The classic prognostic factors in advanced Hodgkin’s lymphoma patients are losing their meaning at the time of Pet-guided treatments

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.

ABVD vs BEACOPP escalated in advanced‐stage Hodgkin’s lymphoma: Results from a multicenter European study

“…It should also be noted that, despite its historical importance, IPS has lost its prognostic value in the modern era using PET-guided therapy. 29 Nevertheless, it is also possible that a larger study may have captured the difference between the two treatment groups. In addition, our study used 6 cycles of BEACOPPesc, while 4 cycles has become the standard in PET2-negative patients since 2018.…”

The neutrophil to lymphocyte ratio (NLR) and the presence of large nodal mass are independent predictors of early response: A subanalysis of the prospective phase II PET‐2‐adapted HD0607 trial

“…40 Bari et al recently published that NLR, LMR, and IPS did not retain any predictive value in the HD0801 trial in which patients with a positive PET-2 (defined as carrying Deauville score 3 or more) after two ABVD cycles underwent a more intense treatment with an early stem-cell transplantation and four cycles of IGEV (ifosfamide, gemcitabine, vinorelbine, prednisone) regimen. 41 Since IPS maintained its prognostic meaning in those trials in which the treatment of PET-2 positive was switched from ABVD to escBEACOPP patients, the authors concluded that the intensification treatment with autologous transplantation in PET-2-positive patients could justify the disappearance of any relevant prognostic factor at baseline, including IPS and NLR. The discrepancy with our results could also be due to the different patient evaluation at PET-2, since in the HD0801 patients with DS = 3 or more belonged to the PET-2-positive cohort, while in the HD0607 trial DS = 3 belonged to the PET-2-negative cohort, and the salvage regimen was more intensive in the study design of the HD0801 trial.…”

First‐line treatment of stage IIB to stage IV classical Hodgkin lymphoma in Italy, Israel, and Spain: Patient characteristics, treatment patterns, and clinical outcomes

“…It has been suggested that PET2 assessments hold a superior prognosis potential to IPS [ 22 , 23 , 24 ]. There continues to be a debate surrounding the effectiveness of early‐response PET assessments to guide de‐escalation of therapy for patients with a high probability of cure after ABVD therapy and escalation for those at higher risk for treatment failure.…”

“…Nonetheless, PET2‐driven strategies have certain limitations. PET scans are not always easily interpretable and PET2‐negative patients do not always display long‐term remissions [ 21 , 22 ].…”