Development and Validation of a Novel Conditional Event-Free Survival Tool in Diffuse Large B-Cell Lymphoma

Zhengming Chen; Danny Luan; Rasmus Rask Kragh Jørgensen; Lasse Jakobsen; Matthew J Maurer; Tarec C El-Galaly; Loretta J Nastoupil; James R Cerhan; Christopher R Flowers; Brian K Link; Izidore S Lossos; Deborah M Stephens; Jonathon Cohen; Thomas M Habermann; Grzegorz Nowakowski; Nancy Bartlett; Jonathan W Friedberg; Brad S Kahl; John P Leonard; Peter Brown; Karin E Smedby; Mats Jerkeman; Peter Martin

doi:10.1002/ajh.70398

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Development and Validation of a Novel Conditional Event-Free Survival Tool in Diffuse Large B-Cell Lymphoma

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Development and Validation of a Novel Conditional Event-Free Survival Tool in Diffuse Large B-Cell Lymphoma

Zhengming Chen, Danny Luan, Rasmus Rask Kragh Jørgensen, Lasse Jakobsen, Matthew J Maurer, Tarec C El-Galaly, Loretta J Nastoupil, James R Cerhan, Christopher R Flowers, Brian K Link, …

American journal of hematology

06/04/2026

DOI: 10.1002/ajh.70398

PMID: 42240061

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Abstract

One quarter of patients with diffuse large B-cell lymphoma (DLBCL) who achieve a complete response following front-line therapy will eventually experience disease relapse. Existing prognostic models use baseline factors to predict outcomes from the start of initial therapy and are not intended for use following completion of treatment. We developed a conditional event-free survival (cEFS) tool that predicts a patient's risk of lymphoma recurrence after completing front-line therapy taking into consideration baseline risk characteristics plus the time the patient has been in remission. Model development used pooled and harmonized data from two observational cohorts and four randomized trials of patients with newly diagnosed DLBCL treated with immunochemotherapy and either achieving a complete response or not experiencing an event within 12 weeks of end of therapy. Cox proportional-hazards regression modeling with backwards stepwise selection was utilized for model development. External validation was performed using a large independent data registry. In total, data from 2757 patients were used for model development. The risk of experiencing an event at a time point after having survived a period of time could be computed parsimoniously using four basic predictors: age, ECOG performance status grade, Ann Arbor stage, and lactate dehydrogenase level. C-index in the model development cohort was 0.65 (95% CI, 0.63-0.68), compared to 0.64 (95% CI, 0.62-0.66) in the external validation cohort. We believe that this dynamic risk prediction tool will not only aid clinicians in providing data-driven recommendations for surveillance, but also assist patients themselves with key decisions, such as family planning.

Details

Title: Subtitle: Development and Validation of a Novel Conditional Event-Free Survival Tool in Diffuse Large B-Cell Lymphoma
Creators: Zhengming Chen - Cornell University
Danny Luan - Cornell University
Rasmus Rask Kragh Jørgensen - Aalborg University
Lasse Jakobsen - Aalborg University Hospital
Matthew J Maurer - Mayo Clinic
Tarec C El-Galaly - Aarhus University
Loretta J Nastoupil - The University of Texas MD Anderson Cancer Center
James R Cerhan - Mayo Clinic
Christopher R Flowers - The University of Texas MD Anderson Cancer Center
Brian K Link - University of Iowa
Izidore S Lossos - University of Miami
Deborah M Stephens - University of North Carolina at Chapel Hill
Jonathon Cohen - Emory University
Thomas M Habermann - Mayo Clinic
Grzegorz Nowakowski - Mayo Clinic
Nancy Bartlett - Washington University in St. Louis
Jonathan W Friedberg - University of Rochester Medical Center
Brad S Kahl - Washington University in St. Louis
John P Leonard - NYU Langone Health
Peter Brown - Rigshospitalet
Karin E Smedby - Karolinska University Hospital
Mats Jerkeman - Lund University
Peter Martin - NYU Langone Health
Resource Type: Journal article
Publication Details: American journal of hematology
DOI: 10.1002/ajh.70398
PMID: 42240061
NLM abbreviation: Am J Hematol
ISSN: 1096-8652
eISSN: 1096-8652
Publisher: Wiley
Grant note: National Cancer Institute of the National Institutes of Health: U10CA180820, U10CA180794, UG1CA232760, UG1CA233329, UG1CA233373, UG1CA233247, UG1CA233339, UG1CA233230
This work was supported by various grants, including P50CA97274 (MER), U01CA195568 (LEO), U10CA180821 (CALGB 50303), U10CA180888 (SWOG), and F2022-011 (LYFO). This study was coordinated by the ECOG-ACRIN Cancer Research Group (Peter J. O'Dwyer, MD and Mitchell D. Schnall, MD, PhD, Group Co-Chairs) and supported by the National Cancer Institute of the National Institutes of Health under award numbers: U10CA180820, U10CA180794, UG1CA232760, UG1CA233329, UG1CA233373, UG1CA233247, UG1CA233339, and UG1CA233230. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Language: English
Electronic publication date: 06/04/2026
Academic Unit: Hematology, Oncology, and Blood & Marrow Transplantation; Epidemiology; Internal Medicine
Record Identifier: 9985174501302771

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