SENIOR-IPI: An easily applicable prognostic index for first-line large B-cell lymphomas patients >80 years treated with curative intent.

Using LYmphoma Study Association clinical trials combining 438 first-line large B-cell lymphomas (LBCL) patients >80 years old, we defined SENIOR-IPI, an easily applicable prognostic index for this elderly population treated with an anti-CD20-miniCHOP (cyclophosphamide, doxorubicin, vincristine and prednisone)-based regimen. SENIOR-International Prognostic Index (SENIOR-IPI) takes into account accessible variables (number of aaIPI predictors, lactate dehydrogenase > 3x Upper Limit of Normal (LDH >3× ULN), albumin <35 g/L and number of years over 80) and segregates patients into four risk categories. In the training cohort, SENIOR-IPI performed better than IPI, age-adjusted IPI (aaIPI) and National Comprehensive Cancer Network IPI (NCCN-IPI) for progression-free survival (PFS) and overall survival (OS). The validation cohort included 195 patients from the real-world REal world all dAta in LYmphoma and Survival in Adults (REALYSA) cohort and confirmed better performance of SENIOR-IPI than IPI, aaIPI and NCCN-IPI both for PFS (C-index 0.66 vs. 0.61, 0.64 and 0.61 respectively) and OS (C-index 0.67 vs. 0.59, 0.62 and 0.61 respectively). Restricted mean survival times at 2 and 5 years were also evaluated: at 2 years, 10 additional SENIOR-IPI points led to 3.7 and 3.6 months of survival lost, respectively, in the training and validation cohorts. Overall, SENIOR-IPI is an easily applicable and reproducible prognostic index, using only readily available clinical and biological data, which better stratifies prognosis of LBCL patients >80 years old fit for age-adapted immunochemotherapy than IPI, aaIPI and NCCN-IPI.