Factors predicting long‐term survival in low‐risk diffuse large B‐cell lymphoma

The International Prognostic Index (IPI) is widely used for risk stratification of patients with diffuse large B‐cell lymphoma (DLBCL). However, even among patients with low‐risk disease, according to the IPI a substantial proportion of patients ultimately succumb to their disease. Using mature population‐based data from the Danish Lymphoma Group, we analyzed if prognostic clinical pretreatment factors could be identified in patients with low‐risk DLBCL. One hundred seventy‐seven patients, all with a prognostic profile as favorable as possible according to the IPI and treated with anthracycline‐based combination chemotherapy (92%) or loco‐regional radiotherapy/surgery (8%) with curative intent were included. The median age was 50 years and 170 achieved complete remission. The median follow‐up time was 11 years. Twenty‐six patients relapsed, with a median time to relapse of 12.1 months. Overall survival at 5 years and 10 years was 85% and 75%, respectively. Stage II was associated with poor response to treatment (P = 0.044). In a multivariate analysis, Stage II (P = 0.001) and age >50 years (P = 0.043) were independently associated with poor outcome. Patients without these adverse factors had an excellent prognosis, with a survival at 5 and 15 years of 90% and 80%, respectively. In contrast, patients with both adverse factors had poor outcome, with survival at 5 and 15 years of 70% and 29%, respectively (P < 0.001). The present data suggest that risk stratification of DLBCL patients with a favorable IPI score can be improved by the simple use of two clinical pretreatment factors. Am. J. Hematol. 74:94–98, 2003. © 2003 Wiley‐Liss, Inc.