Beyond linearity and static risk: re-evaluating core prognostic factors in diffuse large B-cell lymphoma.

IF 2.8 4区医学 Q2 HEMATOLOGY

Expert Review of Hematology Pub Date : 2026-05-01 Epub Date: 2026-03-12 DOI:10.1080/17474086.2026.2643330

Rashad Ismayilov, Murat Ozdede, Yahya Buyukasik

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引用次数: 0

Abstract

Background: This study challenges the static and linear assumptions of traditional prognostic models for diffuse large B-cell lymphoma (DLBCL), such as the International Prognostic Index (IPI).

Research design and methods: Analyzing 664 DLBCL patients treated with R-CHOP, the research explored the time-dependent and nonlinear effects of established risk factors.

Results: While the IPI maintained strong overall prognostic stability, its individual components exhibited dynamic behavior. ECOG performance score, beta-2 microglobulin (β2 M), and lactate dehydrogenase (LDH) were key predictors of early mortality, with their influence diminishing over time. Conversely, the importance of Ann Arbor stage and extranodal involvement grew, identifying them as markers of later risk. Notably, the study found a resurgence in the predictive power of β2 M after two years. Furthermore, restricted cubic spline modeling revealed significant nonlinear relationships between overall survival and age, LDH, and β2 M (all p < 0.001 for nonlinearity).

Conclusions: The prognostic impact of baseline factors in DLBCL follows dynamic and nonlinear trajectories, challenging the one-size-fits-all approach of current risk scores. Future models should incorporate these temporal dynamics to provide a more accurate, personalized risk assessment.

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超越线性和静态风险：重新评估弥漫性大b细胞淋巴瘤的核心预后因素。

背景：本研究挑战了弥漫性大b细胞淋巴瘤（DLBCL）传统预后模型的静态和线性假设，如国际预后指数（IPI）。研究设计与方法：分析664例接受R-CHOP治疗的DLBCL患者，探讨已知危险因素的时间依赖性和非线性效应。结果：虽然IPI保持了很强的整体预后稳定性，但其各个组成部分表现出动态行为。ECOG表现评分、β -2微球蛋白（β 2m）和乳酸脱氢酶（LDH）是早期死亡率的关键预测指标，其影响随着时间的推移而减弱。相反，安娜堡分期和结外浸润的重要性增加，将它们确定为后期风险的标志。值得注意的是，该研究发现β2 M的预测能力在两年后再次出现。此外，限制三次样条模型显示，总生存率与年龄、LDH和β2 M之间存在显著的非线性关系（均p）。结论：基线因素对DLBCL预后的影响遵循动态和非线性轨迹，挑战了当前风险评分的一刀切方法。未来的模型应该纳入这些时间动态，以提供更准确、更个性化的风险评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Hematology HEMATOLOGY-

CiteScore

4.70

自引率

3.60%

发文量

审稿时长

6-12 weeks

期刊介绍： Advanced molecular research techniques have transformed hematology in recent years. With improved understanding of hematologic diseases, we now have the opportunity to research and evaluate new biological therapies, new drugs and drug combinations, new treatment schedules and novel approaches including stem cell transplantation. We can also expect proteomics, molecular genetics and biomarker research to facilitate new diagnostic approaches and the identification of appropriate therapies. Further advances in our knowledge regarding the formation and function of blood cells and blood-forming tissues should ensue, and it will be a major challenge for hematologists to adopt these new paradigms and develop integrated strategies to define the best possible patient care. Expert Review of Hematology (1747-4086) puts these advances in context and explores how they will translate directly into clinical practice.