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Updated: Aug 17, 2026
Flow-sorting and Exome Sequencing of the Reed-Sternberg Cells of Classical Hodgkin Lymphoma
Published on: June 10, 2017
How to define intermediate stage in Hodgkin's lymphoma?
C Gisselbrecht1, N Mounier, M André
1Service d'Hémato-Oncologie, INSERM ERM0220 Hôpital Saint Louis, Paris, France. christian.gisselbrecht@sls.ap-hop-paris.fr
Insights
This study compared Hodgkin
Area of Science:
- Oncology
- Clinical Trials
- Biostatistics
Background:
- Hodgkin's lymphoma (HL) staging relies on multiple scoring systems.
- EORTC, GHSG, and Canadian-ECOG systems are used for intermediate/unfavorable stages.
- Correlation with the International Prognostic Score (IPS) for advanced HL requires investigation.
Purpose of the Study:
- To evaluate the efficacy of different scoring systems in Hodgkin's lymphoma.
- To assess the correlation between these systems and the International Prognostic Score (IPS).
- To identify key prognostic factors for overall survival in HL.
Main Methods:
- Prospective study of 1156 localized stage HL patients in GELA H8/H9 protocols.
- Analysis of scoring system factors (EORTC, GHSG, Canadian) and IPS.
- Multivariate Cox analysis for overall survival (OS) incorporating clinical variables.
Main Results:
- All scoring systems significantly discriminated patient subgroups.
- Age > 45, male sex, low hemoglobin, low lymphocytes, B symptoms, and extranodal sites were independent significant prognostic factors.
- Overall survival probabilities varied significantly based on the number of prognostic factors (P < 0.0001).
Conclusions:
- Identified prognostic factors are similar to IPS, with extranodal sites replacing advanced stages.
- A simplified prognostic score for localized and advanced Hodgkin's lymphoma is proposed.
- Validation of this new score in prospective trials is recommended.
Background:
Intermediate or unfavourable stage Hodgkin's lymphoma (HL) definition relies upon at least three different scoring systems defined by cooperative groups (EORTC, GHSG and Canadian-ECOG). We aimed to investigate their efficacy and their correlation with International Prognostic Score (IPS) for advanced HL.
Patients And Methods:
We studied a population of 1156 patients with localized stage HL treated prospectively within GELA centres in H8 (518 patients) and H9 (638 patients) protocols. Median age: 30 yr, 18%, Female 50%; stage I: 25%; stage II: 75%. According to scoring systems 70% had 0-1 EORTC factors; 60% 0-1 GHSG factors and 82% 0-1 Canadian factors. The IPS for advanced stages was available only in H9 study with 64% 0-1 factor.
Results:
Survival curves according to each of the different scoring systems could significantly discriminate the subgroup populations. When a multivariate Cox analysis was performed for overall survival (OS) including all the scoring system variables: age > 45 yr, sex male, Haemoglobin < 10.5 g/dL, lymphocytes < 600/microL, B symptoms with elevated ESR, extra nodal sites did retain an independent significant value. Probability of OS was 99%, 98%, 92%, 82% and 73% for patients with 1-5 factors, respectively P < 0.0001.
Conclusion:
These factors are similar for most of them with those described in the IPS when stages III and IV are replaced by extra nodal localization. This new score should be validated in other prospective trials, as it will simplify the Hodgkin prognostic scoring systems for localized and advanced stages.
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