A 70-year-old man with diffuse large B-cell lymphoma (DLBCL) completes 6 cycles of R-CHOP and achieves complete metabolic response on PET-CT. What is the MOST important prognostic marker that was assessed at diagnosis to guide initial intensity of therapy in DLBCL?
- A International Prognostic Index (IPI) score ✓
- B Lactate dehydrogenase (LDH) level alone
- C Ki-67 proliferation index
- D Bone marrow trephine biopsy
Correct answer: A. International Prognostic Index (IPI) score
Explanation
The International Prognostic Index (IPI) — comprising age >60, stage III/IV, elevated LDH, ECOG PS ≥2, and >1 extranodal site — is the most validated and clinically used prognostic tool for DLBCL, stratifying patients into low, low-intermediate, high-intermediate, and high-risk groups influencing treatment decisions. LDH is one component of IPI but not sufficient alone. Ki-67 is more relevant for distinguishing Burkitt from DLBCL. Bone marrow biopsy is part of staging, not primary prognosis.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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