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

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

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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.

Original languageEnglish (US)
Pages (from-to)530-538
Number of pages9
JournalBritish Journal of Haematology
Volume171
Issue number4
DOIs
StatePublished - Nov 1 2015

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Hodgkin Disease
Survival
Age Factors
Hemoglobins
Proportional Hazards Models
Calibration
Multivariate Analysis

All Science Journal Classification (ASJC) codes

  • Hematology

Cite this

Diefenbach, Catherine S. ; Li, Hailun ; Hong, Fangxin ; Gordon, Leo I. ; Fisher, Richard I. ; Bartlett, Nancy L. ; Crump, Michael ; Gascoyne, Randy D. ; Wagner Jr., Henry ; Stiff, Patrick J. ; Cheson, Bruce D. ; Stewart, Douglas A. ; Kahl, Brad S. ; Friedberg, Jonathan W. ; Blum, Kristie A. ; Habermann, Thomas M. ; Tuscano, Joseph M. ; Hoppe, Richard T. ; Horning, Sandra J. ; Advani, Ranjana H. / Evaluation of the International Prognostic Score (IPS-7) and a Simpler Prognostic Score (IPS-3) for advanced Hodgkin lymphoma in the modern era. In: British Journal of Haematology. 2015 ; Vol. 171, No. 4. pp. 530-538.
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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.",
author = "Diefenbach, {Catherine S.} and Hailun Li and Fangxin Hong and Gordon, {Leo I.} and Fisher, {Richard I.} and Bartlett, {Nancy L.} and Michael Crump and Gascoyne, {Randy D.} and {Wagner Jr.}, Henry and Stiff, {Patrick J.} and Cheson, {Bruce D.} and Stewart, {Douglas A.} and Kahl, {Brad S.} and Friedberg, {Jonathan W.} and Blum, {Kristie A.} and Habermann, {Thomas M.} and Tuscano, {Joseph M.} and Hoppe, {Richard T.} and Horning, {Sandra J.} and Advani, {Ranjana H.}",
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Diefenbach, CS, Li, H, Hong, F, Gordon, LI, Fisher, RI, Bartlett, NL, Crump, M, Gascoyne, RD, Wagner Jr., H, Stiff, PJ, Cheson, BD, Stewart, DA, Kahl, BS, Friedberg, JW, Blum, KA, Habermann, TM, Tuscano, JM, Hoppe, RT, Horning, SJ & Advani, RH 2015, 'Evaluation of the International Prognostic Score (IPS-7) and a Simpler Prognostic Score (IPS-3) for advanced Hodgkin lymphoma in the modern era', British Journal of Haematology, vol. 171, no. 4, pp. 530-538. https://doi.org/10.1111/bjh.13634

Evaluation of the International Prognostic Score (IPS-7) and a Simpler Prognostic Score (IPS-3) for advanced Hodgkin lymphoma in the modern era. / Diefenbach, Catherine S.; Li, Hailun; Hong, Fangxin; Gordon, Leo I.; Fisher, Richard I.; Bartlett, Nancy L.; Crump, Michael; Gascoyne, Randy D.; Wagner Jr., Henry; Stiff, Patrick J.; Cheson, Bruce D.; Stewart, Douglas A.; Kahl, Brad S.; Friedberg, Jonathan W.; Blum, Kristie A.; Habermann, Thomas M.; Tuscano, Joseph M.; Hoppe, Richard T.; Horning, Sandra J.; Advani, Ranjana H.

In: British Journal of Haematology, Vol. 171, No. 4, 01.11.2015, p. 530-538.

Research output: Contribution to journalArticle

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T1 - Evaluation of the International Prognostic Score (IPS-7) and a Simpler Prognostic Score (IPS-3) for advanced Hodgkin lymphoma in the modern era

AU - Diefenbach, Catherine S.

AU - Li, Hailun

AU - Hong, Fangxin

AU - Gordon, Leo I.

AU - Fisher, Richard I.

AU - Bartlett, Nancy L.

AU - Crump, Michael

AU - Gascoyne, Randy D.

AU - Wagner Jr., Henry

AU - Stiff, Patrick J.

AU - Cheson, Bruce D.

AU - Stewart, Douglas A.

AU - Kahl, Brad S.

AU - Friedberg, Jonathan W.

AU - Blum, Kristie A.

AU - Habermann, Thomas M.

AU - Tuscano, Joseph M.

AU - Hoppe, Richard T.

AU - Horning, Sandra J.

AU - Advani, Ranjana H.

PY - 2015/11/1

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N2 - 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.

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