Dumontet et al identified risk factors for death during induction chemotherapy with the ACVB regimen for aggressive non-Hodgkin's lymphoma. This can help identify patients at increased risk for early death and to help obtain informed consent. The authors are from multiple hospitals in France.
ACVB regimen: high dose CHOP regimen with cyclophosphamide 1,200 mg per square meter and doxorubicin 75 mg per square meter and bleomycin added on days 1 and 5.
Parameters:
(1) "weak" risk factors
(2) age
(3) serum albumin
(4) ECOG performance scale (PS)
Weak risk factors:
(1) serum LDH > upper limit of normal reference range
(2) hemoglobin < 8.5 g/dL
(3) WBC count > 10,000 per µL
|
Parameters |
Finding |
Points |
|
weak risk factors |
>= 1 |
1 |
|
|
0 |
0 |
|
serum albumin |
>= 3.0 g/dL |
0 |
|
|
< 3.0 g/dL |
1 |
|
ECOG performance scale |
0 or 1 |
0 |
|
|
2, 3 or 4 |
1 |
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 3
• The higher the score the greater the risk of early death.
• The final risk of early death depends on the age group of the patient.
|
Total Score |
Risk Group |
Age <= 60 years |
Age > 60 years |
|
0 |
low |
2% |
4% |
|
1 |
low to intermediate |
3 - 5% |
5 - 14% |
|
2 |
intermediate |
5 - 17% |
11 - 35% |
|
3 |
high |
15 - 31% |
31-53% |
NOTE: If you look at the risk in the 2 age columns, moving the column for risk with age > 60 down 1 row shows values that are close to that for risk with age <= 60 years of age. If we make age a risk score with 0 if <= 60 and 1 if > 60, then make the following table:
|
Total Score |
Risk Group |
Rate |
|
0 |
low |
2% |
|
1 |
low to intermediate |
3 - 5% |
|
2 |
intermediate |
5 - 17% |
|
3 |
intermediate to high |
15 - 31% |
|
4 |
high |
31-53% |
Specialty: Hematology Oncology
