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Bjarne Christensen - One of the best experts on this subject based on the ideXlab platform.
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mantle cell lymphoma Prognostic capacity of the follicular lymphoma International Prognostic Index
British Journal of Haematology, 2006Co-Authors: Michael Boe Moller, Niels Tinggaard Pedersen, Bjarne ChristensenAbstract:Summary The International Prognostic Index (IPI) is the most commonly used Prognostic model for mantle cell lymphoma (MCL). However, the Prognostic value of the IPI is limited. The recently published Follicular Lymphoma International Prognostic Index (FLIPI) is built on variables, which are pertinent to MCL. This study was conducted to evaluate the Prognostic value of FLIPI in a population-based series of 93 patients with MCL diagnosed in a 7-year period. End points of the study were response to therapy, overall survival, and disease-free survival (DFS) according to the IPI and FLIPI. Applied to the whole series, the FLIPI identified three risk groups with markedly different outcome with 5-year overall survival rates of 65%, 42%, and 8% respectively. Notably, the high-risk group comprised 53% of patients. In contrast, the IPI only allocated 16% of cases to the high-risk group and had a lower overall predictive capacity. When both the FLIPI and IPI were included in a multivariate analysis, only the FLIPI was related to survival. Multivariate analysis of DFS also identified the FLIPI, and not the IPI, as independently significant. Thus, in the present study, the FLIPI was superior as a Prognostic model compared with the IPI and can therefore be recommended as a clinical Prognostic Index for MCL.
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mantle cell lymphoma Prognostic capacity of the follicular lymphoma International Prognostic Index
Blood, 2005Co-Authors: Michael Boe Moller, Niels Tinggaard Pedersen, Bjarne ChristensenAbstract:Background: The International Prognostic Index (IPI) is the most commonly used Prognostic model in mantle cell lymphoma. However, the Prognostic value of IPI is limited. The recently published Follicular Lymphoma International Prognostic Index (FLIPI) is built on variables (age, stage, lactic dehydrogenase, anemia, and nodal disease) which also are pertinent to mantle cell lymphoma. This study was conducted to evaluate the Prognostic value of FLIPI in patients with mantle cell lymphoma. Patients and Methods: A population-based series of 93 patients with mantle cell lymphoma diagnosed in a 7-year period were studied. End points of the study were response to therapy, overall survival, and failure-free survival according to IPI and FLIPI. Results: Applied to the whole series, FLIPI identified 3 risk groups with markedly different outcome with 5-year overall survival rates of 65%, 42%, and 8%, respectively ( P Conclusion: FLIPI is the superior Prognostic model as compared to IPI and should be the preferred clinical Prognostic Index in mantle cell lymphoma.
Andrew D Zelenetz - One of the best experts on this subject based on the ideXlab platform.
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an evaluation of the chronic lymphocytic leukemia cll International Prognostic Index as a Prognostic tool in patients with relapsed refractory cll in idelalisib phase 3 randomized studies
Journal of Clinical Oncology, 2016Co-Authors: Jacob D Soumerai, Jacqueline C Barrientos, Michael Hallek, Thomas J Kipps, Jeffrey A Jones, Stephan Stilgenbauer, Guan Xing, Loic Ysebaert, Andrew D ZelenetzAbstract:7513Background: The International Prognostic Index for patients (pts) with CLL (CLL-IPI) is a validated scoring system with Prognostic value for overall survival (OS) in untreated CLL, but it has not been studied in relapsed/refractory (R/R) CLL (Kutsch et al. J Clin Oncol.33 (suppl), 2015). The CLL-IPI is a risk-weighted model comprising the risk factors age (relative weight, 1), stage (1), del(17p)/TP53 mutation (−17p/TP53M) (4), IGHV mutation status (2), and β2-microglobulin (2). We hypothesized that idelalisib (IDELA), an agent active in CLL with −17p/TP53M, can overcome the negative impact of high CLL-IPI risk on OS. Methods: The CLL-IPI score was analyzed in 460 pts with R/R CLL treated with IDELA + rituximab (R) vs placebo + R (NCT01539512) or IDELA + ofatumumab (O) vs O (NCT01659021). Subgroup analyses of OS were performed in 274 pts treated with IDELA + R or + O (IDELA cohort) and in 186 pts treated with R or O alone (control). Median OS was estimated for low, intermediate, high, and very high CL...
