Table 3.

Clinical Indexes for Predicting Outcomes in Patients with DLBCL.^*

Prognostic Index, Clinical Factors, and Risk Categories	Proportion of Patients	Estimated 5-yr PFS	Estimated 5-yr OS
	percent
IPI
Age, >60 yr; LDH, >ULN; Ann Arbor stage III or IV; ECOG performance status, >1; no. of extranodal sites of disease, >1
Risk categories
Low (0 or 1 factor)	34	81	88
Low-intermediate (2 factors)	23	67	76
High-intermediate (3 factors)	23	58	67
High (4 or 5 factors)	20	46	54
R-IPI
Age, >60 yr; LDH, >ULN; Ann Arbor stage III or IV; ECOG performance status, >1; no. of extranodal sites of disease, >1
Risk categories
Very good (0 factors)	9	87	93
Good (1 or 2 factors)	48	74	81
Poor (3–5 factors)	43	53	61
NCCN-IPI
Age, >40 to ≤60 yr (1 point), >60 to ≤75 yr (2 points), >75 yr (3 points); LDH ratio, >1 to ≤3 (1 point), >3 (2 points); Ann Arbor stage III or IV (1 point); ECOG performancestatus score, ≥2 (1 point); extranodal disease: lymphoma involvement in bone marrow, CNS, liver or GI tract, or lung (1 point)
Risk categories
Low (0 or 1 point)	13	86	92
Low-intermediate (2 or 3 points)	41	75	84
High-intermediate (4 or 5 points)	36	54	63
High (6–8 points)	10	43	49

^*The three commonly used clinical prognostic indexes established over the past 30 years are based on the most discriminating clinical variables.^25,27,28 The 5-year progression-free survival (PFS) and overall survival (OS) estimates are derived from a large international collaboration involving 2124 patients with DLBCL who were treated between 1998 and 2009 with frontline rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or a variant in seven multicenter, randomized clinical trials.²⁶ An age-adjusted International Prognostic Index (IPI), for patients who are 60 years of age or younger, has been designed that has only three factors: stage, lactate dehydrogenase (LDH) level, and performance status.²⁵ A stage-modified IPI, designed for patients with limited-stage disease, has four factors: age (>60 years), stage (I or II), LDH level, and performance status.²⁹ Other clinical factors associated with a poor outcome have been identified, but many have not retained prognostic significance in multivariable models including the presence of B symptoms, largest tumor diameter (≥7.5 cm or, more commonly, ≥10 cm used as a threshold), elevated serum β₂-microglobulin level, low hemoglobin and serum albumin levels, and bone marrow involvement (although concordant bone marrow involvement with large B cells present has been shown to be an independent factor in some studies²⁰). Recently, baseline total metabolic tumor volume, assessed with ¹⁸F-fluorodeoxyglucose positron-emission tomography and computed tomography, has been identified as a potentially independent prognostic measure.¹⁹ ECOG denotes Eastern Cooperative Oncology Group, GI gastrointestinal, NCCN-IPI National Comprehensive Cancer Network IPI, R-IPI Revised IPI, and ULN upper limit of the normal range.