INVESTIGATION OF PROGNOSTIC FACTORS IN LA RGE-CELL LYMPHOMAS

BACKGROUND: To carry out a study on the prognostic factors in large ce ll lymphomas (LCL) treated during the last decade and validate the Int ernational prognostic index (IPI). METHODS: One hundred twenty-four ca ses of newly diagnosed LCL, treated from 1978 to 1990, with a mean fol low up of 27 months (1-142) were included in the study. The chemothera py used was CHOP (65%), ProMACE-CytaBOM (17%) and others (C-MOPP, MACO P-B). RESULTS: Complete remission (CR) was achieved in 71% of the case s and partial In 11%. Logistic analysis allowed the identification of three adverse factors to CR: Ann Arbor stage III, IV (p = 0.004; odds ratio, OR = 0.19), elevated tumoral load (p = 0.006; OR = 0.22) and ag e greater than or equal to 60 years (p = 0.02; OR = 0.31). Recurrence free survival (RFS) at 3 years was 67% (CI 95%; 55-79) with the median not having been achieved. Cox analysis allowed the identification to the ECOG greater than or equal to 2 scale as the only independent adve rse factor (p = 0.0006; RR = 4.85) while Ann Arbor staging demonstrate d marginal influence (p = 0.08). Global survival (GS) at 5 years was 4 5% (CI 95%; 35.55) with a median of 38 months Multivariant analysis of independent adverse factors of GS were ECOG scale greater than or equ al to 2 (p < 0.00001; RR = 6.07), Ann Arbor stage (p = 0.004; RR = 2.6 4) and hypoalbuminemia (p = 0.01; RR = 2.28). On Inclusion of therapeu tic response (TR) In the analysis, the factors chosen ware absence of CR (p < 0.00001; RR = 9.58) and ECOG greater than or equal to 2 (p = 0 .0004; RR = 4.24). CONCLUSIONS: Three variables evaluated at diagnosis , general state (ECOG), Ann Arbor stage and albumin, determined the pr ognosis In this series of large cell lymphoma. A prognostic model was designed from the same with three risk groups. The application of the international prognostic Index to this series separated the patients I nto 4 groups of differentiated prognosis.