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An evaluation of the chronic lymphocytic leukemia (CLL) International Prognostic Index as a Prognostic tool in patients with relapsed/refractory CLL in idelalisib phase 3 randomized studies.
Journal of Clinical Oncology, 2016Co-Authors: Jacob D Soumerai, Jacqueline C Barrientos, Michael Hallek, Thomas J Kipps, Jeffrey A Jones, Stephan Stilgenbauer, Guan Xing, Loic Ysebaert, Andrew D ZelenetzAbstract:7513Background: The International Prognostic Index for patients (pts) with CLL (CLL-IPI) is a validated scoring system with Prognostic value for overall survival (OS) in untreated CLL, but it has not been studied in relapsed/refractory (R/R) CLL (Kutsch et al. J Clin Oncol.33 (suppl), 2015). The CLL-IPI is a risk-weighted model comprising the risk factors age (relative weight, 1), stage (1), del(17p)/TP53 mutation (−17p/TP53M) (4), IGHV mutation status (2), and β2-microglobulin (2). We hypothesized that idelalisib (IDELA), an agent active in CLL with −17p/TP53M, can overcome the negative impact of high CLL-IPI risk on OS. Methods: The CLL-IPI score was analyzed in 460 pts with R/R CLL treated with IDELA + rituximab (R) vs placebo + R (NCT01539512) or IDELA + ofatumumab (O) vs O (NCT01659021). Subgroup analyses of OS were performed in 274 pts treated with IDELA + R or + O (IDELA cohort) and in 186 pts treated with R or O alone (control). Median OS was estimated for low, intermediate, high, and very high CL...
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an enhanced International Prognostic Index nccn ipi for patients with diffuse large b cell lymphoma treated in the rituximab era
Blood, 2014Co-Authors: Zheng Zhou, Andrew D Zelenetz, Laurie H Sehn, Alfred W Rademaker, Leo I Gordon, Ann S Lacasce, Allison Crosbythompson, Ann Vanderplas, Gregory A Abel, Maria A RodriguezAbstract:The International Prognostic Index (IPI) has been the basis for determining prognosis in patients with aggressive non-Hodgkin lymphoma (NHL) for the past 20 years. Using raw clinical data from the National Comprehensive Cancer Network (NCCN) database collected during the rituximab era, we built an enhanced IPI with the goal of improving risk stratification. Clinical features from 1650 adults with de novo diffuse large B-cell lymphoma (DLBCL) diagnosed from 2000-2010 at 7 NCCN cancer centers were assessed for their Prognostic significance, with statistical efforts to further refine the categorization of age and normalized LDH. Five predictors (age, lactate dehydrogenase (LDH), sites of involvement, Ann Arbor stage, ECOG performance status) were identified and a maximum of 8 points assigned. Four risk groups were formed: low (0-1), low-intermediate (2-3), high-intermediate (4-5), and high (6-8). Compared with the IPI, the NCCN-IPI better discriminated low- and high-risk subgroups (5-year overall survival [OS]: 96% vs 33%) than the IPI (5 year OS: 90% vs 54%), respectively. When validated using an independent cohort from the British Columbia Cancer Agency (n = 1138), it also demonstrated enhanced discrimination for both low- and high-risk patients. The NCCN-IPI is easy to apply and more powerful than the IPI for predicting survival in the rituximab era.
