title: Childhood Hodgkin International Prognostic Score (CHIPS) Predicts event-free survival in Hodgkin Lymphoma: A Report from the Children's Oncology Group.
abstract: Early response to initial chemotherapy in Hodgkin lymphoma (HL) measured by computed tomography (CT) and/or positron emission tomography (PET) after two to three cycles of chemotherapy may inform therapeutic decisions. Risk stratification at diagnosis could, however, allow earlier and potentially more efficacious treatment modifications.
  
  
  
  We developed a predictive model for event-free survival (EFS) in pediatric/adolescent HL using clinical data known at diagnosis from 1103 intermediate-risk HL patients treated on Children's Oncology Group protocol AHOD0031 with doxorubicin, bleomycin, vincristine, etoposide, prednisone, cyclophosphamide (ABVE-PC) chemotherapy and radiation. Independent predictors of EFS were identified and used to develop and validate a prognostic score (Childhood Hodgkin International Prognostic Score [CHIPS]). A training cohort was randomly selected to include approximately half of the overall cohort, with the remainder forming the validation cohort.
  
  
  
  Stage 4 disease, large mediastinal mass, albumin (<3.5), and fever were independent predictors of EFS that were each assigned one point in the CHIPS.  Four-year EFS was 93.1% for patients with CHIPS = 0, 88.5% for patients with CHIPS = 1, 77.6% for patients with CHIPS = 2, and 69.2% for patients with CHIPS = 3.
  
  
  
  CHIPS was highly predictive of EFS, identifying a subset (with CHIPS 2 or 3) that comprises 27% of intermediate-risk patients who have a 4-year EFS of <80% and who may benefit from early therapeutic augmentation.  Furthermore, CHIPS identified higher risk patients who were not identified by early PET or CT response. CHIPS is a robust and inexpensive approach to predicting risk in patients with intermediate-risk HL that may improve ability to tailor therapy to risk factors known at diagnosis.
authors: Division of Pediatrics, UT MD Anderson Cancer Center, Houston, Texas.
authors: Cindy L
authors: CL
authors: Schwartz
authors: Children's Oncology Group, Monrovia, California.
authors: Lu
authors: L
authors: Chen
authors: Department of Radiology R.I. Hospital, Warren Alpert Medical School, Providence, Rhode Island.
authors: Kathleen
authors: K
authors: McCarten
authors: Department of Pediatrics, Memorial Sloan Kettering Cancer Center, NY, New York.
authors: Suzanne
authors: S
authors: Wolden
authors: Department of Radiation Oncology, University of Rochester, Rochester, New York.
authors: Louis S
authors: LS
authors: Constine
authors: Department of Pathology, S.U.N.Y. Upstate Medical University, Syracuse, New York.
authors: Robert E
authors: RE
authors: Hutchison
authors: Department of Pediatrics, University of Illinois College of Medicine, Peoria, Illinois.
authors: Pedro A
authors: PA
authors: de Alarcon
authors: Department of Pediatrics, Emory University, Atlanta, Georgia.
authors: Frank G
authors: FG
authors: Keller
authors: Department of Pediatrics, Roswell Park Cancer Institute, Buffalo, New York.
authors: Kara M
authors: KM
authors: Kelly
authors: Department of Pediatrics, Memorial Sloan Kettering Cancer Center, NY, New York.
authors: Tanya A
authors: TA
authors: Trippet
authors: Department of Radiology, Boston Children's Hospital, Boston, Massachusetts.
authors: Stephan D
authors: SD
authors: Voss
authors: Vanderbilt University School of Medicine, Ingram Cancer Center, Nashville, Tennessee.
authors: Debra L
authors: DL
authors: Friedman
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D012074:Remission Induction; D015996:Survival Rate; D055815:Young Adult
keywords: Hodgkin lymphoma; adolescent; outcomes; pediatric; prognostic score