NCCN Guidelines for Patients® | Diffuse Large B-cell Lymphoma

21 NCCN Guidelines for Patients ® : Diffuse Large B-cell Lymphoma, 2017 Prognostic scores A prognosis is a prediction of the pattern and outcome of a disease. For treatment planning, your doctors will assess the cancer prognosis. The cancer stage and IPI score are the two methods used. Cancer stage A cancer stage is a rating by your doctors of how far the cancer has grown and spread. The Ann Arbor staging system is used to stage DLBCL. In this system, there are four cancer stages. † † Stage I is cancer that is in only one cluster of lymph nodes. † † Stage II is cancer that is in 2 or more clusters either above or below your diaphragm. † † Stage III is cancer that is in lymph tissue on both sides of your diaphragm. † † Stage IV is cancer that has widely spread outside the lymphatic system. When the cancer is staged, other letters are also assigned. The letters “A” and “B” indicate whether B symptoms have been present in the past 6 months. No symptoms is rated A, and if symptoms are present, B. The letter “E” stands for extranodal disease, which is cancer in sites other than the lymph nodes. The letter “X” means the cancer is large (>10 cm). In general, earlier cancer stages have better outcomes. However, doctors define cancer stages with information from thousands of patients, so a cancer stage gives an average outcome. It may not tell the outcome for one person. Some people will do better than expected. Others will do worse. Other factors not used for staging cancer are also very important. Such factors include your general health and the features of the cancer. International Prognostic Index The IPI ( I nternational P rognostic I ndex) is a scoring system that uses risk factors to assess prognosis. A risk factor is anything that increases your chances of an event or outcome. The first IPI was created over 20 years ago. In the standard version, 1 point is given for every risk factor that describes you. The five risk factors are: 1) older than 60 years of age; 2) lactate dehydrogenase level above normal; 3) performance status score of 2 or greater; 4) stage III or IV; and 5) more than one extranodal site. The total number of points is used to assign you to one of four risk groups, which are: † † Low risk includes scores of 0 and 1. † † Low-intermediate risk includes a score of 2. † † High-intermediate risk includes a score of 3. † † High risk includes scores of 4 or more. There is now more than one version of the IPI. There is an age-adjusted version for people 60 years of age and younger. One point is given for: 1) stage III or IV; 2) lactate dehydrogenase level above normal; and 3) performance status score of 2 or greater. A score of 0 is low risk, a score of 1 is low-intermediate risk, a score of 2 is high-intermediate risk, and a score of 3 is high risk. NCCN-IPI The NCCN-IPI is a newer version that works better than the standard version. One point is given for: 1) ages 41 to 60; 2) lactate dehydrogenase level between 1 and 3; 3) stage III or IV; 4) extranodal disease; and 5) performance status score of 2 or greater. Two points are given for: 1) ages 61 to 74; and 2) lactate dehydrogenase level greater than 3. Three points are given for age 75 and older. 2 Treatment planning Prognostic scores