The Geriatric Prognostic Index: a clinical prediction model for survival of older diffuse large B-cell lymphoma patients treated with standard immunochemotherapy
Kathrine T. Isaksen,
Renate Galleberg,
Maria Adele Mastroianni,
Marit Rinde,
Leiv Sindre Rusten,
Dlawer Barzenje,
Frode Ramslien,
Oystein Fluge,
Marit Slaaen,
Peter Meyer,
Knut Liestol,
Erlend B. Smeland,
Ole Christian Lingjarde,
Harald Holte,
Marianne Brodtkorb
Affiliations
Kathrine T. Isaksen
Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway; KG Jebsen Centre for B cell malignancies, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo
Renate Galleberg
Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen
Maria Adele Mastroianni
Department of Hematology, Akershus University Hospital, Lorenskog
Marit Rinde
Department of Hematology, Vestfold Hospital Trust, Tonsberg
Leiv Sindre Rusten
Department of Surgery, Section of Oncology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen
Dlawer Barzenje
Department of Oncology, Ostfold Hospital Trust, Kalnes
Frode Ramslien
Department of Hematology, Telemark Hospital Trust, Skien
Oystein Fluge
Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen
Marit Slaaen
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; The Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, Ottestad
Peter Meyer
Stavanger University Hospital–Rogaland, Stavanger
Knut Liestol
Department of Informatics, University of Oslo, Oslo, Norway; Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo
Erlend B. Smeland
Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway; KG Jebsen Centre for B cell malignancies, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo
Ole Christian Lingjarde
Department of Informatics, University of Oslo, Oslo, Norway; Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo
Harald Holte
KG Jebsen Centre for B cell malignancies, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Oncology, Oslo University Hospital, Oslo
Marianne Brodtkorb
Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway; Department of Oncology, Oslo University Hospital, Oslo
The International prognostic Index (IPI) is the most widely used clinical prediction model for diffuse large B-cell lymphoma (DLBCL) patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP), but may be suboptimal in older patients. We aimed to develop and externally validate a clinical prediction model for older, RCHOP- treated DLBCL patients by examining geriatric assessment and lymphoma-related parameters in real-world cohorts. A population-based training set of 365 R-CHOP-treated DLBCL patients ≥70 years was identified through the Cancer Registry of Norway. The external test set consisted of a population-based cohort of 193 patients. Data on candidate predictors were retrieved from the Cancer Registry and through review of clinical records. Cox regression models for 2-year overall survival were used for model selection. Activities of daily living, the Charlson Comorbidity Index, age, sex, albumin, stage, Eastern Cooperative Oncology Group performance status and lactate dehydrogenase level were identified as independent predictors and combined into a Geriatric Prognostic Index (GPI). The GPI demonstrated good discrimination (optimismcorrected C-index 0.752), and identified low-, intermediate- and high-risk groups with significantly different survivals (2- year overall survival, 94%, 65%, and 25%, respectively). At external validation, the continuous and grouped GPI demonstrated good discrimination (C-index 0.727 and 0.710, respectively) and the GPI groups had significantly different survivals (2-year overall survival 95%, 65%, and 44%, respectively). Both the continuous and grouped GPI showed better discrimination than the IPI, revised-IPI and National Comprehensive Cancer Network (NCCN)-IPI (C-index 0.621, 0.583, and 0.670, respectively). In conclusion, we have developed and externally validated a GPI for older DLBCL patients treated with R-CHOP that outperformed the IPI, revised-IPI and NCCN-IPI. A web-based calculator is available at https://wide.shinyapps. io/GPIcalculator/.