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examination of the follicular lymphoma International Prognostic Index flipi in the national lymphocare study nlcs a prospective us patient cohort treated predominantly in community practices
Annals of Oncology, 2013Co-Authors: Ajay K Nooka, Andrew D Zelenetz, Chadi Nabhan, Xiaolei Zhou, Michael D Taylor, Michelle Byrtek, Thomas P Miller, Jonathan W Friedberg, Brian K Link, James R CerhanAbstract:ABSTRACT Background Because follicular lymphoma (FL) patients have heterogeneous outcomes, the FL International Prognostic Index (FLIPI) was developed to risk-stratify patients and to predict survival. However, limited data exist regarding the role of FLIPI in the era of routine first-line rituximab (R) and R-chemotherapy regimens and in the setting of community oncology practices. Patients and Methods We evaluated the outcome data from the National LymphoCare Study (NLCS), a prospective, observational cohort study, which collects data on patients with FL in the United States (US) community practices. Results Among 1068 male and 1124 female patients with FLIPI data, most were treated in US community practices (79%); 35% were FLIPI good risk, 30% intermediate risk, and 35% poor risk. FLIPI risk groups were significant predictors of overall survival (OS) and progression-free survival (PFS) for patients who undergo watchful waiting (WW), and those who receive non-R-containing regimens, R-alone, and R-chemotherapy combinations. Conclusions In the setting of contemporary practice with routine R use, stratifying patients into good, intermediate, and poor FLIPI risk groups predicts distinct outcomes in terms of OS and PFS. FLIPI remains an important Prognostic Index in the R era and should be used in clinical practices to support discussions about prognosis.
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Prognostic impact of proliferative Index determined by quantitative image analysis and the International Prognostic Index in patients with mantle cell lymphoma
Annals of Oncology, 2010Co-Authors: R Schaffel, Craig H Moskowitz, Carol S Portlock, Cyrus V Hedvat, Julie Teruyafeldstein, Daniel O Persky, Jocelyn C Maragulia, Andrew D ZelenetzAbstract:Background: The proliferative Index (PI) is a powerful Prognostic factor in mantle cell lymphoma (MCL); however, its utility is hampered by interobserver variability. The mantle cell International Prognostic Index (MIPI) has been reported to have Prognostic importance. In this study, we determined the Prognostic value of the PI as determined by quantitative image analysis in MCL. Patients and methods: Eighty-eight patients with adequate tissue were included in this analysis. Patients were treated with one of two treatment programs: sequential therapy with high-dose therapy consolidation or radioimmunotherapy followed by combination chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisone. Patients were divided into four groups based on PI ( 50%), and outcomes were analyzed. Results: Thirty percent was identified as the optimal cut-off for PI. By univariate analysis, intensive treatment and a low PI were associated with a superior progression-free survival (PFS); only PI was associated with overall survival. By multivariate analysis, both intensive treatment and PI correlated with PFS. The MIPI had no Prognostic impact. Conclusions: PI is the most important Prognostic factor in MCL. The cut-off of 30% is clinically meaningful and can be used to tailor the intensity of therapy in future clinical trials.
Christian H Geisler - One of the best experts on this subject based on the ideXlab platform.
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the International Prognostic Index for patients with cll cll ipi an International meta analysis
Journal of Clinical Oncology, 2015Co-Authors: Nadine Kutsch, Jasmin Bahlo, John C Byrd, Hartmut Dohner, Barbara Eichhorst, Monica Else, Christian H Geisler, Michael R Grever, Stephane Lepretre, Manuela BergmanAbstract:The International Prognostic Index for patients with CLL (CLL-IPI) : An International meta-analysis
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the International Prognostic Index for patients with chronic lymphocytic leukemia cll ipi an International meta analysis
Haematologica, 2015Co-Authors: Jasmin Bahlo, Nadine Kutsch, John C Byrd, Barbara Eichhorst, Monica Else, Christian H Geisler, Michael R Grever, Manuela M Bergmann, Hartmut Doehner, Stephane LepretreAbstract:THE International Prognostic Index FOR PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA (CLL-IPI)-AN International META-ANALYSIS
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confirmation of the mantle cell lymphoma International Prognostic Index in randomized trials of the european mantle cell lymphoma network
Journal of Clinical Oncology, 2014Co-Authors: Eva Hoster, Christian H Geisler, Wolfram Klapper, Olivier Hermine, Hanneke C Kluinnelemans, Jan Walewski, Achiel Van Hoof, Marek Trneny, Francesco Di RaimondoAbstract:Purpose Mantle-cell lymphoma (MCL) is a distinct B-cell lymphoma associated with poor outcome. In 2008, the MCL International Prognostic Index (MIPI) was developed as the first Prognostic stratification tool specifically directed to patients with MCL. External validation was planned to be performed on the cohort of the two recently completed randomized trials of the European MCL Network. Patients and Methods Data of 958 patients with MCL (median age, 65 years; range, 32 to 87 years) treated upfront in the trials MCL Younger or MCL Elderly were pooled to assess the Prognostic value of MIPI with respect to overall survival (OS) and time to treatment failure (TTF). Results Five-year OS rates in MIPI low, intermediate, and high-risk groups were 83%, 63%, and 34%, respectively. The hazard ratios for OS of intermediate versus low and high versus intermediate risk patients were 2.1 (95% CI, 1.5 to 2.9) and 2.6 (2.0 to 3.3), respectively. MIPI was similarly Prognostic for TTF. All four clinical baseline character...
