The International Prognostic Factors Project on advanced HL developed a prognostic score to predict treatment outcome in patients with advanced disease treated with modern chemotherapy,with or without radiotherapy (RT).The score incorporates seven adverse prognostic factors (APF): age ≥45yrs old, male sex, stage IV, hemoglobin<10.5,serum albumin <4 g/dl,leukocytosis≥ 15×109/L and lymphocytopenia (< 0.6× 109/L). Patients with ≤ 2 APF have a two year freedom from progression of 80% while those with 3 or more APF have a worse outcome, each additional factor reduces the prognosis by about 8%.
To study the utility of IPS in less advanced disease, we looked into our patients included in the HD 98 protocol for stages I–II HL.According to this protocol, patients without bulky disease,B symptoms or N< 3, received 4 cycles of standard ABVD plus IFRT.Patients with one or more of the unfavourable characteristics received 6–8 cycles of standard ABVD plus RT in areas of bulky or residual disease.Since December 98, ninety two patients have been included, 91 are evaluable for this report.Patient characteristics were as follows: 44 males,47 females, Age 30yr (15–80).Histologic subtypes were: LP:5, NS:64, MC:21, LR:1. Clinical stages IA:13, IAX: 3, IB:1, IBX:3, IIA:34, IIAX:13, IIB:19, IIBX:5.
Looking to IPS impact in freedom from progression we have simply considered two subgroup of patients: low risk (<3APF) and high risk (≥ 3APF).Only 6/91 patients belonged to the high risk group. With ABVD 92% of the patients got a CR.Four patients were considered to be primary resistant, we have lost follow up of two patients, three persons have relapsed and two of them got a second CR. Currently 85/91 are alive, with a median FU of 56 months .All patients with a high IPS obtained a prolonged CR . Three patients have relapsed at 7,13 and 30 months;all belonged to the low risk IPS group.Four patients with primary resistant HL have died, three of them had had an autologus bone marrow transplant .All primary resistant HL belonged to the low risk IPS group.
We think that IPS is not useful in stages I–II HL, because it is only significantly altered in less than 10% of the patients. One possible explanation might be, that IPS relies on laboratory parameters such as white cell counts in peripheral blood, hemoglobin levels and serum albumin which are less affected, in early stages of the disease .Interestingly 5/6 patients with high risk IPS had B symptoms and 3/5 had bulky or N3 disease, consequently they received 6–8 cycles of ABVD. These facts, might have had influence in our results.
In our experience resistance to ABVD have a dismal prognosis in HL. IPS was not a good predictor of progression or resistance in this cohort of patients.
Disclosure: No relevant conflicts of interest to declare.