Today, we can cure a significant portion of people with aggressive
non-Hodgkin's lymphomas. The cure rate at 5 years for all patients
with advanced diffuse large-cell lymphoma is approximately 35%.
Patients with localized disease are cured the majority of the
time. However, it is important to be able to predict an individual
patient's chance for benefit.
In her talk at the Pan Pacific Lymphoma Conference, Dr. Margaret
Shipp of Dana-Farber Cancer Center described an international
study involving several thousand patients with aggressive non-Hodgkin's
lymphoma that established the International Prognostic Index.
The patients were treated in the 1980s with active combination
This study identified five factors that strongly predicted outcome:
Ann Arbor stage, age, serum LDH level, performance status, and
number of extranodal sites of involvement. When only young patients
were considered, Ann Arbor stage, serum LDH level, and performance
status were the major prognostic factors.
By adding together the adverse factors present in an individual
patient, it is possible to predict the patient's chances of survival
when treated with standard anthracycline-containing combination
chemotherapy regimens. Patients with a very good outlook should
probably receive current standard therapies, and future studies
in these patients might be aimed at efforts to reduce toxicity.
However, we need new treatments for those who have a very poor
It is important to understand why these clinical factors predict
outcome. It must be that they are indirect representations of
adverse characteristics of the tumor. For example, such factors
as tumor proliferative rate, mass size, and serum LDH level might
reflect abnormalities in tumor growth and invasive potential.
Such abnormalities as B symptoms and performance status might
be reflections of the patient's ability to respond to the tumor.
Finally, factors such as the patient's age might be a reflection
of the patient's ability to tolerate therapy.
The International Prognostic Index has recently been demonstrated
to work fairly well for patients with low-grade non-Hodgkin's
lymphomas, and it is likely that it might be used in planning
clinical trials in these tumors as well as in the aggressive non-Hodgkin's