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the mantle cell lymphoma International Prognostic Index mipi is superior to the International Prognostic Index ipi in predicting survival following intensive first line immunochemotherapy and autologous stem cell transplantation asct
Blood, 2010Co-Authors: Christian H Geisler, Arne Kolstad, Anna Laurell, Riikka Raty, Mats Jerkeman, Mikael Eriksson, Marie Nordstrom, Eva Kimby, Anne Marie Boesen, Herman NilssonehleAbstract:Mantle cell lymphoma (MCL) has a heterogeneous clinical course. The recently proposed Mantle Cell Lymphoma International Prognostic Index (MIPI) predicted the survival of MCL better than the International Prognostic Index in MCL patients treated with conventional chemotherapy, but its validity in MCL treated with more intensive immunochemotherapy has been questioned. Applied here to 158 patients of the Nordic MCL2 trial of first-line intensive immunochemotherapy followed by high-dose chemotherapy and autologous stem cell transplantation, the MIPI and the simplified MIPI (s-MIPI) predicted survival significantly better (P .004). Both the MIPI and the s-MIPI mainly identified 2 risk groups, low and intermediate versus high risk, with the more easily applied s-MIPI being just as powerful as the MIPI. The MIPI(B) (biological), incorporating Ki-67 expression, identified almost half of the patients as high risk. We suggest that also a simplified MIPI(B) is feasible.
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confirmation of the mantle cell lymphoma International Prognostic Index mipi in an independent prospective patient cohort
Blood, 2009Co-Authors: Eva Hoster, Christian H Geisler, Olivier Hermine, Hanneke C Kluinnelemans, Jan Walewski, Achiel Van Hoof, Marek Trneny, Joerg Hasford, Vincent Ribrag, Wolfram KlapperAbstract:Abstract 138 Background: The Mantle Cell Lymphoma (MCL) International Prognostic Index (MIPI) has been recently developed as first Prognostic Index especially designed for patients with advanced stage MCL (Hoster et al., Blood 2008). The MIPI is based on four easily available Prognostic factors (age, ECOG performance status, leukocyte count, and LDH). It was internally validated using a bootstrap strategy, and several authors reported its validity on larger patient cohorts (Salek et al., ASH 2008, Geisler et al., EHA 2009). We evaluated the Prognostic relevance of the MIPI using the pooled data of two currently recruiting randomized trials (MCL Younger and MCL Elderly) of the European MCL Network (Dreyling et al., ASH 2007). Methods: Outcome parameters were primarily overall survival (OS) and secondarily time to treatment failure (TTF). Kaplan-Meier curves according to the MIPI Prognostic groups were compared by means of the log rank test and univariate Cox regression. We checked the value of the MIPI Prognostic factors within multiple Cox regression. We also evaluated the simplified MIPI and exploratively included patients with stage II into the analyses. Since randomization is ongoing, all analyses were blinded for treatment arms. Results: Currently, 606 patients with advanced stage MCL were evaluable, 317 in MCL Younger and 289 in MCL Elderly. Median age was 63 years (range 32 – 87), 6% had an ECOG performance status > 1, median LDH/ULN ratio was 0.95 (0.29 – 12.2), and median leukocyte count 7,600/μl (1,075/μl – 396,000/μl). The MIPI classified 220 patients (36%) into the low risk (LR), 187 (31%) into the intermediate risk (IR) and 199 (33%) into the high risk (HR) group. With a median follow-up of 19 months and 116 events, the probability for OS at 24 months was 91%, 77%, and 58% for LR, IR, and HR (medians not reached in LR, IR vs. 28 months in HR patients, p Discussion: We could confirm the Prognostic relevance of the MIPI in a large independent patient cohort treated within current randomized trials. Therefore, the MIPI may be used for risk stratification in future clinical trials, for the comparative interpretation of the results of different trials, for the evaluation of new biological Prognostic factors, and may finally lead to risk-adapted treatment decisions in advanced stage MCL. Disclosures: Hoster:Roche: travel support. Trneny:Roche: Consultancy, Honoraria, Membership on an entity9s Board of Directors or advisory committees, Research Funding; Amgen: Consultancy, Honoraria, Membership on an entity9s Board of Directors or advisory committees, Research Funding; Biogen Idec: Honoraria, Membership on an entity9s Board of Directors or advisory committees, Research Funding. Dreyling:Roche: Honoraria, Research Funding. Unterhalt:Roche: travel support.
