Development of a novel prognostic nomogram for AIDS-associated diffuse large B-cell lymphoma: a retrospective study from northern China.

in Clinical and experimental medicine by Ying Liang, Jing Chang, Yuxue Gao, Ling Zhang, Xue Chen, Caopei Zheng, Yuqing Sun, Xiuqun Zhang, Caiping Guo, Yulin Zhang

TLDR

  • The study developed a new prognostic tool for AIDS-related diffuse large B-cell lymphoma (AR-DLBCL) patients, which can predict survival rates and inform individualized treatment strategies.
  • The tool looked at multiple factors and outperformed existing methods in predicting survival rates, dividing patients into four risk groups.

Abstract

Despite advancements in antiretroviral therapy, AIDS-related diffuse large B-cell lymphoma (AR-DLBCL) remains a major cause of morbidity and mortality. Compared to non-HIV-infected individuals, AR-DLBCL presents with considerable disease heterogeneity, which impairs the accuracy of current prognostic tools. This study aims to develop a novel prognostic model to enhance risk assessment for AR-DLBCL. We retrospectively analyzed 90 AR-DLBCL cases using univariate and multivariate analyses to identify clinical factors affecting overall survival (OS) and progression-free survival (PFS). A nomogram was created based on independent OS risk factors. The cohort had a median age of 43 years (range: 22-75), with 96.5% male patients. The median follow-up was 30 months (range: 1-139), with 5-year OS and PFS rates of 60.7% and 58.7%, respectively. Key prognostic factors for OS included decreased absolute lymphocyte count (p = 0.002), extranodal involvement (p = 0.005), reduced hemoglobin (Hb) levels (p = 0.004), Epstein-Barr virus (EBV) infection (p = 0.005), and elevated lactate dehydrogenase (LDH) levels (p = 0.018). The nomogram demonstrated robust predictive performance, with a 5-year receiver operating characteristic curve area under the curve of 0.949. Its C-index of 0.849 surpassed the International Prognostic Index (IPI) and age-adjusted IPI (aaIPI), which had C-index of 0.708 and 0.693, respectively. Additionally, the nomogram identified significant OS differences among low risk, intermediate-low risk, intermediate-high risk, and high-risk groups, with 5-year survival rates of 100%, 88%, 56%, and 8%, respectively. The model offers a personalized risk assessment for AR-DLBCL patients, facilitating precise prognosis prediction and informing individualized treatment strategies.

Overview

  • The study aims to develop a novel prognostic model to enhance risk assessment for AIDS-related diffuse large B-cell lymphoma (AR-DLBCL).
  • The study retrospectively analyzed 90 AR-DLBCL cases using univariate and multivariate analyses to identify clinical factors affecting overall survival (OS) and progression-free survival (PFS).
  • The primary objective of the study is to create a nomogram for predicting OS in AR-DLBCL patients, which can facilitate precise prognosis prediction and individualized treatment strategies.

Comparative Analysis & Findings

  • The study identified key prognostic factors for OS, including decreased absolute lymphocyte count, extranodal involvement, reduced hemoglobin levels, Epstein-Barr virus infection, and elevated lactate dehydrogenase levels.
  • The nomogram demonstrated robust predictive performance, with a 5-year receiver operating characteristic curve area under the curve of 0.949, surpassing the International Prognostic Index (IPI) and age-adjusted IPI (aaIPI).
  • The nomogram divided patients into four risk groups, with 5-year survival rates ranging from 8% (high-risk group) to 100% (low-risk group).

Implications and Future Directions

  • The study's findings provide a new prognostic tool for AR-DLBCL patients, enabling healthcare providers to offer more personalized treatment strategies and improve patient outcomes.
  • Future studies can explore the application of the nomogram in different patient populations and clinical settings, as well as investigate the impact of emerging therapies on outcomes for AR-DLBCL patients.
  • The nomogram's utility may be expanded to other types of lymphoma or cancer, potentially improving patient care and survival rates across various disease settings.
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