Anovel Prognostic Model For Risk-stratification In HIV-related Diffuse Large B-cell Lymphoma

BackgroundThe International Prognostic Index(IPI)score is still used as the benchmark for determining the prognosis of human immunodeficiency virus(HIV)-related diffuse large B-cell lymphoma(DLBCL)patients,but it is inability to identify a subgroup of patients with very poor survival.New prognosis scores are unavailable and complicated in low-income areas,and little is known about their predictability of high-risk population from HIV-related DLBCL.Thus,a simple,clinically applicable prognostic tool is needed for selecting patients for consideration for novel therapies and prognostication in the HIV-related DLBCL seting.To establish a predictive riskstratification model,we conducted a multicenter and retrospective cohort study.MethodsThe real-world data of primary HIV-related DLBCL patients from 3 centers in China were collected.Overall survival(OS)and progression-free survival(PFS)were estimated using the Kaplan-Meier method and compared by the log-rank test.Univariate and multivariate survival analysis was performed using the Cox regression model.The prognostic model was established with coefficients of the independent prognostic factors weighted by the multivariate analysis.ResultsA total of 78 HIV-related DLBCL patients diagnosed between 2013 and 2020 were enrolled to this study,with a 2-year OS of 30.8%(95%CI,20.9%-41.1%).Age,Ann Arbor stage,lactate dehydrogenase(LDH)ratio,bulky mass,and red blood cell distribution width(RDW)ratio were independent pejorative predictors of OS and were used to build the new prognostic model.It could stratify the patients into three distinct categories:low risk(12.8%),intermediate risk(60.3%),and high risk(26.9%),with an estimated 2-year OS of 80.0%(95%CI,40.9%-94.6%),34.0%(95%CI,21.0%47.5%),and 0.0%respectively.This new model(AUC=0.90,95%CI:0.83-0.97),incorporating IPI score and inflammation,outperformed the IPI(AUC=0.84,95%CI:0.74-0.94)and NCCN-IPI(AUC=0.86,95%CI:0.77-0.95)for two-year mortality.ConclusionWe developed a simple,clinically applicable predictive model of HIV-related DLBCL setting,which uses variables that can be easily obtained in real-life practice.The new prognostic model showed a more precise risk assessment for a subgroup with poor survival.