Prognostic indices in diffuse large B-cell lymphoma: a population-based comparison and validation study of multiple models

Jelena Jelicic, Karen Juul-Jensen, Zoran Bukumiric, Michael Roost Clausen, Ahmed Ludvigsen Al-Mashhadi, Robert Schou Pedersen, Christian Bjørn Poulsen, Peter Brown, Tarec Christoffer El-Galaly, Thomas Stauffer Larsen*

*Corresponding author for this work

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Currently, the International Prognostic Index (IPI) is the most used and reported model for prognostication in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL). IPI-like variations have been proposed, but only a few have been validated in different populations (e.g., revised IPI (R-IPI), National Comprehensive Cancer Network IPI (NCCN-IPI)). We aimed to validate and compare different IPI-like variations to identify the model with the highest predictive accuracy for survival in newly diagnosed DLBCL patients. We included 5126 DLBCL patients treated with immunochemotherapy with available data required by 13 different prognostic models. All models could predict survival, but NCCN-IPI consistently provided high levels of accuracy. Moreover, we found similar 5-year overall survivals in the high-risk group (33.4%) compared to the original validation study of NCCN-IPI. Additionally, only one model incorporating albumin performed similarly well but did not outperform NCCN-IPI regarding discrimination (c-index 0.693). Poor fit, discrimination, and calibration were observed in models with only three risk groups and without age as a risk factor. In this extensive retrospective registry-based study comparing 13 prognostic models, we suggest that NCCN-IPI should be reported as the reference model along with IPI in newly diagnosed DLBCL patients until more accurate validated prognostic models for DLBCL become available. [Figure not available: see fulltext.]

Original languageEnglish
Article number157
JournalBlood Cancer Journal
Number of pages12
Publication statusPublished - 13. Oct 2023

Bibliographical note

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© 2023, Springer Nature Limited.


  • Antineoplastic Combined Chemotherapy Protocols/therapeutic use
  • Humans
  • Lymphoma, Large B-Cell, Diffuse/diagnosis
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Rituximab/therapeutic use


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