Diffuse Large Bcell Lymphoma

The clinical factors identified in the IPI for aggressive NHL have gained widespread use for risk stratification in clinical trials and are used by many clinicians to provide prognostic information for patients with these diseases.20 The risk groups and observed relapse-free and overall survival rates are summarized in Table 66.3. The age adjusted IPI (aa-IPI) is also frequently used, especially for studies investigating dose-intensive approaches such as first remission high-dose therapy and ASCT. A stage-adjusted IPI has also been proposed for patients with limited stage disease.21 The clinical utility of the IPI and aa-IPI has been confirmed in multiple studies of first-line therapy for aggressive NHL, and more recently, in studies for patients undergoing salvage therapy with ASCT.22

Although the IPI and aa-IPI have been valuable tools for risk stratification, there is marked variability in outcome within each of the IPI risk groups, reflecting the underlying biological and pathologic heterogeneity of aggressive NHL. Even in studies where entry is restricted to patients with DLBCL, this variability is still present, indicating the need for more patient-specific, biologically based risk factors.

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