Should we use nomograms for risk predictions in diffuse large B cell lymphoma patients? A systematic review

Models based on risk stratification are increasingly reported for Diffuse large B cell lymphoma (DLBCL). Due to a rising interest in nomograms for cancer patients, we aimed to review and critically appraise prognostic models based on nomograms in DLBCL patients. A literature search in PubMed/Embase identified 59 articles that proposed prognostic models for DLBCL by combining parameters of interest (e.g., clinical, laboratory, immunohistochemical, and genetic) between January 2000 and 2024. Of them, 40 studies proposed different gene expression signatures and incorporated them into nomogram-based prognostic models. Although most studies assessed discrimination and calibration when developing the model, many lacked external validation. Current nomogram-based models for DLBCL are mainly developed from publicly available databases, lack external validation, and have no applicability in clinical practice. However, they may be helpful in individual patient counseling, although careful considerations should be made regarding model development due to possible limitations when choosing nomograms for prognostication. •An increasing number of prognostic models have been proposed for DLBCL patients.•Several models with nomograms for DLBCL patients have been recently proposed.•Most of them include gene-expression signatures derived from public databases.•Most of the current nomogram-based models lack optimal validation.•The clinical utility of nomogram models is prevented due to numerous limitations.