A Numerical Prognostic Index for Clinical use in Identification of Poor-Risk Patients with Hodgkin's Disease at Diagnosis

Abstract

The aim of this study was to assess the feasibility of using objective data obtained at the time of diagnosis of Hodgkin's disease to predict those patients who were likely to die of progressive disease within four years. Ninety-two consecutive patients from one centre (Newcastle upon Tyne) were used to construct a numerical index based on disease stage (Ann Arbor), age, haemoglobin and absolute lymphocyte count. Weight was assigned according to a predictive value from univariate and multivariate analyses based on survival. The index produced was then validated on a separate patient set (455) from other centres within the Scotland and Newcastle Lymphoma Group (SNLG) on whom the same prospective information was available. The index produced provided a useful separation of those patients destined to die of disease. In 101 patients with index > 0.5, 62 (61.4%) were dead at four years, whereas with index < 0.5, 61 (18%) of 336 patients were dead at four years. The index includes Ann Arbor stage but possesses additional practical prognostic value which allows identification of patients with early stage destined to die of disease. Of 149 patients with Stage IA and IIA disease 15 patients had index > 0.5, and 10 (60%) have died, whereas the remaining patients had survival of 90% and 85% respectively. This numerical index has now been strengthened by an added factor for bulk disease > 10 cms and in the SNLG it has replaced Ann Arbor staging for selection of patients requiring aggressive therapy. A randomized study of chemotherapy versus chemotherapy plus autotransplant in first remission using high dose melphalan and VP16 is currently in progress.

Hodgkin's disease in the elderly: a population‐based study

“…Our study suggests that results of treatment in the older patient with HD have not improved since the studies first published in the 1980s (Kennedy et al, 1985). Improvements in treatment outcomes in younger patients have been due to the introduction of more intensive regimens (Proctor et al, 1992;Bartlett et al, 1995;Diehl et al, 1998) but these are poorly tolerated in older patients, even among those initially considered fit enough to undergo intensive treatment. In an effort to improve results by minimizing toxicity, specific regimens for the elderly have been introduced; CVP/ CEB (cyclophosphamide, vincristine, prednisone/carboplatin, etoposide, bleomycin) (Levis et al, 1996) was found to be well tolerated but, unfortunately, the relapse rate was high, a pattern similar to that seen in our small cohort of patients treated within the Scotland and Newcastle Lymphoma Group with PCOME (Table IV; data not shown).…”

The role of radiation therapy in patients with Hodgkin’s lymphoma

“…Over the years, several groups have described prognostic scores and used these factors to tailor treatment [17,18]. At present, treatment is adjusted for patients who are classified into different prognostic groups based on a combination of clinical, biological, and pathological characteristics and extensive staging procedures.…”

Extranodal Hodgkin Disease: Spectrum of Disease

“…Consequently, therapeutic strategies are tailored according to initial prognostic factors. All prognostic scores established for Hodgkin disease take into account either the presence of stage IV disease or the number of extranodal sites (1)(2)(3). Therapeutic groups are determined according to biologic factors (eg, anemia, lymphopenia) and the extent of disease (eg, number of lymph nodes or presence of bulky tumor, extranodal involvement, stage IV disease).…”