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Development of a novel prognostic nomogram for AIDS-associated diffuse large B-cell lymphoma: a retrospective study
Ying Liang1, Jing Chang2, Yuxue Gao3
1Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China.
Insights
A new prognostic model improves risk assessment for AIDS-related diffuse large B-cell lymphoma (AR-DLBCL). This tool enhances overall survival prediction, outperforming existing indices for personalized treatment strategies.
Area of Science:
- Oncology
- Hematology
- Infectious Diseases
Background:
- AIDS-related diffuse large B-cell lymphoma (AR-DLBCL) poses significant challenges despite antiretroviral therapy.
- Disease heterogeneity in AR-DLBCL complicates accurate prognostic assessment.
- Existing prognostic tools lack sufficient accuracy for this patient population.
Purpose of the Study:
- To develop and validate a novel prognostic model for AR-DLBCL.
- To enhance risk stratification and personalize treatment strategies for AR-DLBCL patients.
- To identify key clinical factors influencing overall survival (OS) and progression-free survival (PFS) in AR-DLBCL.
Main Methods:
- Retrospective analysis of 90 AR-DLBCL cases.
- Univariate and multivariate analyses to identify prognostic factors.
- Development of a nomogram based on independent OS predictors.
Main Results:
- Key OS predictors identified: decreased absolute lymphocyte count, extranodal involvement, reduced hemoglobin, Epstein-Barr virus infection, and elevated lactate dehydrogenase.
- The developed nomogram showed superior predictive performance (C-index=0.849) compared to IPI (0.708) and aaIPI (0.693).
- The nomogram effectively stratified patients into distinct risk groups with significant survival differences.
Conclusions:
- The novel nomogram provides a robust and personalized risk assessment for AR-DLBCL.
- This model facilitates more precise prognosis prediction.
- It aids in guiding individualized treatment decisions for AR-DLBCL patients.
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.
