New Scoring System Devised for Youth With Hodgkin's Lymphoma

SAN DIEGO – A simple scoring system identified a subset of young patients with Hodgkin’s lymphoma who are predicted to have an event-free survival rate of less than 80%.

The system, known as the Childhood Hodgkin International Prognostic Score (CHIPS), found that four factors were predictive of worse event-free survival: stage IV disease, large mediastinal adenopathy, albumin level of less than 3.5 g/dL, and fever, Dr. Cindy L. Schwartz reported during a poster session at the annual meeting of the American Society of Hematology.

She and her associates with the Children’s Oncology Group evaluated 1,721 patients with intermediate risk Hodgkin’s lymphoma who were younger than age 21 and treated on AHOD0031: a phase III study of dose-intensive therapy.

The current study involved tailoring treatment by early response in 770 patients who were randomized or assigned to receive the same treatment (four cycles of doxorubicin, bleomycin, vincristine, etoposide, prednisone and cyclophosphamide (ABVE-PC) and 21 Gy involved field radiotherapy (IFRT).

According to Dr. Schwartz, director of the division of pediatric hematology/oncology at Hasbro Children’s Hospital, Providence, R.I., rapid early response was defined as a two-dimensional tumor reduction of greater than 60% on CT after two cycles of ABVE-PC. Complete response was defined as a greater than 80% two-dimensional reduction by CT, and resolution of nuclear imaging abnormalities.

Rapid responders who achieved complete response after two additional ABVE-PC treatments were randomized to receive 21 Gy radiation. Slow early responders were randomized to receive dexamethasone, etoposide, cisplatin, and cytarabine (DECA) in addition to the four ABVE-PC treatments and 21 Gy radiation treatment.

Using Cox regression analysis and multivariable predictive modeling, the researchers identified four predictors of event-free survival: stage IV disease (hazard ratio, 1.6), mediastinal adenopathy (HR 1.7), albumin of less than 3.5 g/dL (HR 1.8), and fever (HR 2.5).

Because the hazard ratios were similar, the researchers devised the CHIPS score, which gave one point for each of the four adverse predictors. Using this approach, they determined that the event-free survival rate was 90% for patients with a CHIPS score of 0 or 1, 78% for those with a CHIPS score of 2, and 62% for those with a CHIPS score of 3. (Because the study enrolled only patients with intermediate-risk disease, no one had a CHIPS score of 4.) From this they determined that 22% of an intermediate-risk population can be predicted to have an event-free survival rate of less than 80%.

"Now that we know who’s a good responder to initial chemotherapy, we’re going to try and change their treatment much earlier than we have been able to previously," Dr. Schwartz said in an interview. "The next thing to do is analyze some of the biologic factors that contribute to their response rate."

Studies of CHIPS in additional cohorts of newly diagnosed patients are also planned, she said.

Dr. Schwartz said that she had no relevant financial disclosures to make.

SAN DIEGO – A simple scoring system identified a subset of young patients with Hodgkin’s lymphoma who are predicted to have an event-free survival rate of less than 80%.

The system, known as the Childhood Hodgkin International Prognostic Score (CHIPS), found that four factors were predictive of worse event-free survival: stage IV disease, large mediastinal adenopathy, albumin level of less than 3.5 g/dL, and fever, Dr. Cindy L. Schwartz reported during a poster session at the annual meeting of the American Society of Hematology.

She and her associates with the Children’s Oncology Group evaluated 1,721 patients with intermediate risk Hodgkin’s lymphoma who were younger than age 21 and treated on AHOD0031: a phase III study of dose-intensive therapy.

The current study involved tailoring treatment by early response in 770 patients who were randomized or assigned to receive the same treatment (four cycles of doxorubicin, bleomycin, vincristine, etoposide, prednisone and cyclophosphamide (ABVE-PC) and 21 Gy involved field radiotherapy (IFRT).

According to Dr. Schwartz, director of the division of pediatric hematology/oncology at Hasbro Children’s Hospital, Providence, R.I., rapid early response was defined as a two-dimensional tumor reduction of greater than 60% on CT after two cycles of ABVE-PC. Complete response was defined as a greater than 80% two-dimensional reduction by CT, and resolution of nuclear imaging abnormalities.

