Prognostic Scores In All Stages Experience of the Scotland and Newcastle Lymphoma Group SNLG therapy working party

From 1979 to 1986, 723 Hodgkin's lymphoma patients were registered and detailed clinical and laboratory data were collected by the SNLG.28 Sufficient information was available for 547 (76%) patients. Of these, 92 were used to develop a prognostic index and 455 for index validation. Almost half of the patients had stage III-IV disease. The end point used was overall survival.

Five factors were independently associated with a high risk of death with multivariate analysis: age, clinical stage, hemoglobin level, absolute lymphocyte count, and tumor bulk more than 10 cm. A prognostic index, I, was calculated as follows: I = 1.5858 - 0.0363 age + 0.0005 (age)2 + 0.0683 clinical stage - 0.086 lymphocyte count - 0.0587 hemoglobin [+ 0.3 if bulky disease present], in which age is entered as an absolute figure, clinical stage is coded according to Ann Arbor classification (IA, IIA, IIIA coded 1, IB or IIB coded 2, IIIB coded 3, IV coded 4), absolute lymphocyte count is entered as a score (< 1.0 X 109 /L coded 1, 1.0 - 1.5 X 109 /L coded 2, > 1.5 - 2.0 x 109 /L coded 3, > 2 X 109 /L coded 4), and hemoglobin in g/dL is entered as an absolute figure. Bulky disease, if available, corresponds to the presence of a single node more than or equal to 5 cm or mediastinal to thoracic ratio more than 0.30. Applied to the patients in the validation group, the index demonstrated its ability to discriminate patients at high risk of death if I > 0.5. It was also able to discriminate patients with classical Ann Arbor stage IA and IIA disease with poor prognosis. Later, the SNLG index was used to select poor risk patients to receive intensive multiagent chemotherapy with or without autotransplant.29

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