Schmitz et al developed an index for predicting CNS relapse in a patient with diffuse large B-cell lymphoma (DLBCL) following R-CHOP therapy. They identified a high risk group that may benefit from more aggressive management. The authors are from multiple hospitals in Germany and Canada.
Patient selection: diffuse large B-cell lymphoma treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone)
Outcome: CNS relapse
Parameters:
(1) age in years
(2) Ann Arbor stage
(3) serum LDH
(4) number of extranodal sites
(5) kidney and/or adrenal gland involvement
(6) ECOG performance status
Parameter
Finding
Points
age in years
<= 60 years
0
> 60 years
1
Ann Arbor stage
I or II
0
III or IV
1
serum LDH
<= upper limit of normal (ULN)
0
> ULN
1
number of extranodal sites
0 or 1
0
2 or more
1
kidney and/or adrenal gland
absent
0
present
1
ECOG performance
0 or 1
0
2, 3 or 4
1
where:
• The adrenal gland and kidney are extranodal sites.
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 6
• The higher the score the greater the risk for CNS relapse.
Score
Risk Group
2-Year CNS Disease
0 or 1
Low
0.8%
2 or 3
intermediate
2.9%
4 to 6
High
10%
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