-Author name in bold denotes the presenting author
-Asterisk * with author name denotes a Non-ASH member
Clinically Relevant Abstract denotes an abstract that is clinically relevant.

PhD Trainee denotes that this is a recommended PHD Trainee Session.

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2121 Proposal of a Novel Latin American International Prognostic Index (LATAM-IPI) for Diffuse Large B-Cell Lymphoma (DLBCL) By the Grupo Para El Estudio De Linfoproliferativos En Latino-America (GELL)

Program: Oral and Poster Abstracts
Session: 627. Aggressive Lymphoma (Diffuse Large B-Cell and Other Aggressive B-Cell Non-Hodgkin Lymphomas)—Results from Retrospective/Observational Studies: Poster II
Hematology Disease Topics & Pathways:
Adult, Study Population, Clinically relevant
Sunday, December 6, 2020, 7:00 AM-3:30 PM

Luis Villela Villela, MD, MC1*, Ana Ramirez-Ibarguen, MD2*, Brady E Beltran, MD3,4*, Camila Peña, MD5*, Denisse A. Castro, MD6,7, Gladys P Agreda-Vasquez, MD8*, Myrna Candelaria, MD, PharmD9, Maria Alejandra Torres Viera, MD10,11*, Henry Idrobo, MD12,13*, Lorena Fiad, MD14*, Fabiola Valvert, MD15, Efreen Montaño Figueroa, MD, PhD16*, Juan Ospina Idarraga17*, Alana Von Glasenapp, MD18*, Sally Paredes, MD6*, Melani Otañez, MD19*, Fernando Perez-Jacobo20*, Daniela Zambrano21*, Humberto Martínez Cordero, MD22*, Virginia Otero, MD23*, Lidiane Andino24*, Mercedes Royg Arriola, MD25*, Maria Elvira Enciso, MD18*, Maria Prates, MD26, Cristaldo Nancy, MD27*, Ivan Perdomo, MD28*, Maria E Cabrera, MD21*, María Lorena Cardozo, MD29*, Cristobal Augusto Frutos Ortiz, MD30*, Eloisa Riva, MD31, Juan Antonio Choque, MD32*, Alfredo Reinaldo Quiroz, MD18*, Guilherme Fleury Perini, MD33*, David Gomez-Almaguer, MD 34, Guillermo J. Ruiz-Arguelles, FRCP, MACP35, Marcos Distefano36*, Katerine Garcia37*, Carolina Feres, MD33*, Mariana Kalmus38*, Julian Cordova39*, Magali DelosRios, MD40*, Rosio Baena, MD41*, Luis Malpica Castillo, MD42,43, Eduardo Sotomayor, MD44 and Jorge J. Castillo, MD45

1Campus Hermosillo, Universidad del Valle de Mexico, Hermosillo, Mexico
2Instituto Nacional de Cancerologia, Mexico, Mexico
3Departamento de Oncología y Radioterapia,, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
44Centro de Investigación de Medicina de Precisión, Universidad de San Martin de Porres, Lima, Peru
5Hematología del Hospital del Salvador, Santiago de Chile, Hematología del Hospital del Salvador, Santiago de Chile, Santiago, Chile
6Departamento de Oncología y Radioterapia, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
7Centro de Investigación de Medicina de Precisión, Universidad de San Martin de Porres, Lima, Peru
8Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
9Research Division, Instituto Nacional de Cancerología, Mexico City, Mexico
10Universidad Central de Venezuela, Caracas, Venezuela (Bolivarian Republic of)
11Clinica Santa Sofia, Caracas, Miranda, Venezuela
12Facultad de Medicina., Universidad Del Valle, Cali, Colombia
13Hospital Universitario del Valle, Cali, Colombia
14Hematología, Hospital Italiano de La Plata, La Plata, Argentina
15Instituto De Cancerología y Hospital Dr. Bernardo Del Valle (INCAN), Ciudad de Guatemala, Guatemala
16Hospital General de México, SSA, mexico, EM, Mexico
17Grupo Hemato-Oncologia, Insituto Nacional de Cancerología, Bogotá, Colombia
18Department of Hematology, Instituto de Prevision Social, Asuncion, Paraguay
19Hematology, Hospital General del Estado, Hermosillo, SO, Mexico
20Hematology and blood bank services, Hospital Central Norte PEMEX, CDMX, Mexico
21Hematology Service, Hospital del Salvador, Santiago, Chile
22Facultad de Medicina, Maestría en Epidemiología, Universidad el Bosque, Bogota, Colombia
23Hematology Service, Hospital Italiano, Buenos Aires, Argentina
24Hematology Service, Hospital Central del Instituto de Previsión Social, Asuncion, Paraguay
25Hospital Declinicas-Instituto Prev. Social, San Lorenzo, Central, PRY
26Hematology, Hospital Italiano La Plata, La Plata, Argentina
27Hospital Italiano de Buenos Aires (HIBA), Buenos Aires, Argentina
28Clínica Los Nogales, Bogota, Colombia
29Hematology Service, Hospital Central del Instituto de Previsión Social, Montevideo, URY
30Hospital Central Del Instituto De Prevision Social, Asuncion, Paraguay
31hematology service, Hospital de Clinicas & Hospital Britanico, Montevideo, Uruguay
32Servicio de Hematologia, Caja Nacional de Salud - Hospital de Especialidades Materno Infantil La Paz, La Paz, La Paz, Bolivia
33Hospital Israelita Albert Einstein, São Paulo, Brazil
34University of Nuevo Leon, Monterrey, Mexico
35Centro De Hematologia Medicina Interna, Puebla, Pue, Mexico
36Hematology Service, Hospital Solon Espinoza Ayala, Quito, Ecuador
37Hematology Service, Hospital de SOLCA, Guayaquil, Ecuador
38Inst. De Investigaciones Hematológicas Dr. M. R. Castex, Academia Nacional De Me, Buenos Aires, ARG
39Hematology Service, Clinica La Estancia, Popayan, Colombia
40Hematology Service, Clinica del Country, Bogota, Colombia
41Instituto Oncológico Nacional Caja Petrolera de Salud, Cochabamba, Bolivia
42Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
43University of North Carolina at Chapel Hill, Chapel Hill, NC
44George Washington University Cancer Center, Washington, DC
45Bing Center for Waldenström Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA

