International Prognostic Index IPI

The International Prognostic Factors Project for Advanced Hodgkin's lymphoma was initiated by the GHSG to propose a score that could predict for both freedom from progression of disease and overall sur-vival.24 Twenty-five cooperative groups or institutions participated and a total of 5141 cases treated with combination chemotherapy for advanced Hogkin's disease, with or without radiotherapy, were collected. The IPI score was calculated from the set of patients with complete data (31% of all patients) and partially validated on an additional 2643 patients (51%) with not all data available. Seven factors displayed independent prognostic value on progression-free survival: serum albumin less than 4.0 g/dL, hemoglobin less than 10.5 g/dL, male gender, stage IV disease, age more than or equal to 45 years, white-cell count more than or equal to 15,000/mm3, and lymphocyte count less than 600/mm3 or 8% of white-cell count. All seven factors were associated with coefficients of risk that were similar (range 1.26-1.49). Therefore, the IPI score was calculated as the sum of the factors present, ranging from 0 to 7. Among the "working" patient group (N = 1618), the score was equal to 0 in 7%, 1 in 22%, 2 in 29%, 3 in 23%, 4 in 12%, and more than or equal to 5 in 7%. In the validation patient group (N = 2643), these figures were 7, 25, 31, 22, 11, and 4%, respectively. The score highly predicted for progression-free survival, and a proposal was made that patients be sub-grouped in those presenting with 0-2 factors and those presenting with more than or equal to three factors. The IPI score also predicted for overall survival: the higher the score, the lower the survival rate. Later, Bierman and coworkers reported that the IPI score predicts for both event-free survival and overall survival in patients with advanced Hodgkin's lymphoma treated with autologous hematopoietic stem cell trans-plantation.25 The IPI score could be calculated for 579 of the 739 advanced-stage patients enrolled into the EORTC H34 trial.26 Forty percent of patients had 0-2 factors and 60% three factors or more. The 5-year progression-free survival rates were 84% and 74% in the two groups, respectively (P = 0.002), while the 8-year overall survival rates were 85% and 64% (P < 0.001) (unpublished data). The applicability of the IPI score to early stage disease (I-II-IIIA) was tested by the GHSG.27 The IPI score was applied to patients enrolled into two consecutive trials and could be calculated in 961 (70%) of all patients. In patients with unfavorable early stage disease (clinical stage I-II with one or more GHSG risk factors, or IIA without any risk factor), the IPI score (0-2 vs > 3) predicted for disease-free survival while it was found of no prognostic value in favorable early stage disease patients.

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