International prognostic score in advanced Hodgkin’s lymphoma

LYMPHOID TUMORS , , , ,

K.D. Kaplanov1, A.L. Shipaeva1, V.A. Vasil’yeva1, E.G. Gemdjian2, I.V. Matveeva1, L.S. Tregubova1, T.U. Klitochenko1, K.V. Demidenko1, O.B. Kalashnikova1, G.U. Vyskub1, O.E. Golubeva1, O.V. Levina1, V.A. Orlov1, and E.A. Demina3

1 Volgograd Regional Oncology Clinic #1, Volgograd, Russian Federation

2 Hematology Research Center, RF Ministry of Health, Moscow, Russian Federation

3 N.N. Blokhin Russian Cancer Research Center, RAMS, Moscow, Russian Federation

ABSTRACT

Since chemotherapy of Hodkgin’s lymphoma was introduced in early 60s, it has undergone fundamental changes that were associated with dramatic improvement in the disease prognosis. Currently, the various intensive modifications of original BEACOPP, such as BEACOPP-14 and escalate BEACOPP, are among the most widely used for treatment of advanced Hodkgin’s lymphoma.

Initially, the International Prognostic Score (IPS) was developed for patients treated with MOPP and MOPP-ABVD protocols. We suggest that due to the well-known changing value of the various prognostic signs with protocols of different intensity, the significance of IPS for BEACOPP-based therapy should be reconsidered.

One hundred seventy two patients with advanced Hodgkin’s lymphoma were included in our trial. All these patients were treated at the Hematology department of Volgograd Regional Oncology Clinic #1. Treatment options were as follows: 64 (37%), 84 (49%), and 24 (14%) patients received intensive BEACOPP-based, standard BEACOPP, or ABVD therapy, respectively. The final data presented are related to the period up to June 30, 2012.

We retrospectively evaluated the treatment outcomes for each IPS group. To distinguish the most significant prognostic signs from all six IPS factors, we studied the impact of each factor on treatment efficacy.

The greatest difference in overall 3- and 4-year survival was observed between the groups of patients with IPS 0–1 and ³ 2; for IPS 0–1, 3- and 4-year overall survival rate was 93%; for IPS ³ 2, 3- and 4-year overall survival rate was 81% and 75%, respectively (p = 0.05). 3-year overall survival was significantly negatively affected by such factors as age over 45 (70% versus 87%, relative risk (RR) = 3.95% CI: 1.7–7, p = 0.01) and albumin level < 40 g/L (79% versus 88%, RR= 2.8, 95% CI: 1.2–6.8, p = 0.02). Overall 3-year survival rate in males (n = 91) and females (n = 81) was 80% and 88%, respectively (p = 0.09). We found no effect on overall and freedom-from-treatment-failure survival (FFTF) of such factors as hemoglobin levels, lymphocyte count, leukocytes count, and IV stage disease. With respect to overall survival, multivariate analysis showed the greatest significance of age (relative risk, RR =3.6, 95% CI: 1.8–7, p = 0.001) and albumin level (OR = 2.6, 95% CI: 1.1–6, p = 0.036).

Keywords: Hodgkin’s lymphoma, international prognostic score (IPS), advanced stages, overall survival (OS), freedom-from-treatment-failure survival (FFTFS), BEACOPP, ABVD

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