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.

中文翻译：

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晚期霍奇金淋巴瘤患者的经典预后因素在接受宠物指导治疗时已失去其意义。

国际预后评分（IPS）是晚期霍奇金淋巴瘤（HL）患者最常用的风险分层工具。它包含七个与较差结果独立相关的临床参数：男性，年龄，IV期，血红蛋白水平，白细胞和淋巴细胞计数以及白蛋白水平。自IPS的发展以来，治疗和支持治疗取得了重大进展。最近的研究表明，由于ABVD疗法可改善结局，因此IPS的识别性较差。本研究的目的是基于中期PET扫描评估经典预后因素在适应性治疗时是否维持其预后意义。我们评估了520例接受PET引导的晚期HL患者的IPS的预后意义，HD0801试验中，PET2阳性患者在ABVD 2个周期后接受了早期干细胞移植的更严格治疗。我们观察到，在这些患者中，IPS和所有有助于IPS的单个参数一起完全丧失了其预后价值。此外，中性粒细胞，单核细胞，淋巴细胞及其比例也不再具有任何预测价值。我们相信，早期自体移植治疗的PET2阳性患者的生存结局有了实质性改善，可以解释IPS残余预后意义的完全消失。IPS完全失去了其预后价值，而所有有助于IPS的单个参数也随之丧失。此外，中性粒细胞，单核细胞，淋巴细胞及其比例也不再具有任何预测价值。我们相信，早期自体移植治疗的PET2阳性患者的生存结局有了实质性改善，可以解释IPS残余预后意义的完全消失。IPS完全失去了其预后价值，而所有有助于IPS的单个参数也随之丧失。此外，中性粒细胞，单核细胞，淋巴细胞及其比例也不再具有任何预测价值。我们相信，早期自体移植治疗的PET2阳性患者的生存结局有了实质性改善，可以解释IPS残余预后意义的完全消失。