Hodgkin: Hasenclever Index
Prognostic score for advanced Hodgkin lymphoma
Sum the number of adverse prognostic factors to give a prognostic score:
- Serum albumin < 40 g/L
- Hemoglobin < 10.5 g/dL
- Male sex
- Ann Arbor Stage IV
- Age ≥ 45 years
- White cell count ≥ 15 x109/L
- Lymphocyte count < 0.6 x109/L
| Prognostic score | Proportion of patients (%) | 5 year PFS (%) | 5 year OS (%) |
|---|---|---|---|
| 0 | 7 | 84 | 89 |
| 1 | 22 | 77 | 90 |
| 2 | 29 | 67 | 81 |
| 3 | 23 | 60 | 78 |
| 4 | 12 | 51 | 61 |
| ≥ 5 | 7 | 42 | 56 |
Note: The survival data presented in the table above are from the original 1998 Hasenclever paper (patients treated between 1983 and 1992), and may not reflect survival statistics for patients treated with current treatment protocols.
The Hasenclever Index (International Prognostic Index) was developed from a multivariate analysis of survival of 4695 patients with newly-diagnosed advanced Hodgkin lymphoma, treated with combination chemotherapies between 1983 and 1992 (1). 75% of patients received an anthracycline-containing regimen, and a further 20% received MOPP or a similar regimen.
The seven adverse prognostic factors identified each carried a similar impact: Each factor reduced the 5 year progression-free survival by ~8%.
The Hasenclever Index retains prognostic relevance among patients treated uniformly with ABVD/COPP or with the more intensive BEACOPP regimens (2). It also helps determine prognosis among patients with relapsed or refractory Hodgkin lymphoma undergoing autologous stem cell transplant (3).
References:
1. New Engl J Med 1998; 339: 1506-1514
2. New Engl J Med 2003; 348: 2386-2395
3. Ann Oncol 2008; 19: 1312-1319