The first individualized risk prediction model for adults with early-stage classical Hodgkin lymphoma (cHL) has been developed and validated. According to a report published in NEJM Evidence, the Early-Stage cHL International Prognostic Index (E-HIPI) model estimates 2-year progression-free survival to determine which patients have worse prognoses and require more individualized treatment. Findings were also presented during the 18th International Conference on Malignant Lymphoma (Abstract 126).
“We developed a robust, dynamic, and data-driven model that leverages common clinical variables to generate more precise predictive insights. This tool has the potential to enhance clinical decision-making, personalize treatment strategies, and ultimately improve long-term outcomes for patients worldwide,” said co-first study author Andrew M. Evens, DO, MBA, MSc, Deputy Director for Clinical Services for the Rutgers Cancer Institute and Chief Physician Officer of the Jack & Sheryl Morris Cancer Center. Dr. Evens is also System Director of Medical Oncology and Oncology Lead, RWJBarnabas Health Medical Group, and Associate Vice Chancellor for Clinical Innovation and Data Analytics at Rutgers Biomedical and Health Sciences.
Study Methods and Results
The researchers based the E-HIPI model off 3,000 adults with newly diagnosed early-stage classical Hodgkin lymphoma from four international phase III trials between 1994 and 2011. The model was based off of the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis guidelines.
They also gathered two validation cohorts of 2,360 patients from five international registries of treated patients with classical Hodgkin lymphoma.
For the model’s estimation of 2-year progression-free survival, the researchers used a Cox model with backward elimination of pretreatment variables.
In the development cohort, the median age was 31.2 years and 77.4% had stage II disease. In this population, the estimated 2-year progression-free survival rate was 93.7%. Two-year progression-free survival rates were lower in the validation cohorts at 90.3% and 91.6%.
After elimination, the remaining variables in the model were sex, maximum tumor diameter, hemoglobin levels, and albumin levels, with male sex, lower hemoglobin or albumin levels, and higher maximum tumor diameters all associated with worse progression-free survival. The model showed an optimism-corrected C statistic, a measurement of how well a predictive model will handle unseen data, of 0.63 (95% confidence interval [CI] = 0.60–0.69).
“When we compared our model to existing classification systems, it had better performance and was more strongly related to patient outcomes. The online calculator we developed as a result of this work is accurate, accessible, easy-to-use and is completely free for patients and clinicians,” said lead study statistician Angie Mae Rodday, PhD, Investigator in the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center and Biostatistician at the Tufts Clinical and Translational Science Institute.
Higher-risk E-HIPI scores were associated with worse outcomes in the EORTC unfavorable and favorable subgroups. EORTC status was not associated with PFS, but the E-HIPI was.
“We hope that this model will enhance communication between patients and clinicians, and promote a greater understanding of the short- and long-term risks and benefits of different treatment options for early-stage classic Hodgkin’s lymphoma,” said co-senior study author Susan K. Parsons, MD, MRP, Medical Director Of The Adolescent And Young Adult (AYA) Cancer Survivorship Program, Research Director of the Center for Health Solutions at Tufts Medical Center, and Co-Founder of the HoLISTIC Consortium. “Ideally, this type of information about treatment trade-offs will alleviate some of the burden experienced in the cancer journey."
Disclosure: The study was funded by the National Cancer Institute. For full disclosures of the study authors, visit nejm.org.
