Clinical risk scores do not accurately identify a very high risk population with diffuse large B cell lymphoma—an analysis of 386 Portuguese patients

  • Rita CoutinhoEmail author
  • J. Lobato
  • S. Esteves
  • J. Cabeçadas
  • M. Gomes da Silva
Original Article


The identification of high-risk patients deserving alternative first-line treatments to R-CHOP is a research priority in diffuse large B cell lymphoma (DLBCL). Despite the increasing recognition of biological features underlying aggressive behavior, clinical scores remain the basis for prognostic evaluation and treatment stratification in DLBCL. We performed a retrospective analysis of patients with DLBCL uniformly treated with immunochemotherapy with the aim of assessing the discriminative power of the NCCN international prognostic index (IPI) and the GELTAMO-IPI scores in risk group stratification and compared them with the IPI. Additionally, we investigated if bulky disease, gender, beta-2 microglobulin (β2m), body mass index, and B-symptoms have independent prognostic impact. We confirmed the discriminative ability of the three prognostic scores in terms of progression-free survival and overall survival and found that the NCCN-IPI performs better in the identification of a high-risk population compared to the IPI and the GELTAMO scores. In an attempt to improve the prognostic power of the NCCN-IPI we analyzed additional clinical variables. Bulky disease and elevated β2m were found to be independent predictors of prognosis when controlling for the NCCN-IPI risk groups. However, they seem to bring no incremental power to the latter in the identification of poor outcome patients. We support the use of the NCCN-IPI for the clinical identification of high-risk patients in DLBCL. Future studies to unravel the biological heterogeneity within NCCN-IPI groups are needed to improve risk prediction and design targeted therapies for poor prognosis patients.


Diffuse large B cell lymphoma GELTAMO-IPI NCCN-IPI Outcome High risk 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Ethics Committee of Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal.

Supplementary material

277_2019_3676_MOESM1_ESM.docx (16 kb)
ESM 1 (DOCX 15 kb)
277_2019_3676_MOESM2_ESM.docx (13 kb)
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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of HematologyCentro Hospitalar Universitário do PortoPortoPortugal
  2. 2.Department of HematologyInstituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E.LisbonPortugal
  3. 3.Clinical Research UnitInstituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E.LisbonPortugal
  4. 4.Department of PathologyInstituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E.LisbonPortugal

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