Abstract 773P
Background
Although the International Prognostic Index (IPI) is the primary prognostic tool for diffuse large B-cell lymphoma (DLBCL), its predictive value has declined due to changes in treatment over time. The Kyoto Prognostic Index (KPI) was proposed as a new prognostic model for DLBCL treated with R-CHOP based therapy, which may have high capability to discriminate especially higher-risk DLBCL patients (pts) (Blood Cancer J, 2016;6:e383. Jpn J Clin Oncol, 2022;52:583). However, its utility in lower-risk DLBCL pts remains unclear. We herein evaluated the utility of the KPI in DLBCL pts who participated in JCOG0601, a randomized phase II/3 trial that compared standard R-CHOP-21 with RW-CHOP-21, in which rituximab was administered weekly 8 times from the commencement of treatment, in lower-risk untreated DLBCL pts.
Methods
The KPI is consisted of following risk factors: serum lactate dehydrogenase level, Eastern Cooperative Oncology Group performance status, serum albumin level, and sites of involvement, and a maximum of 5 points is assigned. Accordingly, pts are grouped as low (L: 0), low-intermediate (LI: 1-2), high-intermediate (HI: 3) and high risk (H: 4-5). Kaplan-Meier method was used to estimate the survival proportions, and Herrel’s C-index was used to compare the discrimination ability.
Results
A total of 359 pts with pathologically reviewed DLBCL, not otherwise specified were analyzed. The numbers of pts classified as the IPI-defined L, LI, HI and H were 180, 111, 46 and 22, and those classified as the KPI were 149, 181, 18 and 11, respectively. Of note, many of pts classified as the IPI-defined HI were classified as LI by the KPI. The KPI discriminated low- and high-risk subgroups (10-year overall survival [OS]: 87% vs. 42%, progression-free survival [PFS]: 71% vs. 27%) equally with the IPI (10-year OS: 88% vs. 53%, PFS: 75% vs. 40%). The C-indices of OS and PFS by the KPI were 0.62 and 0.56, while those by the IPI were 0.63 and 0.59, respectively. Based on the cell of origin, the discrimination ability of the KPI were equivalent to that of the IPI in pts with both non-GCB type and GCB type.
Conclusions
The KPI has the same level of discrimination ability as the IPI also in lower-risk DLBCL pts treated with R-CHOP.
Clinical trial identification
Editorial acknowledgement
The authors are grateful to the members of the JCOG Data Centre and JCOG Operations Office for their support on this study.
Legal entity responsible for the study
The authors.
Funding
The study was supported in part by National Cancer Center Research and Development Fund (23-A-16, 23-A-17, 26-A-4, 29-A-3, 2020-J-3, 2023-J-03), Grants-in-Aid for Cancer Research (20S-1, 20S-6, 23-A-16, 23-A-17) and Health and Labour Sciences Research Grant for Clinical Cancer Research (19-20 and 22-14) from the Ministry of Health, Labour and Welfare.
Disclosure
T. Kobayashi: Financial Interests, Personal, Speaker’s Bureau: Bristol Myers Squibb, Chugai Pharmaceutical, Nippon Shinyaku, Sanofi, AstraZeneca, AbbVie, SymBio Pharmaceuticals, Janssen Pharmaceutical. K. Ohmachi: Financial Interests, Personal, Speaker’s Bureau: Chugai Pharmaceutical, Kyowa Kirin. N. Nakamura: Financial Interests, Personal, Speaker’s Bureau: Novartis Pharmaceuticals, Sanofi, Eisai, Janssen Pharmaceutical, Chugai Pharmaceutical, MSD, Sumitomo Dainippon Pharma, Nippon Kayaku, Nippon Shinyaku, AstraZeneca, Kyowa Kirin. J. Kuroda: Financial Interests, Personal, Speaker, Consultant, Advisor: Janssen Pharmaceutical, AbbVie, Pfizer, BeiGene, Bristol Myers Squibb; Financial Interests, Personal and Institutional, Research Funding: Kyowa Kirin, Chugai Pharmaceutical, Japan Blood Product Organization, Sumitomo Pharmaceutical, Otsuka Pharmaceutical, Asahikasei; Financial Interests, Personal, Research Funding: Mochida Pharmaceutical; Financial Interests, Personal, Speaker’s Bureau: Janssen Pharmaceutical, Kyowa Kirin, Chugai Pharmaceutical, Ono Pharmaceutical, Sanofi, Bristol Myers Squibb, Novartis, AbbVie, Pfizer, Astellas Pharmaceutical. W. Munakata: Financial Interests, Institutional, Research Grant: Chugai Pharmaceutical, Janssen Pharmaceutical, Ono Pharmaceutical, Kyowa Kirin, Genmab, Nippon Shinyaku; Financial Interests, Personal, Speaker’s Bureau: Janssen Pharmaceutical, Takeda Pharmaceutical, Ono Pharmaceutical, Eisai, Chugai Pharmaceutical, Novartis, Bristol Myers Squibb, AstraZeneca, SymBio Pharmaceuticals, Genmab, Mundipharma, Nippon Shinyaku, Gilead Sciences, Nippon Kayaku, MSD, AbbVie, Amgen. H. Nagai: Financial Interests, Institutional, Research Grant: AbbVie, AstraZeneca, Beigene, Genmab, HUYA, Janssen Pharmaceutical, Eli Lilly, Takeda Pharmaceutical, Kyowa Kirin, MSD, Mitsubishi Tanabe, Chugai Pharmaceutical, Haihe, Daiichi Sankyo, Celgene, Zenyaku Kogyo, Solasia, Ono Pharmaceutical, Regeneron; Financial Interests, Personal, Speaker’s Bureau: AbbVie, AstraZeneca, Genmab, Janssen Pharmaceutical, Eli Lilly, Takeda Pharmaceutical, Kyowa Kirin, MSD, Eisai, Novartis, Ono Pharmaceutical, Dainippon Sumitomo, Chugai Pharmaceutical, Meiji Seika, Mundipharma, GSK, Bristol Myers Squibb, Nihon Kayaku, Nippon Shinyaku, Beigene. All other authors have declared no conflicts of interest.