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ASH 2015: Prognostic score helps assess chances of progression-free survival in HL autologous transplant recipients
by Thomas R. Collins: Researchers have developed a prognostic “score” to gauge the chances of progression-free survival in patients with relapsed or refractory Hodgkin lymphoma who have had a successful autologous stem cell transplant.
They say they hope the findings, presented here at the 57th American Society of Haematology Annual Meeting, can give some confidence to clinicians when deciding which patients would be best on scaled-back therapy and which need a ramping-up of treatment.
Using a cohort of more than 600 patients to find the risk factors that are the most prognostic, and another cohort of more than 300 to validate those findings, researchers settled on five factors that best help characterize patients as either low risk, lower intermediate risk, higher intermediate risk and high risk.
“We are aiming on the one hand to try to decrease toxicity for those patients who might be in the low-risk group,” said Dr Paul Brӧckelmann, MD, a physician and researcher with the University Hospital of Cologne who was involved with the German Hodgkin Study Group, which provided the largest amount of patient data for the study. “There’s also the high-risk group where we tried to have consolidative approaches for example or intensified salvage chemotherapy. We will have to look at this when novel are therapeutics implemented, of course.”
In the first part of the study, data for about 500 patients from the German group were used along with data from about 100 patients in the French H96 Hodgkin lymphoma trial. Researchers analyzed 20 known risk factors to assess their predictive value and non-redundancy for predicting progression-free survival.
They eventually settled on five that were the best window into a poor chance of progression-free survival:
- a time to relapse of 3 months or less;
- Stage IV disease at relapse;
- bulk of disease of at least 5 cm at relapse;
- no response to salvage therapy;
- and an ECOG loss-of-function score of at least 1.
“These risk factors potentially represent five distinct clinical dimensions: disease extent, tumor growth, performance status, tumor volume and chemo sensitivity of disease,” researchers wrote.
They found that the scores were best used in equal weight, which Dr. Brockelmann said researchers found a little surprising.
“It turned out that it’s not going to be more accurate if we weight them unequally, therefore we stick to the easiest way,” he said. “We were expecting that some factors — for example, non-response to salvage therapy — would be weighted more heavily, for example, than the ECOG status,” which ultimately was not the case.
Researchers then used data from about 300 patients from a U.S. cohort and about 70 from a Danish cohort to validate their findings.
Those with no risk factors are considered the low-risk group; 1 the lower-risk intermediate group; 2 the higher-risk intermediate group; and 3 to 5 the high-risk group. risk factors used to generate the scores.
Researchers emphasized that the scores are “only prognostic but not predictive.”
Dr. Brockelmann said that he hopes the simplicity of the scoring will make it of value to clinicians.
“We think this is a very robust and accurate prognostic score which is highly reliable in clinical practice, and also easy to implement, since it’s not associated with any additional cost,” he said. “It’s basically routine clinical documentation.”
Reference
Paul J Bröckelmann, Horst Müller, Olivier Casasnovas, Martin Hutchings, Bastian von Tresckow, Peter Borchmann, Craig Moskowitz and Andreas Engert. Risk Factors and a Prognostic Score for Progression Free Survival after Treatment with Autologous Stem Cell Transplantation (ASCT) in Patients with Relapsed or Refractory Hodgkin Lymphoma (rrHL). Presented at the 57th Annual Meeting of the American Society of Hematology. 2015 Dec 5-8. Orlando FL. Abstract 1978.
