Hematology-Oncology - Volume 12, Part5, Sept/Oct 2017

30 Hospital Physician Board Review Manual www.mdedge.com/jcso/hphemonc
Advanced Stage and Relapsed/Refactory Hodgkin Lymphoma

This index consists of 7 factors: male gender,
age 45 years or older, stage IV disease, hemoglo-
bin < 10. 5 g/dL, white blood cell (WBC) count
> 15,000/μL, lymphopenia (absolute lympho-
cyte count < 600 cells/μL or lymphocytes < 8%
of WBC count), and serum albumin < 4 g/dL. 5
In the original study by Hasenclever et al, 5 the
5-year freedom from progression (FFP) ranged
from 42% to 84% and the 5-year overall survival
(OS) ranged from 56% to 90%, depending
on the number of factors present. This scor-
ing system, however, was developed using a
patient population treated prior to 1992. Using
a more recently treated patient population,
the British Columbia Cancer Agency (BCCA)
found that the IPS is still valid for prognostica-
tion, but outcomes have improved across all IPS
groups, with 5-year FFP now ranging from 62%
to 88% and 5-year OS ranging from 67% to
98%. 6 This improvement is likely a reflection of
improved therapy and supportive care. Table 1
shows the PFS and OS within each IPS group,
comparing the data from the German Hodgkin
Study Group (GHSG) and BCCA group. 5, 6 A
closer evaluation of the 7 IPS variables was per-
formed using data from patients enrolled in the
Eastern Cooperative Oncology Group (ECOG)
2496 trial. 7 This analysis revealed that, though
the original IPS remained prognostic, its prog-
nostic range has narrowed. Age and stage of
disease remained significant for FFP, while
age, stage of disease, and hemoglobin level
remained significant for OS. An alternative
prognostic index, the IPS- 3, was constructed
using age, stage, and hemoglobin levels. IPS- 3,
which identifies 4 risk groups, performed as a
better tool for risk prediction for both FFP and
OS, suggesting that it may provide a simpler
and more accurate risk assessment than the IPS
in advanced HL. 7

High expression of CD68 is associated with adverse outcomes, whereas high FOXP3 and CD20 expression on tumor cells are predictors of superior outcomes. 8 A recent study found that CD68 expression was associated with OS. Five-year OS was 88% in those with less than