Michael Boe Moller - One of the best experts on this subject based on the ideXlab platform.
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mantle cell lymphoma Prognostic capacity of the follicular lymphoma International Prognostic Index
British Journal of Haematology, 2006Co-Authors: Michael Boe Moller, Niels Tinggaard Pedersen, Bjarne ChristensenAbstract:Summary The International Prognostic Index (IPI) is the most commonly used Prognostic model for mantle cell lymphoma (MCL). However, the Prognostic value of the IPI is limited. The recently published Follicular Lymphoma International Prognostic Index (FLIPI) is built on variables, which are pertinent to MCL. This study was conducted to evaluate the Prognostic value of FLIPI in a population-based series of 93 patients with MCL diagnosed in a 7-year period. End points of the study were response to therapy, overall survival, and disease-free survival (DFS) according to the IPI and FLIPI. Applied to the whole series, the FLIPI identified three risk groups with markedly different outcome with 5-year overall survival rates of 65%, 42%, and 8% respectively. Notably, the high-risk group comprised 53% of patients. In contrast, the IPI only allocated 16% of cases to the high-risk group and had a lower overall predictive capacity. When both the FLIPI and IPI were included in a multivariate analysis, only the FLIPI was related to survival. Multivariate analysis of DFS also identified the FLIPI, and not the IPI, as independently significant. Thus, in the present study, the FLIPI was superior as a Prognostic model compared with the IPI and can therefore be recommended as a clinical Prognostic Index for MCL.
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mantle cell lymphoma Prognostic capacity of the follicular lymphoma International Prognostic Index
Blood, 2005Co-Authors: Michael Boe Moller, Niels Tinggaard Pedersen, Bjarne ChristensenAbstract:Background: The International Prognostic Index (IPI) is the most commonly used Prognostic model in mantle cell lymphoma. However, the Prognostic value of IPI is limited. The recently published Follicular Lymphoma International Prognostic Index (FLIPI) is built on variables (age, stage, lactic dehydrogenase, anemia, and nodal disease) which also are pertinent to mantle cell lymphoma. This study was conducted to evaluate the Prognostic value of FLIPI in patients with mantle cell lymphoma. Patients and Methods: A population-based series of 93 patients with mantle cell lymphoma diagnosed in a 7-year period were studied. End points of the study were response to therapy, overall survival, and failure-free survival according to IPI and FLIPI. Results: Applied to the whole series, FLIPI identified 3 risk groups with markedly different outcome with 5-year overall survival rates of 65%, 42%, and 8%, respectively ( P Conclusion: FLIPI is the superior Prognostic model as compared to IPI and should be the preferred clinical Prognostic Index in mantle cell lymphoma.
Dick Johan Van Spronsen - One of the best experts on this subject based on the ideXlab platform.
