A numerical index can be used to identify those patients presenting with Hodgkin's disease who may be in a poor prognostic group with progressive disease. This may help determine if more aggressive therapy is required.
Parameters:
(1) clinical stage by the Ann Arbor classification
(2) age
(3) absolute lymphocyte count
(4) hemoglobin in g/dL
Parameter |
Finding |
Value |
clinical stage according to Ann Arbor classification |
IA, IIA, IIIA |
1 |
|
IB, IIB |
2 |
|
IIIB |
3 |
|
IV |
4 |
absolute lymphocyte count per liter |
< 1.0 * 10^9 |
1 |
|
1.0 - 1.5 * 10^9 |
2 |
|
1.5 - 2.0 * 10^9 |
3 |
|
> 2.0 * 10^9 |
4 |
where:
• "B" symptoms include one or more of the following: unexplained weight loss of > 10% of the body weight in the 6 months prior to diagnosis, unexplained fever > 38°C, drenching night sweats; pruritis may be used as a defining symptom if it is recurrent, generalized, otherwise unexplained, and has an intensity that parallels disease activity.
• If a person does not have "B" symptoms, then they are classed as "A".
index =
= 1.5858 - (0.0363 * (age)) + (0.0005 * ((age) ^2)) + (0.0683 * (value for clinical stage)) - (0.086 * (value for lymphocyte count)) - (0.0587 * (hemoglobin in g/dL))
NOTE: In the 1992 version of the equation, 0.3 is added to the index if bulk disease (tumor > 10 cm) is present.
Interpretation:
• Patients with index scores > 0.5 have a poor prognosis when compared to those with index scores <= 0.5.
• 4 year survival in poor prognosis group was about 30%, vs 75-85% in those not in poor prognosis group.
Specialty: Hematology Oncology