Risk stratification of dlbcl with mved2 score using integrative host adipose density and metabolic tumor characteristics compared to other indexes

Introduction: The prognosis of diffuse large B-cell lymphoma (DLBCL) is assessed by the International Prognostic Index (IPI). Since 1993 developments in diagnosis and therapy have improved the prognosis of DLBCL, especially for high-risk groups. Although IPI remains prognostic, its ability to estimate treatment failure has reduced. FDG-PET-CT has been routinely implemented to evaluate the lymphoma extent at baseline and the metabolic response during treatment. At baseline, FDG-PET-CT also quantifies more accurately the tumor burden by two metabolic measures, the total metabolic tumor volume (TMTV) and the distance between 2 lesions (SDmax), and a host parameter, the lumbar subcutaneous adipose density (LSAD). We recently demonstrated that the MVED2 score (TMTV, ECOG PS, SDMax, LSAD) allowed to discriminate the very high-risk DLBCL pts. The aim of this analysis was to compare the performance of MVED2 score to the IPI and other prognostic scores for DLBCL, NCCN IPI, international metabolic prognostic index (IMPI), and the ECOG/TMTV score. Methods: Pts were included in the REMARC study (NCT01122472), DLBCL >60–80 years old, responder to R-CHOP randomized between lenalidomide or placebo maintenance. The discriminatory power measured by C-index was compared between the MVED2 score (0.59 (if TMTV > 220) + 0.57 (if ECOG PS ≥ 2) + 0.76 (if SDMax > 32) + 0.70 (if LSAD > −90)) and the other scores. Results: 273 patients were analyzed. According to the MVED2 score, 10% of the patients were classified into the high-risk category, compared to 38% into the high-risk (4–5) IPI, 14% high-risk NCCN IPI, 10% into the IMPI, and 10% into the high-risk ECOG-PS score. The MVED2 score had a significant impact on PFS (p < 0.001) and OS (p < 0.001). The MVED2 score allowed better identification of pts with shorter PFS and OS than did the IPI, the NCCN IPI, the IMPI, and the ECOG-PS score. The MVED2 score displayed higher model performance than IPI and the other scores, showing a higher C-index for both PFS and OS (Table 1). Conclusion: The MVED2 score outperforms IPI, NCCN IPI, IMPI, and TMTV/ECOG score, and enables individualized estimates of pts outcome. *H risk pts with event/total—** L and I risk pts without PFS/total—*** 95% CI Keyword: risk models No conflicts of interests pertinent to the abstract.