Stage IV and age over 45 years are the only prognostic factors of the International Prognostic Score for the outcome of advanced Hodgkin lymphoma in the Spanish Hodgkin Lymphoma Study Group series

Abstract

The International Prognostic Score (IPS) is the most widely used system to date for identifying risk groups for the outcome of patients with advanced Hodgkin lymphoma, although important limitations have been recognized. We analyzed the value of the IPS in a series of 311 patients with advanced classical Hodgkin lymphoma (cHL) (Ann Arbor stage III, IV or stage II with B symptoms and/or bulky masses) treated with first-line chemotherapy including adriamycin (adriamycin, bleomycin, vinblastine, dacarbazine [ABVD] or equivalent variants). In univariate and multivariate analyses, stage IV disease and age ≥ 45 years were the only factors with independent predictive significance for overall survival (OS) (p = 0.002 and p < 0.001, respectively). Stage IV was still significant for freedom from progression (FFP) (p = 0.001) and age ≥ 45 years was borderline significant (p = 0.058). IPS separates prognostic groups, as in the original publication, but this is mainly due to the high statistical significance of stage IV and age ≥ 45 years. Moreover, the combination of these two factors enables a simpler system to be constructed that separates groups with different FFP and OS. In conclusion, in our series, stage IV and age ≥ 45 years are the key prognostic factors for the outcome of advanced cHL.

Keywords::

• Hodgkin lymphoma
• International Prognosis Score (IPS)
• outcome prediction

Acknowledgements

This work was supported, in part, by grants from the FIS (Fondo Investigaciones Sanitarias, Ministerio de Sanidad, Spain) N°08/1985 and Asociación Española contra el Cancer (AECC) 2010.

Potential conflict of interest:

Disclosure forms provided by the authors are available with the full text of this article at www.informahealthcare.com/lal.

Appendix

The following centers and investigators participate in the Spanish Hodgkin Lymphoma Study Group and contribute to the studies with tumor samples and clinical data:

R. Ramos, J. Rodríguez, F. Mestre (Hospital Son Dureta, Palma de Mallorca); P. Domínguez, C. Jara (Fundación Hospital Alcorcón, Madrid); M. J. Mestre, R. Quibén, M. Méndez (Hospital de Móstoles, Madrid); M. A. Martínez, C. Grande (Hospital 12 de Octubre, Madrid); M. García-Cosío, C. Montalbán, J. García-Laraña (Hospital Ramón y Cajal, Madrid); M. Canales, J. Alves (Hospital La Paz, Madrid); C. Bellas, M. Provencio (Hospital Puerta de Hierro, Madrid); A. Castaño, P. Sánchez-Godoy (Hospital Severo Ochoa, Leganés, Madrid); C. Martín, R. Martínez (Hospital Clínico Universitario San Carlos, Madrid); J. Menárguez, P. Sabín, E. Flores (Hospital Gregorio Marañón, Madrid); J. González-Carrero, C. Poderós (Hospital Xeral-Cies, Vigo); A. Salar, S. Serrano (Hospital del Mar, Barcelona); T. Álvaro, L. Font (Hospital Verge de la Cinta, Tortosa); V. Romagosa, A. Fernández de Sevilla (Hospital Duran i Reynalds, Institut Catala d'Oncologia, Barcelona); M. Mollejo, M. A. Cruz (Hospital Virgen de la Salud, Toledo); A. Cánovas, C. Camarero (Hospital de Cruces, Baracaldo). H. Álvarez-Arguelles, M. Llanos (Hospital Universitario Canarias, Tenerife); R. Arranz, A. Acevedo (Hospital La Princesa, Madrid); R. García-Sanz, T. Flores (Hospital Universitario de Salamanca); C. Morante (Hospital Cabueñes, Gijón); A. Marín, E. Ríos (Hospital Virgen del Rocío, Sevilla); F. Mazorra, E. Conde (Hospital Marqués de Valdecilla, Santander); M. F. Fresno, C. Rayón, C. Nicolás (Hospital Central de Asturias, Oviedo); C. Santonja, Jose L. López (Fundación Jiménez Díaz, Madrid); T. Flores, R. García-Sanz (Hospital Universitario de Salamanca, Salamanca); J. Guma (Hospital Sant Joan, Reus); P. Gonzalvo (Hospital Comarcal de Jarrio, Coaña); G. Fernández (Hospital Alvarez Buylla, Mieres); J. Forteza, M. Fraga, J. L. Bello (F Med Santiago de Compostela); A. Bas (Hospital Universitario Virgen de la Arrixaca, Murcia); J. R. Méndez (Hospital Valle de Nalón, Asturias); J.F. Tomás, M. Estevez, J. F. García (MD Anderson España, Madrid); C. Ruiz-Marcellán , A. López (Hospital Vall d'Hebron) and, M. M. Morente (CNIO, Madrid) and M. A. Piris (Hospital Marques de Valdecilla, Santander).