Are prognostic scores still useful for predicting outcomes for patients with advanced Hodgkin’s lymphoma?

This study examined if international prognostic scores (IPS) could help predict treatment outcomes for patients with advanced Hodgkin's lymphoma (HL). The authors found that the IPS system is losing its predictability as treatment strategies improve for these patients.

Patients with HL need to be treated based on the severity of the disease. The IPS system grades HL based on specific characteristics that may make HL more challenging to treat. These risk factors include being male, older than 45 years, having stage 4 disease, or having low levels of blood cells.

Since the IPS system was created, treatments for advanced HL have changed. PET scanning during chemotherapy treatment is commonly used to see how well treatment is working. The type and dose of chemotherapy can then be adjusted depending on how well the patient is responding. This strategy has improved results for patients, but it is unclear if it affects the predictability of the IPS system.

510 patients with advanced HL had PET scanning after 2 cycles of chemotherapy. 409 patients responded to treatment (PET-negative) and continued with planned chemotherapy. The cancer progressed in 101 patients (PET-positive) and they were given different chemotherapy.

Overall, 79.6% of patients did not experience cancer worsening within 24 months of treatment. This did not differ significantly based on PET status. 80.6% of patients who were PET-negative did not experience cancer worsening. 75.6% of patients who were PET-positive did not experience cancer worsening.

Most IPS factors did not predict how well patients responded to treatment.  For example, in the PET-negative group, 80.9% of male patients and 80.3% of female patients did not have cancer progression.  This was comparable to 78.2% of male patients and 72.6% of female patients in the PET-positive group. Similar results were seen for age, HL stage, blood protein levels, and certain white blood cell levels.

Certain IPS factors were associated with poor response to treatment. These included levels of red blood cells and lymphocytes (white blood cells that help fight infections). Low red blood cell levels (below 10.5 g/dL) predicted poor patient responses in the PET-negative group. Low lymphocyte levels (below 0.6 x 10⁹/L) predicted poor patient responses in the PET-positive group.

This study concluded that the IPS system may not be helpful in predicting which patients have unfavorable treatment outcomes. The authors suggest that more research is needed to identify more useful risk factors.