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validation revision and extension of the mantle cell lymphoma International Prognostic Index in a population based setting
Haematologica, 2010Co-Authors: Saskia A M Van De Schans, Maryska L G Janssenheijnen, Marten R Nijziel, Ewout W Steyerberg, Dick Johan Van SpronsenAbstract:Background The aim of this study was to validate the Mantle Cell Lymphoma International Prognostic Index in a population-based cohort and to study the relevance of its revisions. Design and Methods We analyzed data from 178 unselected patients with stage III or IV mantle cell lymphoma, registered between 1994 and 2006 in the Eindhoven Cancer Registry. Follow-up was completed up to January 1st, 2008. Multiple imputations for missing covariates were used. Validity was assessed by comparing observed survival in our cohort with predicted survival according to the original Mantle cell lymphoma International Prognostic Index. A revised model was constructed with Cox regression analysis. Discrimination was assessed by a concordance statistic (‘c’). Results The original Mantle cell lymphoma International Prognostic Index could stratify our cohort into three distinct risk groups based on Eastern Cooperative Group performance status, white blood cell count, lactate dehydrogenase level, and age, with the discrimination being nearly as good as in the original cohort (c 0.65 versus 0.63). A modified model including performance status in five categories (0/1/2/3/4) instead of two (0–1/2–4), the presence of B-symptoms (yes/no) and sex (male/female) in addition to the original variables resulted in a better Prognostic Index (c 0.75). Conclusions The Mantle cell lymphoma International Prognostic Index is a valid tool for risk stratification, comparison of prognosis, and treatment decisions in an unselected Dutch population-based setting. Although the Index can be significantly improved, external validation on an independent data set is warranted before broad application of the modified instrument could be recommended.
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validation revision and extension of the follicular lymphoma International Prognostic Index flipi in a population based setting
Annals of Oncology, 2009Co-Authors: Saskia A M Van De Schans, Maryska L G Janssenheijnen, Marten R Nijziel, Ewout W Steyerberg, G J Creemers, Dick Johan Van SpronsenAbstract:textabstractBackground: The aim of this study was to validate the Follicular Lymphoma International Prognostic Index (FLIPI) in a population-based cohort and to study the relevance of revision and extension of the FLIPI. Patients and methods: Data of 353 unselected patients, 1993-2002, in the Eindhoven Cancer Registry, were collected. Follow-up was completed up to 1 January 2006. Multiple imputations for missing covariates were used. Validity was assessed by comparing observed to predicted survival of the original model and of a revised model with other Prognostic variables. Results: The original FLIPI stratified our cohort into three different risk groups based on stage, Hb, lactate dehydrogenase, nodal involvement and age. The discrimination between risk groups was not as good as in the original cohort. A model including age in three categories (≤60/ 61-70/>70 years) and presence of cardiovascular disease (CVD) (yes/ no) resulted in a better Prognostic Index. The 5-year overall survival rates were 79%, 59% and 28% in the low-, intermediate- and high-risk groups for the extended FLIPI compared with 81%, 66% and 47% for the original FLIPI, respectively. Conclusions: The performance of the FLIPIwas validated in a population-based setting, but could significantly be improved by a more refined coding of age and by including the presence of CVD.
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a population based study of severity of comorbidity among patients with non hodgkin s lymphoma Prognostic impact independent of International Prognostic Index
British Journal of Haematology, 2005Co-Authors: Maryska L G Janssenheijnen, Dick Johan Van Spronsen, Valery E P P Lemmens, Saskia Houterman, Kees D G W Verheij, Jan Willem CoeberghAbstract:Over 60% of patients aged over 70 years, diagnosed with non-Hodgkin's lymphoma (NHL) in the Netherlands have serious comorbidity. We studied the independent influence of comorbidity on choice of treatment, dose reductions, treatment-related toxicity and prognosis, using data from a random sample of 381 patients from the population-based Eindhoven Cancer Registry. About 45% of patients over 60 years of age with NHL had high impact comorbidity at the time of cancer diagnosis. The proportion of patients with aggressive NHL who received chemotherapy decreased from 85% in patients aged 40-60 years to 70% in those over 60 years. About 65% of systematically treated patients with aggressive NHL suffered from treatment-related toxicity. Toxicity appeared to be more common among females and those with high-intermediate or high International Prognostic Index (IPI) risk. Among patients with aggressive NHL, the chance of dying for those with high impact comorbidity was twice as high compared with those without comorbidity. This was independent of the IPI risk. Dose reductions are frequently unavoidable for patients with severe comorbidity, poor performance status or chemotherapy-related toxicity. Whether the less frequent prescription of (full dose) chemotherapy for patients with advanced age and/or with comorbidity is justified remains a question for debate.