Abstract
The International Prognostic Score (IPS) is the most commonly used risk stratification tool for patients with advanced Hodgkin lymphoma (HL). It incorporates seven clinical parameters independently associated with a poorer outcome: male sex, age, stage IV, hemoglobin level, white blood cell and lymphocyte counts, and albumin level. Since the development of the IPS, there have been significant advances in therapy and supportive care. Recent studies suggest that the IPS is less discriminating due to improved outcomes with ABVD therapy. The aim of the present study was to asses if classic prognostic factors maintain their prognostic meaning at the time of response-adapted treatment based on interim PET scans. We evaluated the prognostic significance of IPS in the 520 advanced stage HL patients enrolled in the PET-guided, HD0801 trial in which PET2-positive patients underwent a more intense treatment with an early stem-cell transplantation after 2 cycles of ABVD. We observed that in these patients, the IPS completely loses its prognostic value together with all the single parameters that contribute to the IPS. Furthermore, neutrophils, monocytes, lymphocytes, and the ratio among them also no longer had any predictive value. We believe that the substantial improvement in survival outcomes in PET2-positive patients treated with early autologous transplantation could explain the complete disappearance of the residual prognostic significance of the IPS.
Highlights
The International Prognostic Score (IPS) is the most commonly used risk stratification tool for patients with advanced Hodgkin lymphoma (HL)
In an analysis restricted to 686 patients aged ≤ 65 years, as in the original index, the IPS remained prognostic for failure-free survival (FFS) and overall survival (OS), but with a narrower range of outcomes, probably related to the improvement in survival outcomes in all risk groups and mainly in the poorer-risk groups
In the 292 patients in which Absolute monocyte count (AMC) was added to the original CFR, we evaluated the prognostic meaning of AMC, neutrophil lymphocyte ratio (NLR), and lymphocyte monocyte ratio (LMR)
Summary
The International Prognostic Score (IPS) is the most commonly used risk stratification tool for patients with advanced Hodgkin lymphoma (HL) It incorporates seven clinical parameters independently associated with a poorer outcome: male sex, age, stage IV, hemoglobin level, white blood cell and lymphocyte counts, and albumin level. The results showed that all individual factors, with the exception of gender, were prognostic in univariate analysis for FFS, but only age and hemoglobin level maintained significance in multivariate analysis These results confirmed that IPS remains prognostic in patients with advanced-stage HL, but the range of outcomes delineated on the basis of the number of factors present at diagnosis has significantly diminished. The aim of the present study was to assess whether classic prognostic factors maintain their prognostic meaning at the time of PET-guided treatment
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