Introduction. There are different scoring systems to differentiate risk groups in patients with DLBCL treated with chemoimmunotherapy. Those systems have used the same 5 variables (age, performance status, LDH, stage, extranodal involvement) for 27 years. However, LATAM data have not been included in the development of previous scoring systems. It is important to mention that novel biological variables, such as albumin, beta-2-microglobulin (B2M) and platelet/lymphocyte ratio (PLR), have been reported and could improve discrimination (Villela et al. Blood 2019; 134Suppl_1: 1613). Therefore, we carried out a large, multinational study to develop and validate a LATAM-IPI score.

Methods. This is a retrospective cohort of 1030 patients with a diagnosis of DLBCL treated with standard chemoimmunotherapy with curative intent between 2010 and 2018. Data were obtained from 8 LATAM countries: Argentina, Colombia, Chile, Guatemala, Mexico, Paraguay, Peru, and Venezuela. The five classic IPI variables (age, ECOG, extranodal involvement, LDH, stage) were analyzed and albumin and PLR were added (Villela et al. Blood 2019; 134Suppl_1: 1613). B2M was not included because it was not requested regularly in all countries. Development of LATAM-IPI: The training set consisted of 85% of the sample, randomly selected, and the remaining 15% was reserved for internal validation. Using the training set, the univariate and multivariate association between clinical prognostic factors and OS was analyzed fitting Cox proportional-hazard models.

Outcomes. Clinical characteristics of the training (n=878) and internal validation (n=151) cohorts are shown in Table 1. There were no statistical differences in baseline characteristics between the cohorts. The median follow-up for the whole cohort was 36 months (IQR: 11-57). When exploring the classic IPI variables on the training set, all variables were associated with high risk of mortality [age 65-74, Hazard Ratio (HR) 1.24, 95% CI 0.96 to 1.58, p=0.08; age ≥75, HR 1.71, 95% CI 1.28 to 2.28, p=0.0003), ECOG (≥ 2, HR=2, 95% CI 1.61 to 2.53; p<0.0001), EN (≥2, HR=1.53, 95% CI 1.18 to 1.97; p=0.0012), stage (III/IV, HR=2.1, 95% CI 1.64 to 2.69; p<0.0001) and LDH (ratio 1.1-2.9, HR=1.55, 95% CI 1.22 to 1.97; p=0.0003; ratio ≥3, HR= 2.68, 95% CI 1.93 to 3.7, p<0.0001). Similarly, the biological variables Albumin (≤3.5 mg/dL, HR 2.37, 95% CI 1.9 to 2.95, p<0.0001) and PLR (≥273, HR= 1.52, 95% CI 1.23 to 1.87; p=0.0001) were associated with high risk of death. Next, these variables were evaluated by multivariate analysis. The independent variables were albumin (<3.5 mg/dL, HR 1.84, 95% CI 1.45 to 2.3, p<0.0001, 1 point), LDH (ratio 1.1 to 2.9, HR 1.30, 95% CI 1.02 to 1.67, p=0.03, 1 point; ratio ≥3, HR=1.84, 95% CI 1.31 to 2.5, p=0.0004, 2 points), advanced stage (HR 1.65, 95% CI 1.27 to 2.13, p=0.0001, 1 point), age (≥75, HR= 1.51, 95% CI 1.15 to 1.98, p=0.003, 1 point), and ECOG (≥2, HR 1.40, 95% CI 1.10 to 1.77, p=0.005). Now, for the development of LATAM-IPI, the groups were distributed as follows: 0 points, low; 1-3 points, intermediate; 4-6 points, high risk. There were no differences in the distribution of the risk groups between training and validation sets (Table 2). In the learning cohort, the 5-year OS rates for low, intermediate and high risk were 81%, 63% and 33%, respectively (p<0.0001). In the validation cohort, the 5-year OS rates for low, intermediate and high risk were 81%, 63% and 44%, respectively (p=0.02) (Figure 1).

Conclusions: Using multinational learning and validation cohorts including over 1,000 DLBCL patients treated with standard chemoimmunotherapy in LATAM, we developed a novel LATAM-IPI score using age ≥75 years, ECOG ≥2, advanced stage, LDH ratio (1.1-29 and ≥3) and albumin <3.5 mg/dl. Next steps are to disseminate our results with other involved researchers in LATAM to prospectively assess and reproduce our results. We expect this score will help to further define the prognosis of DLBCL patients in LATAM.

Disclosures: Villela: amgen: Speakers Bureau; Roche: Other: advisory board, Speakers Bureau. Idrobo: Janssen: Honoraria, Speakers Bureau; Amgen: Honoraria, Speakers Bureau; Abbvie: Honoraria, Speakers Bureau; Tecnofarma: Honoraria, Speakers Bureau; Takeda: Honoraria, Speakers Bureau. Gomez-Almaguer: Amgen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; AbbVie: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Janssen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celgene/BMS: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; AstraZeneca: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Pfizer: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Roche: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Castillo: Abbvie: Research Funding; TG Therapeutics: Research Funding; Janssen: Consultancy, Research Funding; Beigene: Consultancy, Research Funding; Kymera: Consultancy; Pharmacyclics: Consultancy, Research Funding.

*signifies non-member of ASH