American Board of Internal Medicine (ABIM) Certification Practice Exam

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What is the greatest influence on the prognosis in patients with diffuse large B-cell lymphoma?

Age at diagnosis
The presence of secondary malignancies
The revised International Prognostic Index (r-IPI) score
Type of chemotherapy administered

The correct answer is: The revised International Prognostic Index (r-IPI) score

The greatest influence on prognosis in patients with diffuse large B-cell lymphoma (DLBCL) is indeed the revised International Prognostic Index (r-IPI) score. The r-IPI is a clinical tool used to predict outcomes in patients with DLBCL based on several parameters, including age, stage of the disease, lactate dehydrogenase (LDH) levels, Eastern Cooperative Oncology Group (ECOG) performance status, and extranodal involvement. This scoring system stratifies patients into different risk categories, allowing clinicians to estimate the likelihood of treatment success and overall survival rates. Higher r-IPI scores indicate worse prognostic outcomes, making it a crucial factor when assessing treatment options and expected responses in DLBCL. Other factors such as age at diagnosis, presence of secondary malignancies, and the type of chemotherapy administered do influence prognosis to some degree, but they do not have the comprehensive impact that the r-IPI score has in predicting patient outcomes based on a combination of clinical and biological characteristics. The r-IPI thus serves as a standardized measure that is widely recognized in clinical practice, making it the most significant prognostic factor in this context.