Evaluation of the International Prognostic Score (IPS-7) and a Simpler Prognostic Score (IPS-3) for advanced Hodgkin lymphoma in the modern era.

Abstract

The International Prognostic Score (IPS-7) is the most commonly used risk stratification tool for advanced Hodgkin lymphoma (HL), however recent studies suggest the IPS-7 is less discriminating due to improved outcomes with contemporary therapy. We evaluated the seven variables for IPS-7 recorded at study entry for 854 patients enrolled on Eastern Cooperative Oncology Group 2496 trial. Univariate and multivariate Cox models were used to assess their prognostic ability for freedom from progression (FFP) and overall survival (OS). The IPS-7 remained prognostic however its prognostic range has narrowed. On multivariate analysis, two factors (age, stage) remained significant for FFP and three factors (age, stage, haemoglobin level) for OS. An alternative prognostic index, the IPS-3, was constructed using age, stage and haemoglobin level, which provided four distinct risk groups [FFP (P = 0·0001) and OS (P < 0·0001)]. IPS-3 outperformed the IPS-7 on risk prediction for both FFP and OS by model fit and discrimination criteria. Using reclassification calibration, 18% of IPS-7 low risk patients were re-classified as intermediate risk and 13% of IPS-7 intermediate risk patients as low risk. For patients with advanced HL, the IPS-3 may provide a simpler and more accurate framework for risk assessment in the modern era. Validation of these findings in other large data sets is planned.

• Authors: Catherine S Diefenbach, Hailun Li, Fangxin Hong, Leo I Gordon, Richard I Fisher, Nancy L Bartlett, Michael Crump, Randy D Gascoyne, Henry Wagner Jr, Patrick J Stiff, Bruce D Cheson, Douglas A Stewart, Brad S Kahl, Jonathan W Friedberg, Kristie A Blum, Thomas M Habermann, Joseph M Tuscano, Richard T Hoppe, Sandra J Horning, Ranjana H Advani
• Journal: British journal of haematology (Br J Haematol) Vol. 171 Issue 4 Pg. 530-8 (Nov 2015) ISSN: 1365-2141 [Electronic] England
• PMID: 26343802 (Publication Type: Comparative Study, Evaluation Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 John Wiley & Sons Ltd.

Chemical References

• Bleomycin
• Mechlorethamine
• Vincristine
• Vinblastine
• Etoposide
• Dacarbazine
• Doxorubicin
• Prednisone

Topics

• Age Factors
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, therapeutic use)
• Area Under Curve
• Bleomycin (administration & dosage)
• Clinical Trials, Phase III as Topic
• Dacarbazine (administration & dosage)
• Disease-Free Survival
• Doxorubicin (administration & dosage)
• Etoposide (administration & dosage)
• Hodgkin Disease (drug therapy, mortality, pathology)
• Humans
• Kaplan-Meier Estimate
• Mechlorethamine (administration & dosage)
• Multicenter Studies as Topic
• Prednisone (administration & dosage)
• Prognosis
• Proportional Hazards Models
• Randomized Controlled Trials as Topic
• Risk Assessment
• Risk Factors
• Sample Size
• Severity of Illness Index
• Survival Analysis
• Vinblastine (administration & dosage)
• Vincristine (administration & dosage)