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Leo I. Gordon, MD, FACP


Predicting Tolerability to Immunochemotherapy in DLBCL: Novel Tool Under Study

By: Julia Fiederlein
Posted: Friday, April 1, 2022

Tarec C. El-Galaly, MD, of Aalborg University Hospital, Denmark, and colleagues developed a tool to identify patients with newly diagnosed diffuse large B-cell lymphoma who are unlikely to tolerate a full course of treatment with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). The results of this study, which were published in JCO Clinical Cancer Informatics, may inform treatment decisions in this population.

“The Tolerability of R-CHOP in Aggressive Lymphoma (TRAIL) score is a simple model that can be easily applied in a clinical setting,” the investigators remarked. “This model showed superior performance [compared with] other commonly used prognostic factors for chemotherapy tolerability, such as age, International Prognostic Index, and Eastern Cooperative Oncology Group, in two validation data sets.”

The TRAIL score was developed using a training data set from the phase III GOYA trial; the investigators focused on patients who prematurely stopped or required reductions of treatment with R-CHOP. Robustness of the final model was evaluated using a GOYA holdout data set and the phase III MAIN data set as external validation.

This model comprises four predictors available in the routine clinical setting: Charlson Comorbidity Index, presence of cardiovascular disease or diabetes, serum albumin, and creatinine clearance. With use of the area under the curve, the model generalization performance was estimated to be around or above 0.70 in the GOYA training, GOYA holdout, and MAIN data sets. After classifying patients into low-, intermediate- and high-risk categories, the tolerability event rates were, respectively, determined for each validation data set: 3.3%, 12.4%, and 32.9% in the GOYA holdout data set; and 9.7%, 9.7%, and 34.2% in the MAIN data set.

Disclosure: For full disclosures of the study authors, visit

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