Validation of a new prognostic tool in aggressive large B-cell lymphoma

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In a new study, researchers validated a recently developed prognostic scoring system for use with patients with aggressive large B-cell lymphoma (LBCL). In this analysis, the researchers found the tool to identify patients with high-risk disease before starting first-line treatment. The results of the study were reported in the journal Blood Advances.

The prognostic tool associates 2 risk factors: total metabolic tumor volume (TMTV) > 220 cm3as determined by F18– fluorodeoxyglucose positron emission tomography/computed tomography, and an Eastern Cooperative Oncology Group (ECOG-PS) performance index ≥2. With the inclusion of these 2 risk factors, researchers had previously found the prognostic tool useful in identifying risk status in 301 elderly patients in the Phase 3 REMARC study (ClinicalTrials.gov Identifier: NCT01122472) who had an aggressive LBCL.

In the current study, researchers evaluated the use of this prognostic tool in patients across 2 clinical trials and in real-world clinics. The clinical trials were the PETAL trial (ClinicalTrials.gov Identifier: NCT00554164) and the GOYA trial (ClinicalTrials.gov Identifier: NCT01287741). Patients of all ages with aggressive LBCL were included in these trial populations. The results were compared with those obtained using the International Prognostic Index (IPI).


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There were 2174 patients included in this study, of which 510 were enrolled in the PETAL trial, 1315 were in the GOYA trial, and 349 were real-world clinic patients. The use of 3 risk categories showed significant discrimination in the results. The low-risk category was defined as having no risk factors, while the intermediate-risk category had 1 risk factor and the high-risk category had 2 risk factors.

Among patients included in PETAL, GOYA, and real-world populations, the presence of 2 risk factors was linked to a worse outcome than the absence of any risk factor. In patients in the PETAL trial, the presence of 2 risk factors, compared to the absence of risk factors, was associated with progression-free survival (PFS; hazard ratio [HR]3.32 (95% CI, 2.00-5.50; P P <.001 in the goya population similar results were observed for pfs ci>P P <.001 similarly for patients in the real-world series results were similar with risk factors both pfs ci>P P <.001 compared to risk factors.>

Additionally, the researchers reported that, compared to low-risk status, intermediate-risk status was associated with significantly worse outcomes. The researchers also determined that this prognostic model using TMTV and ECOG-PS scores performed better than IPI in some analyses.

The researchers concluded that “the combination of TMTV and ECOG-PS is a reliable tool that can be used as an adjunct to IPI with important clinical implications for the initial identification of aggressive LBCL patients that can be implemented in studies exploring the efficacy of new regimens directed at specific targets.

Disclosures: Some authors have disclosed affiliations or received funding from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.

Reference

Thieblemont C, Chartier L, Duhrsen U, et al. A tumor volume and performance state model to predict pre-treatment outcomes in diffuse large B-cell lymphoma. Adv of blood. Published online August 31, 2022. doi:10.1182/bloodadvances.2021006923

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