title: International Prognostic Score in advanced-stage Hodgkin's lymphoma: altered utility in the modern era.
abstract: OBJECTIVE
  The International Prognostic Score (IPS) is the most widely used risk stratification index for Hodgkin's lymphoma (HL). It is based on patients treated before 1992 and predicts 5-year freedom from progression (FFP) and overall survival (OS) ranging from 42% to 84% and 56% to 89%, respectively. The IPS has not been validated in a recently treated population in which outcomes have improved compared with historic results.
  
  
  METHODS
  By using the British Columbia Cancer Agency Lymphoid Cancer Database, we identified all patients age ≥ 16 years newly diagnosed with advanced-stage HL (stage III to IV, or stage I to II with "B" symptoms or bulky disease ≥ 10 cm) from 1980 to 2010, treated with curative intent with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) or an ABVD-equivalent regimen with complete clinical information.
  
  
  RESULTS
  In all, 740 patients were identified. Five-year FFP and OS were 78% and 90%, respectively. The IPS was prognostic for both FFP (P < .001) and OS (P < .001), with 5-year FFP ranging from 62% to 88% and 5-year OS ranging from 67% to 98%. Analysis limited to patients age 16 to 65 years (n = 686) demonstrated a narrower range of outcomes, with 5-year FFP ranging from 70% to 88% and 5-year OS ranging from 73% to 98%.
  
  
  CONCLUSIONS
  The IPS remains prognostic for advanced-stage HL, but the range of outcomes has narrowed considerably. This improvement in outcome with ABVD should be acknowledged before consideration of alternate initial therapies and when comparing results from current trials with those of historic controls.
authors.affiliation: British Columbia Cancer Agency and University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Alden A
authors.initials: AA
authors.lastname: Moccia
authors.forename: Jane
authors.initials: J
authors.lastname: Donaldson
authors.forename: Mukesh
authors.initials: M
authors.lastname: Chhanabhai
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Hoskins
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Klasa
authors.forename: Kerry J
authors.initials: KJ
authors.lastname: Savage
authors.forename: Tamara N
authors.initials: TN
authors.lastname: Shenkier
authors.forename: Graham W
authors.initials: GW
authors.lastname: Slack
authors.forename: Brian
authors.initials: B
authors.lastname: Skinnider
authors.forename: Randy D
authors.initials: RD
authors.lastname: Gascoyne
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Connors
authors.forename: Laurie H
authors.initials: LH
authors.lastname: Sehn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols; D001761:Bleomycin; D001955:British Columbia / Q000453:epidemiology; D003606:Dacarbazine; D004317:Doxorubicin; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D015203:Reproducibility of Results; D016019:Survival Analysis; D014747:Vinblastine
chemical_list: D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin