An international prognostic index to predict the early chemoimmunotherapy failure of diffuse large B-cell lymphoma

Qifan Xu ¹, Yang Li ^2,3, Beibei Xin ⁴

¹Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
²Beijing International Center for Mathematical Research, Department of Biostatistics, Peking University, Beijing, China.
³Chongqing Research Institute of Big Data, Peking University, Chongqing, China.
⁴Shanghai Rightongene Biotechnology Co., Ltd, Shanghai, China.
⁵Beijing International Center for Mathematical Research, Department of Biostatistics, Peking University, Beijing, China. azhou@math.pku.edu.cn.
⁶Chongqing Research Institute of Big Data, Peking University, Chongqing, China. azhou@math.pku.edu.cn.
⁷Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. dr_wangli@126.com.
⁸Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. zhao.weili@yahoo.com.

⁰Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Annals of Hematology +

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September 10, 2025

View abstract on PubMed

Summary

Identifying patients with diffuse large B-cell lymphoma (DLBCL) at high risk of early chemoimmunotherapy failure (ECF) is crucial for guiding treatment. Two new prognostic models, ECF-IPI-basic and ECF-IPI-advance, show improved accuracy in predicting ECF compared to the standard IPI score.

Area Of Science

Hematology
Oncology
Biostatistics

Background

Diffuse large B-cell lymphoma (DLBCL) has a significant proportion of patients (30-40%) experiencing relapse or refractory disease.
Accurate prediction of early chemoimmunotherapy failure (ECF) is essential for optimizing treatment strategies, including novel therapies like CAR-T cell therapy.

Purpose Of The Study

To develop and validate novel prognostic models for predicting ECF in DLBCL patients.
To compare the predictive performance of these new models against the established International Prognostic Index (IPI) score.

Main Methods

Two models, ECF-IPI-basic (using 5 clinical variables) and ECF-IPI-advance (using 7 variables including biomarkers like IL-2R), were developed using data from 1200 and 699 DLBCL patients, respectively.
Variables considered included age, Ann Arbor stage, MYC/BCL2 double expression (DE), ECOG performance status (ECOG PS), lactate dehydrogenase (LDH), and additional biomarkers in the advanced model.

Main Results

The ECF-IPI-basic model (AUC 0.768) and ECF-IPI-advance model (AUC 0.824) demonstrated superior discriminatory capacity for identifying ECF compared to the IPI score (AUC 0.701 and 0.724, respectively).
The ECF-IPI-advance model incorporates age, sex, Ann Arbor stage, DE, ECOG PS, LDH, and IL-2R.

Conclusions

The developed ECF-IPI-basic and ECF-IPI-advance models are potent tools for accurately distinguishing DLBCL patients with ECF.
These models can aid in improving patient prognosis and guiding personalized treatment decisions for DLBCL.

Keywords:

Diffuse large B-cell lymphoma Early chemoimmunotherapy failure Predict model Prognosis