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Annals of Oncology Advance Access published online on November 17, 2009
Annals of Oncology, doi:10.1093/annonc/mdp531
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Prognostic models for diffuse large B-cell lymphoma in the rituximab era: a never-ending story

A. Bari1, L. Marcheselli1, S. Sacchi1,*, R. Marcheselli1, S. Pozzi1, P. Ferri2, E. Balleari3, P. Musto4, S. Neri5, M. A. Aloe Spiriti6 and M. C. Cox6

1 Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena
2 Department of Public Health Sciences, University of Modena and Reggio Emilia, Modena
3 Department of Internal Medicine, University of Genoa, Genoa
4 Unit of Hematology and Stem Cell Transplantation, IRCCS-CROB, Oncology Referral Center of Basilicata, Rionero in Vulture, Potenza
5 Unit of Hematology, Papardo Hospital, Messina
6 Department of Hematology, AO Sant'Andrea, La Sapienza University, Rome, Italy

* Correspondence to: Prof. S. Sacchi, Department of Oncology and Hematology, University of Modena and Reggio Emilia, Largo del Pozzo 71, 41124 Modena, Italy. Tel: +39-059-422-2175; Fax: +39-059-422-3707; E-mail: stefano.sacchi{at}unimo.it

Background: Improved treatment have modified survival outcome in patients with diffuse large B-cell lymphoma (DLBCL) and altered the importance of previously recognized prognostic markers.

Design and methods: To evaluate International Prognostic Index (IPI) score before and after rituximab introduction and to validate the absolute lymphocyte count (ALC)/revised International Prognostic Index (R-IPI) model, we carried out a retrospective analysis on a total of 831 patients with DLBCL.

Results: Our results show that IPI lost its discriminating power with the introduction of rituximab. The analysis of our second set allowed us to validate the ALC/R-IPI model. The R-IPI and ALC/R-IPI could still be used for designing clinical trials, but both have difficulty recognizing a high percentage of poor prognosis patients, though it remains an important goal of a good prognostic model considering the modest impact of salvage treatments on survival.

Conclusions: A new model on the basis of significant variables in the rituximab era and built on a large database of patients treated with rituximab is urgently needed. As prognostic models are changing with the efficacy and mechanisms of action of treatment utilized, looking for a new prognostic score is a never-ending story in which researchers are trying to hit a continuously moving target.

clinical trials, DLBCL, innovative treatments, NHL, prognostic models, rituximab

Received for publication July 1, 2009. Revision received October 1, 2009. Accepted for publication October 15, 2009.


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