Rapid responders who achieved complete response after two additional ABVE-PC treatments were randomized to receive 21 Gy radiation. Slow early responders were randomized to receive dexamethasone, etoposide, cisplatin, and cytarabine (DECA) in addition to the four ABVE-PC treatments and 21 Gy radiation treatment.

Using Cox regression analysis and multivariable predictive modeling, the researchers identified four predictors of event-free survival: stage IV disease (hazard ratio, 1.6), mediastinal adenopathy (HR 1.7), albumin of less than 3.5 g/dL (HR 1.8), and fever (HR 2.5).

Because the hazard ratios were similar, the researchers devised the CHIPS score, which gave one point for each of the four adverse predictors. Using this approach, they determined that the event-free survival rate was 90% for patients with a CHIPS score of 0 or 1, 78% for those with a CHIPS score of 2, and 62% for those with a CHIPS score of 3. (Because the study enrolled only patients with intermediate-risk disease, no one had a CHIPS score of 4.) From this they determined that 22% of an intermediate-risk population can be predicted to have an event-free survival rate of less than 80%.

"Now that we know who’s a good responder to initial chemotherapy, we’re going to try and change their treatment much earlier than we have been able to previously," Dr. Schwartz said in an interview. "The next thing to do is analyze some of the biologic factors that contribute to their response rate."

Studies of CHIPS in additional cohorts of newly diagnosed patients are also planned, she said.

Dr. Schwartz said that she had no relevant financial disclosures to make.

SAN DIEGO – A simple scoring system identified a subset of young patients with Hodgkin’s lymphoma who are predicted to have an event-free survival rate of less than 80%.

The system, known as the Childhood Hodgkin International Prognostic Score (CHIPS), found that four factors were predictive of worse event-free survival: stage IV disease, large mediastinal adenopathy, albumin level of less than 3.5 g/dL, and fever, Dr. Cindy L. Schwartz reported during a poster session at the annual meeting of the American Society of Hematology.

She and her associates with the Children’s Oncology Group evaluated 1,721 patients with intermediate risk Hodgkin’s lymphoma who were younger than age 21 and treated on AHOD0031: a phase III study of dose-intensive therapy.

The current study involved tailoring treatment by early response in 770 patients who were randomized or assigned to receive the same treatment (four cycles of doxorubicin, bleomycin, vincristine, etoposide, prednisone and cyclophosphamide (ABVE-PC) and 21 Gy involved field radiotherapy (IFRT).

According to Dr. Schwartz, director of the division of pediatric hematology/oncology at Hasbro Children’s Hospital, Providence, R.I., rapid early response was defined as a two-dimensional tumor reduction of greater than 60% on CT after two cycles of ABVE-PC. Complete response was defined as a greater than 80% two-dimensional reduction by CT, and resolution of nuclear imaging abnormalities.

Rapid responders who achieved complete response after two additional ABVE-PC treatments were randomized to receive 21 Gy radiation. Slow early responders were randomized to receive dexamethasone, etoposide, cisplatin, and cytarabine (DECA) in addition to the four ABVE-PC treatments and 21 Gy radiation treatment.

Using Cox regression analysis and multivariable predictive modeling, the researchers identified four predictors of event-free survival: stage IV disease (hazard ratio, 1.6), mediastinal adenopathy (HR 1.7), albumin of less than 3.5 g/dL (HR 1.8), and fever (HR 2.5).

Because the hazard ratios were similar, the researchers devised the CHIPS score, which gave one point for each of the four adverse predictors. Using this approach, they determined that the event-free survival rate was 90% for patients with a CHIPS score of 0 or 1, 78% for those with a CHIPS score of 2, and 62% for those with a CHIPS score of 3. (Because the study enrolled only patients with intermediate-risk disease, no one had a CHIPS score of 4.) From this they determined that 22% of an intermediate-risk population can be predicted to have an event-free survival rate of less than 80%.

"Now that we know who’s a good responder to initial chemotherapy, we’re going to try and change their treatment much earlier than we have been able to previously," Dr. Schwartz said in an interview. "The next thing to do is analyze some of the biologic factors that contribute to their response rate."

Studies of CHIPS in additional cohorts of newly diagnosed patients are also planned, she said.

Dr. Schwartz said that she had no relevant financial disclosures to make.