A patient with aggressive non-Hodgkins lymphoma and certain risk factors at the time of presentation is at high risk for disease recurrence and reduced overall survival. Such patients may benefit from more aggressive therapy than the standard CHOP regimen. The authors are from the M.D. Anderson Cancer Center in Houston.
Parameters at the time of presentation associated with survival on multivariate analysis:
(1) age
(2) number of extranodal sites
(3) bulky disease
(4) serum LDH
"Bulky" disease - at least 1 of the following:
(1) 1 or more tumor masses >= 7 cm
(2) a mediastinal mass visible on a standing PA chest X-ray
|
Parameter |
Finding |
Points |
|
age |
<= 60 years |
0 |
|
|
> 60 years |
1 |
|
number of extranodal sites |
0 or 1 |
0 |
|
|
> 1 |
1 |
|
bulky disease |
absent |
0 |
|
|
present |
1 |
|
serum LDH |
< 10% increase |
0 |
|
|
>= 10% increase |
1 |
where:
• I am assuming that the 10% increase is relative to the upper limit of normal for the reference range.
progression-free survival score =
= (points for extranodal sites) + (points for bulky disease) + (points for serum LDH)
overall survival score =
= (points for age) + (points for bulky disease) + (points for serum LDH)
Interpretation:
• minimum scores: 0
• maximum scores: 3
• The lower the scores, the better.
|
Progression-Free Survival Score |
4 year Progression-Free Survival |
|
0 |
75% |
|
1 |
63% |
|
2 or 3 |
30% |
after Figure 1, page 2444
|
Overall Survival Score |
5 year Survival |
8 year Survival |
|
0 |
90% |
90% |
|
1 |
74% |
62% |
|
2 or 3 |
58% |
58% |
after Figure 2, page 2445
Specialty: Hematology Oncology
