ORIGINAL RESEARCH article
Front. Oncol.
Sec. Hematologic Malignancies
A Novel Prognostic Model Integrating Host Vulnerability and Tumor Biology for Elderly Patients with Diffuse Large B-Cell Lymphoma: The BAMAL Score
Provisionally accepted
- Zhengzhou University, Zhengzhou, China
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Abstract Background: Clinical management of elderly patients with diffuse large B-cell lymphoma (DLBCL) is challenged by patient heterogeneity and frailty. Traditional prognostic models like the NCCN-IPI primarily focus on tumor-centric features, often overlooking host vulnerability. This study aimed to develop the BAMAL score, a novel prognostic model integrating tumor features with geriatric and biochemical markers. Methods: A retrospective cohort study analyzed 136 newly diagnosed DLBCL patients aged ≥65 years (Jan 2022–Jun 2023). Independent prognostic factors for overall survival (OS) were identified via multivariate Cox regression to construct the BAMAL score. Model performance was evaluated using time-dependent AUC, Akaike Information Criterion (AIC), calibration plots, and Decision Curve Analysis (DCA), comparing against IPI, R-IPI, and NCCN-IPI. Results: Five independent adverse predictors were identified: bone marrow involvement (HR 2.895), elevated AST (>40 U/L; HR 3.132), modified frailty index (mFI-5) ≥2 (HR 1.788), age ≥75 years (HR 1.437), and elevated LDH (>245 U/L; HR 1.993). The BAMAL score stratified patients into low-, intermediate-, and high-risk groups with significantly divergent 2-year OS rates (84.2%, 58.3%, and 16.7%, respectively; P<0.001). High-risk patients showed zero Complete Responses and significantly reduced tolerance to standard immunochemotherapy. Although the BAMAL AUC (0.760) was not statistically superior to NCCN-IPI (0.716), BAMAL demonstrated the best model fit (lowest AIC: 366.5). Furthermore, DCA indicated that BAMAL offered superior net clinical benefit for 2-year prediction, particularly in identifying high-risk patients (threshold probability >60%). Conclusion: The BAMAL score effectively synergizes tumor biology with host vulnerability, providing superior model fit and clinical utility compared to standard indices for geriatric DLBCL. It offers actionable insights by identifying high-risk patients for whom current cytotoxic regimens are futile, underscoring the urgent need for novel, chemotherapy-free approaches.
Keywords: BAMAL Score, Diffuse large B-cell lymphoma (DLBCL), elderly patients, Frailty, Host vulnerability, Prognostic model
Received: 09 Oct 2025; Accepted: 04 Feb 2026.
Copyright: © 2026 Feiyang Zong, Zhang, Hua, Zhang, Qiao, Duan and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Xudong Zhang
Qingjiang Chen
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