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- Title
The classic prognostic factors in advanced Hodgkin's lymphoma patients are losing their meaning at the time of Pet-guided treatments.
- Authors
Bari, Alessia; Marcheselli, Raffaella; Sacchi, Stefano; Re, Alessandro; Pagani, Chiara; Tucci, Alessandra; Botto, Barbara; Vitolo, Umberto; Molinari, Anna Lia; Puccini, Benedetta; Pulsoni, Alessandro; Santoro, Armando; Tani, Monica; Nassi, Luca; Meli, Erika; Pavone, Vincenzo; Bonfichi, Maurizio; Evangelista, Andrea; Gioia, Daniela; Levis, Alessandro
- 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.
- Subjects
HODGKIN'S disease; LEUKOCYTE count; AUTOTRANSPLANTATION; STEM cell transplantation; HODGKIN'S disease treatment; RESEARCH; CLINICAL trials; DOXORUBICIN; DACARBAZINE; RESEARCH methodology; ANTINEOPLASTIC agents; PROGNOSIS; EVALUATION research; MEDICAL cooperation; AUTOGRAFTS; TUMOR classification; COMPARATIVE studies; BLEOMYCIN; VINBLASTINE
- Publication
Annals of Hematology, 2020, Vol 99, Issue 2, p277
- ISSN
0939-5555
- Publication type
journal article
- DOI
10.1007/s00277-019-03893-7