Archiv - Oktober 2010

Internationaler Prognoseindex für Lymphome – Gültigkeit unter Immunochemotherapie gezeigt

Eine Arbeitsgruppe des Institutes für Medizinische Informatik, Statistik und Epidemiologie der Medizinischen Fakultät unter Leitung von Marita Ziepert und Markus Löffler konnte kürzlich erstmals die uneingeschränkte Gültigkeit des Internationalen Prognostischen Index (IPI) für Patienten mit aggressiven Lymphomen für die neu eingeführte Immunochemotherapie mit Rituximab nachweisen. Diese hatte die Therapieergebnisse deutlich verbessert und der IPI musste überprüft werden. Die Patienten werden mithilfe des Prognoseindex in vier Risikogruppen eingeteilt. Die Bestätigung der Gültigkeit des IPI ermöglicht die weltweit einheitliche Einteilung von Patienten in die Gruppen des IPI und gewährleistet damit die internationale Vergleichbarkeit der Therapieergebnisse.

Standard International Prognostic Index Remains a Valid Predictor of Outcome for Patients With Aggressive CD20+ B-Cell Lymphoma in the Rituximab Era

Ziepert M, Hasenclever D, Kuhnt E, Glass B, Schmitz N, Pfreundschuh M, Loeffler M

From the Institute for Medical Informatics, Statistics, and Epidemiology, Universität Leipzig, Leipzig; Department of Hematology, Asklepios Klinik St Georg, Hamburg; and the Medizinische Klinik I, Saarland University Medical School, Homburg/Saar, Germany.

J Clin Oncol 2010; 28(14): 2373-2380

Purpose The International Prognostic Index (IPI) is widely used for risk stratification of patients with aggressive B-cell lymphoma. The introduction of rituximab has markedly improved outcome, and R-CHOP (rituximab + cyclophosphamide, doxorubicin, vincristine, prednisone) has become the standard treatment for CD20+ diffuse large B-cell lymphoma. To investigate whether the IPI has maintained its power for risk stratification when rituximab is combined with CHOP, we analyzed the prognostic relevance of IPI in three prospective clinical trials.

Patients and Methods In total, 1,062 patients treated with rituximab were included (MabThera International Trial [MInT], 380 patients; dose-escalated regimen of cyclophosphamide, doxorubicin, vincristine, etoposide, and prednisone (MegaCHOEP) trial, 72 patients; CHOP + rituximab for patients older than age 60 years [RICOVER-60] trial, 610 patients). A multivariate proportional hazards modeling was performed for single IPI factors under rituximab on event-free, progression-free, and overall survival.

Results IPI score was significant for all three end points. Rituximab significantly improved treatment outcome within each IPI group resulting in a quenching of the Kaplan-Meier estimators. However, IPI was a significant prognostic factor in all three end points and the ordering of the IPI groups remained valid. The relative risk estimates of single IPI factors and their order in patients treated with R-CHOP were similar to those found with CHOP.

Conclusion The effects of rituximab were superimposed on the effects of CHOP with no interactions between chemotherapy and antibody therapy. These results demonstrate that the IPI is still valid in the R-CHOP era.

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