Proposed New Dynamic Prognostic Index for Diffuse Large B-Cell Lymphoma: International Metabolic Prognostic Index

N George Mikhaeel*, Martijn W Heymans, Jakoba J Eertink, Henrica C W de Vet, Ronald Boellaard, Ulrich Dührsen, Luca Ceriani, Christine Schmitz, Sanne E Wiegers, Andreas Hüttmann, Pieternella J Lugtenburg, Emanuele Zucca, Gerben J C Zwezerijnen, Otto S Hoekstra, Josée M Zijlstra, Sally F Barrington

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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PURPOSE: Baseline metabolic tumor volume (MTV) is a promising biomarker in diffuse large B-cell lymphoma (DLBCL). Our aims were to determine the best statistical relationship between MTV and survival and to compare MTV with the International Prognostic Index (IPI) and its individual components to derive the best prognostic model.

METHODS: PET scans and clinical data were included from five published studies in newly diagnosed diffuse large B-cell lymphoma. Transformations of MTV were compared with the primary end points of 3-year progression-free survival (PFS) and overall survival (OS) to derive the best relationship for further analyses. MTV was compared with IPI categories and individual components to derive the best model. Patients were grouped into three groups for survival analysis using Kaplan-Meier analysis; 10% at highest risk, 30% intermediate risk, and 60% lowest risk, corresponding with expected clinical outcome. Validation of the best model was performed using four studies as a test set and the fifth study for validation and repeated five times.

RESULTS: The best relationship for MTV and survival was a linear spline model with one knot located at the median MTV value of 307.9 cm3. MTV was a better predictor than IPI for PFS and OS. The best model combined MTV with age as continuous variables and individual stage as I-IV. The MTV-age-stage model performed better than IPI and was also better at defining a high-risk group (3-year PFS 46.3% v 58.0% and 3-year OS 51.5% v 66.4% for the new model and IPI, respectively). A regression formula was derived to estimate individual patient survival probabilities.

CONCLUSION: A new prognostic index is proposed using MTV, age, and stage, which outperforms IPI and enables individualized estimates of patient outcome.

Original languageEnglish
Pages (from-to)2352-2360
Number of pages9
JournalJournal of clinical oncology : official journal of the American Society of Clinical Oncology
Issue number21
Early online date31 Mar 2022
Publication statusPublished - 2022

Bibliographical note

The PETRA project is supported by the Alpe d’HuZes/KWF fund, provided by the Dutch Cancer Society (VU 2012-5848). King's College London and UCL Comprehensive Cancer Imaging Centre is funded by the CRUK and EPSRC in association with the MRC and Department of Health and Social Care (England). This work was also supported by core funding from the Wellcome/EPSRC Centre for Medical Engineering at King's College London [WT203148/Z/16/Z] and the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London and/or the NIHR Clinical Research Facility. The PETAL trial was supported by grants from Deutsche Krebshilfe (107592 and 110515 to U.D.). This work is supported by KWF Dutch Cancer Society (project 11648; Radiomics for better prediction of outcome in DLBCL patients). S.F.B. acknowledges support from the National Institute for Health Research and Social Care (NIHR) [RP-2-16-07-001].

© 2022 by American Society of Clinical Oncology

Funding Information:
Concordance was higher for MTV (c-index = 0.650 and 0.667 for PFS and OS, respectively) than for IPI (c-index = 0.619 and 0.646, respectively). This is supported by their AIC values, which was lowest for MTV. Hence, MTV was a better predictor (Data Supplement).

Publisher Copyright:
© American Society of Clinical Oncology.


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