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Clinical Trial
. 2019 Jun;94(6):658-666.
doi: 10.1002/ajh.25473. Epub 2019 Apr 10.

The utility of prognostic indices, early events, and histological subtypes on predicting outcomes in non-follicular indolent B-cell lymphomas

Sean I Tracy  1 , Melissa C Larson  2 , Andrew L Feldman  2 , Matthew J Maurer  2 , Anne J Novak  2 , Susan L Slager  2 , Jose C Villasboas  2 , Cristine Allmer  2 , Thomas M Habermann  2 , Umar Farooq  3 , Sergei Syrbu  3 , James R Cerhan  2 , Brian K Link  3
Affiliations
Clinical Trial

The utility of prognostic indices, early events, and histological subtypes on predicting outcomes in non-follicular indolent B-cell lymphomas

Sean I Tracy et al. Am J Hematol. 2019 Jun.

Abstract

Indolent B-cell lymphomas other than follicular lymphoma account for up to 10% of all B-cell neoplasms. While they typically follow a slowly progressive course, some patients experience rapid progression and early mortality. Prognostic scoring systems have not been adopted, hindering the ability of clinicians or researchers to predict outcomes, or risk-stratify patients during clinical trials. To address this, we evaluated the utility of existing prognostic indices and novel, early disease-related outcomes, to predict subsequent long term survival. Baseline characteristics and outcomes data were generated from a longitudinal cohort study that prospectively enrolled 632 patients newly diagnosed with marginal zone lymphoma, lymphoplasmacytic lymphomas, or B-cell lymphomas not otherwise specified, beginning in 2002. The International Prognostic Index (IPI), Follicular Lymphoma International Prognostic Index (FLIPI), and MALT International prognostic index (MALT-IPI) demonstrated c-statistics that ranged from 0.593-0.612 for event-free survival (EFS), and 0.683-0.714 for overall survival (OS). Patients who attained event-free survival at 12 months (EFS12) experienced similar mortality to the US general population (standardized mortality ratio [SMR] 1.19; 95% CI 0.95-1.46). Patients who did not attain EFS12 had subsequent worse morality (SMR 3.14 (95% CI 2.05-4.59). The MALT-IPI demonstrated utility in predicting subsequent long-term outcomes among patients with non-follicular indolent B-cell lymphomas. This index should be used by clinicians giving guidance to patients at the time of initial diagnosis, and risk stratification during clinical studies. The divergent long-term outcomes experienced by patients who do or do not attain EFS12 suggest there exists a subset of patients who harbor high-risk disease. Future research efforts should focus on methods to identify these patients at the time of diagnosis, in order to enable risk-tailored therapy.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1A:
FIGURE 1A:
Distribution of Risk Categories using IPI FLIPI or MALT-IPI for the entire NFIBL cohort and subtypes. Gastric MALT is included in EMZL. B-G, Kaplan Meyer Estimates for the entire NFIBL cohort of OS (left) and EFS (right), as distinguished by IPI (top row), FLIPI (middle row), and MALT-IPI (bottom row). EFS, event-free survival; EMZL, extranodal marginal zone lymphomas; IPI FLIPI, International Prognostic Index Follicular Lymphoma International Prognostic Index; NFIBLs, non-follicular indolent B cell lymphomas; OS, overall survival
FIGURE 2:
FIGURE 2:
Kaplan Meyer Estimates of (A) EFS and (B) OS by NFIBL histological subtype. EFS event-free survival; OS, overall survival
FIGURE 3:
FIGURE 3:
Kaplan Meyer Estimates compared to age and gender matched general US population for (A) the entire NFIBL cohort, (B) patients who achieved EFS12, (C) patients who did not achieve EFS12, and (D) patients who did not achieve EFS24. EFS12, event-free survival at 12 months; NFIBL, non-follicular indolent B cell lymphoma
See this image and copyright information in PMC

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