armitage, James Olen

PY - 1991/1/1

Y1 - 1991/1/1

N2 - The objectives of this study were to determine prognostic factors for response to treatment, freedom-from-relapse (FFR) survival, and overall survival of 737 aggressive malignant lymphoma patients treated with the doxorubicin, cyclophosphamide, vindesine, bleomycin, methylprednisolone, methotrexate with leucovorin, ifosfamide, etoposide, asparaginase, and cytarabine (LNH-84) regimen; to construct a prognostic index with factors isolated by multivariate analyses; and to validate this prognostic index with another set of patients. Complete response (CR) was reached in 75% of LNH-84 patients, and 30% of them relapsed. With a median follow-up of 36 months, median FFR survival and median overall survival were not reached. Low serum albumin level, high tumoral mass, weight loss, bone marrow involvement, ≥ 2 extranodal sites, and increased lactic dehydrogenase (LDH) level were associated with a low response rate. Advanced stage, increased LDH level, and nonlarge-cell histologic subtypes (diffuse mixed, lymphoblastic, and small non-cleaved) were statistically associated with a high relapse rate and short FFR survival. Increased LDH level, low serum albumin level, tumoral mass larger than 10 cm, ≥ 2 extranodal sites, advanced stage, and age older than 65 years were statistically associated with short overall survival. Four of these parameters, namely, LDH level, stage, number of extranodal sites, and tumoral mass, were put together to construct a prognostic index. This index partitioned LNH-84 patients into three subgroups of good, intermediate, and poor prognosis (P < .00001): CR rates of 93%, 83%, and 61%; relapse rates of 12%, 25%, and 45%; 3-year FFR survival of 87%, 73%, and 53%; and 3-year survival of 88%, 71%, and 41%, respectively. This prognostic index was applied to a test set of patients: 155 patients treated on protocols of the Nebraska Lymphoma Study Group. Using this index, these patients had 3-year FFR survival of 70%, 40%, and 22% (P = .0002) and 3-year survival of 79%, 52%, and 31 % (P = .005). In patients with aggressive lymphomas, this simple prognostic index could distinguish between patients requiring intensive treatment such as autologous bone marrow transplantation in first complete remission and those who could be treated with standard regimens.

AB - The objectives of this study were to determine prognostic factors for response to treatment, freedom-from-relapse (FFR) survival, and overall survival of 737 aggressive malignant lymphoma patients treated with the doxorubicin, cyclophosphamide, vindesine, bleomycin, methylprednisolone, methotrexate with leucovorin, ifosfamide, etoposide, asparaginase, and cytarabine (LNH-84) regimen; to construct a prognostic index with factors isolated by multivariate analyses; and to validate this prognostic index with another set of patients. Complete response (CR) was reached in 75% of LNH-84 patients, and 30% of them relapsed. With a median follow-up of 36 months, median FFR survival and median overall survival were not reached. Low serum albumin level, high tumoral mass, weight loss, bone marrow involvement, ≥ 2 extranodal sites, and increased lactic dehydrogenase (LDH) level were associated with a low response rate. Advanced stage, increased LDH level, and nonlarge-cell histologic subtypes (diffuse mixed, lymphoblastic, and small non-cleaved) were statistically associated with a high relapse rate and short FFR survival. Increased LDH level, low serum albumin level, tumoral mass larger than 10 cm, ≥ 2 extranodal sites, advanced stage, and age older than 65 years were statistically associated with short overall survival. Four of these parameters, namely, LDH level, stage, number of extranodal sites, and tumoral mass, were put together to construct a prognostic index. This index partitioned LNH-84 patients into three subgroups of good, intermediate, and poor prognosis (P < .00001): CR rates of 93%, 83%, and 61%; relapse rates of 12%, 25%, and 45%; 3-year FFR survival of 87%, 73%, and 53%; and 3-year survival of 88%, 71%, and 41%, respectively. This prognostic index was applied to a test set of patients: 155 patients treated on protocols of the Nebraska Lymphoma Study Group. Using this index, these patients had 3-year FFR survival of 70%, 40%, and 22% (P = .0002) and 3-year survival of 79%, 52%, and 31 % (P = .005). In patients with aggressive lymphomas, this simple prognostic index could distinguish between patients requiring intensive treatment such as autologous bone marrow transplantation in first complete remission and those who could be treated with standard regimens.

UR - http://www.scopus.com/inward/record.url?scp=0025975739&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0025975739&partnerID=8YFLogxK

U2 - 10.1200/JCO.1991.9.2.211

DO - 10.1200/JCO.1991.9.2.211

M3 - Article

VL - 9

SP - 211

EP - 219

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 2

ER -