TY - JOUR
T1 - Validation of prognostic models in elderly patients with diffuse large B-cell lymphoma in a real-world nationwide population-based study – development of a clinical nomogram
AU - Jelicic, Jelena
AU - Juul-Jensen, Karen
AU - Bukumiric, Zoran
AU - Runason Simonsen, Mikkel
AU - Kragh Jørgensen, Rasmus Rask
AU - Roost Clausen, Michael
AU - Ludvigsen Al-Mashhadi, Ahmed
AU - Schou Pedersen, Robert
AU - Bjørn Poulsen, Christian
AU - Ortved Gang, Anne
AU - Brown, Peter
AU - El-Galaly, Tarec Christoffer
AU - Stauffer Larsen, Thomas
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024.
PY - 2025
Y1 - 2025
N2 - The International Prognostic Index (IPI) is the most frequently used tool for prognostication in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) of all ages. This study validated and compared six models developed for patients above 60 with International Prognostic Indices (IPI, R-IPI, NCCN-IPI). Moreover, we created a clinical nomogram with an online tool for individualized predictions. A total of 2,835 patients aged over 60 with newly diagnosed DLBCL treated with potentially curative immunochemotherapy were identified in the Danish Lymphoma Registry. A nomogram was developed by combining NCCN-IPI variables (excluding extranodal localization), albumin, and platelet levels in 1,970 patients and verified the results in the remaining 956 patients. Compared to other models, the elderly IPI (E-IPI) and age-adjusted IPI (aaIPI) showed better accuracy and discriminatory ability. However, the models failed to identify a high-risk group with a 3-year overall survival rate below 40%. Our nomogram-based model demonstrated superior discriminatory ability and provided more precise individual predictions than all other models based on a risk stratification system. Most clinical prognostic models fail to accurately predict patient outcomes in patients over 60 years old. Therefore, nomogram-based models should be considered in this population to prevent information loss due to variable dichotomization.
AB - The International Prognostic Index (IPI) is the most frequently used tool for prognostication in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) of all ages. This study validated and compared six models developed for patients above 60 with International Prognostic Indices (IPI, R-IPI, NCCN-IPI). Moreover, we created a clinical nomogram with an online tool for individualized predictions. A total of 2,835 patients aged over 60 with newly diagnosed DLBCL treated with potentially curative immunochemotherapy were identified in the Danish Lymphoma Registry. A nomogram was developed by combining NCCN-IPI variables (excluding extranodal localization), albumin, and platelet levels in 1,970 patients and verified the results in the remaining 956 patients. Compared to other models, the elderly IPI (E-IPI) and age-adjusted IPI (aaIPI) showed better accuracy and discriminatory ability. However, the models failed to identify a high-risk group with a 3-year overall survival rate below 40%. Our nomogram-based model demonstrated superior discriminatory ability and provided more precise individual predictions than all other models based on a risk stratification system. Most clinical prognostic models fail to accurately predict patient outcomes in patients over 60 years old. Therefore, nomogram-based models should be considered in this population to prevent information loss due to variable dichotomization.
KW - Elderly
KW - Nomogram
KW - Prognostic models
KW - To index the content: diffuse large B cell lymphoma
KW - Validation
U2 - 10.1007/s00277-024-06155-3
DO - 10.1007/s00277-024-06155-3
M3 - Journal article
AN - SCOPUS:85213712245
JO - Revue d'hématologie
JF - Revue d'hématologie
SN - 0945-8077
ER -