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. 2025 Jan;104(1):433-444.
doi: 10.1007/s00277-024-06155-3. Epub 2024 Dec 31.

Validation of prognostic models in elderly patients with diffuse large B-cell lymphoma in a real-world nationwide population-based study - development of a clinical nomogram

Jelena Jelicic  1 , Karen Juul-Jensen  1 , Zoran Bukumiric  2 , Mikkel Runason Simonsen  3   4 , Rasmus Rask Kragh Jørgensen  3   5 , Michael Roost Clausen  6 , Ahmed Ludvigsen Al-Mashhadi  3   7 , Robert Schou Pedersen  8 , Christian Bjørn Poulsen  9   10 , Anne Ortved Gang  10   11 , Peter Brown  10   11 , Tarec Christoffer El-Galaly  1   3   12   13 , Thomas Stauffer Larsen  14   15
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Validation of prognostic models in elderly patients with diffuse large B-cell lymphoma in a real-world nationwide population-based study - development of a clinical nomogram

Jelena Jelicic et al. Ann Hematol. 2025 Jan.

Abstract

The International Prognostic Index (IPI) is the most frequently used tool for prognostication in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) of all ages. This study validated and compared six models developed for patients above 60 with International Prognostic Indices (IPI, R-IPI, NCCN-IPI). Moreover, we created a clinical nomogram with an online tool for individualized predictions. A total of 2,835 patients aged over 60 with newly diagnosed DLBCL treated with potentially curative immunochemotherapy were identified in the Danish Lymphoma Registry. A nomogram was developed by combining NCCN-IPI variables (excluding extranodal localization), albumin, and platelet levels in 1,970 patients and verified the results in the remaining 956 patients. Compared to other models, the elderly IPI (E-IPI) and age-adjusted IPI (aaIPI) showed better accuracy and discriminatory ability. However, the models failed to identify a high-risk group with a 3-year overall survival rate below 40%. Our nomogram-based model demonstrated superior discriminatory ability and provided more precise individual predictions than all other models based on a risk stratification system. Most clinical prognostic models fail to accurately predict patient outcomes in patients over 60 years old. Therefore, nomogram-based models should be considered in this population to prevent information loss due to variable dichotomization.

Keywords: Elderly; Nomogram; Prognostic models; To index the content: diffuse large B cell lymphoma; Validation.

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Conflict of interest statement

Declarations. Competing interests: JJ has received travel support from AstraZeneca and Roche. PB has served on advisory boards for Roche, Abbvie, and SERB. TSL has served on advisory boards/consultancy for Roche, Novartis, Gilead, and BMS. TSL received a research Grant from Genentech and travel support from Roche. Other authors have no relevant financial or non-financial interests to disclose. Ethical approval and consent to participate: This study was performed in accordance with the principles of the Declaration of Helsinki. The Advisory Board for Clinical Quality Development Program (RKKP) (project number 21/27006) has granted approval for conducting this registry-based study, ensuring total anonymity of patients. Further details can be found in the Declaration on passing personal data covered by § 10, a subsection of the Data Protection Act, 1 and 2’, https://www.retsinformation.dk/eli/lta/2019/1509 . Therefore, informed consent from patients was not obtained.

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