CNS-IPI for CNS Relapse in Diffuse Large B-Cell Lymphoma

Key Points

  • The risk model includes IPI risk factors plus involvement of kidney/adrenal glands in patients with DLBCL treated with R-CHOP.
  • Two-year risk of CNS relapse was < 5% in the low- and intermediate-risk groups and ≥ 10% in the high-risk group.

As reported in the Journal of Clinical Oncology, Schmitz et al have developed and validated a risk score for CNS relapse—the Central Nervous System International Prognostic Index (CNS-IPI)—in patients with diffuse large B-cell lymphoma (DLBCL) treated with R-CHOP (rituximab [Rituxan] and cyclophosphamide, doxorubicin, vincristine, prednisone).

Factors in Risk Model

The study involved analysis of risk of relapse/disease progression and development of the risk model in 2,164 patients aged 18 to 80 years with aggressive B-cell lymphomas (80% DLBCL) who were enrolled in German High-Grade Non-Hodgkin Lymphoma Study Group studies and the MabThera International Trial. The risk model identified in this cohort consisted of five IPI factors (age > 60 years, lactate dehydrogenase level higher than normal, Eastern Cooperative Oncology Group performance status > 1, Ann Arbor stages III or IV, and > 1 extranodal disease site) and involvement of kidney or adrenal glands, with 1 point assigned for each factor present; in a three-risk group model, low risk was 0 to 1 point; intermediate risk was 2 to 3 points; and high risk was 4 to 6 points. In this model, the low-risk group (46% of all patients), the intermediate-risk group (41%), and the high-risk group (12%) had 2-year rates of CNS disease of 0.6%, 3.4%, and 10.2%, respectively.

Validation Cohort

In a validation cohort of 1,597 patients with DLBCL from the British Columbia Cancer Agency Lymphoid Cancer database, 2-year rates of CNS disease were 0.8% in the low-risk group, 3.9% in the intermediate-risk group, and 12.0% in the high-risk group.

The investigators concluded: “The CNS-IPI is a robust, highly reproducible tool that can be used to estimate the risk of CNS relapse/progression in patients with DLBCL treated with R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy. Close to 90% of patients with DLBCL belong to the low- and intermediate-risk groups and have a CNS relapse risk < 5%; they may be spared any diagnostic and therapeutic intervention. In contrast, those in the high-risk group have a > 10% risk of CNS relapse and should be considered for CNS-directed investigations and prophylactic interventions.”

Norbert Schmitz, MD, PhD, of Asklepios Hospital St Georg, Hamburg, Germany, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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