Investigators from Rutgers Cancer Institute of New Jersey, the state's only NCI-designated Comprehensive Cancer Center and leading cancer program along with Tufts Medical Center in Boston, developed and validated the Advanced-stage Hodgkin lymphoma International Prognostication Index (A-HIPI). A-HIPI is a state-of-the-art clinical decision model to predict five-year progression-free and overall survival in adults with advanced-stage classic Hodgkin lymphoma using comprehensive individual patient data from international clinical trials and large prospective cancer registries. To enhance the use of A-HIPI, the team developed an online calculator to assist clinicians and patients in estimating individualized prognosis. This work was published in the Journal of Clinical Oncology (DOI: https://ascopubs.org/doi/full/10.1200/JCO.22.02473) simultaneously with an oral abstract presentation at the 2022 American Society of Hematology (ASH) Annual Meeting and Exposition.
For the last 25 years, the International Prognostic Score (IPS) has been the most commonly used risk stratification tool for patients with advanced Hodgkin lymphoma, however, more modern tools to help inform individualized treatment and promote personalized cancer care are needed. Significant debate remains about the optimal treatment for Hodgkin lymphoma patients in the modern era, in part as its treatment comes at human cost, including an increased risk of treatment-related late effects like secondary malignant neoplasms and cardiovascular disease, compromised health-related quality of life, and the potential loss of young lives.
A-HIPI is the inaugural work of the HoLISTIC project (Hodgkin Lymphoma International Study for Individual Care), building on detailed multi-source individual patient data from more than 15,000 Hodgkin lymphoma patients. A-HIPI development was performed on eight recent seminal phase 3 clinical trials conducted around the world. External validation was performed from contemporaneously treated patients in four "real-world" Hodgkin lymphoma registries across North America and Australia.
HoLISTIC is spearheaded by Andrew M. Evens, DO, MBA, MSc, associate director for clinical services at Rutgers Cancer Institute and system director of medical oncology and oncology lead, RWJBarnabas Health and Susan K. Parsons, MD, MRP, medical director of the adolescent and young adult (AYA) program and research director of the Center for Health Solutions at Tufts Medical Center, who are co-principal investigators on the work.
Through continued collaboration with worldwide Hodgkin lymphoma clinical experts, decision scientists, statisticians, epidemiologists, and patient advocates, we're one step closer to improving individualized prognostication and enhancing personalized medicine for Hodgkin lymphoma patients across all ages and disease stages. Through HoLISTIC, we will continue to develop innovative and evidence-based decision support models to guide Hodgkin lymphoma patients and their families and healthcare providers."
Dr. Andrew M. Evens, DO, MBA, MSc, associate director for clinical services, Rutgers Cancer Institute
"The A-HIPI model is an exciting first step for the HoLISTIC Consortium," notes Dr. Parsons, who is also professor of medicine and pediatrics at Tufts University School of Medicine. "The next phase of the project will be significant, as we will extend the rigorous clinical modeling methodology to early-stage Hodgkin lymphoma and relapsed/refractory disease. We will also explore the impact of treatment selection and integrate PET imaging results and important biologic factors into the model." The investigators plan to synthesize all of this information into a comprehensive and robust clinical decision model that estimates the likelihood of cure, life expectancy, post-acute and late effects, and quality-adjusted life expectancy for individual patients across varied treatment options.
The dynamic and interactive decision support models generated by the HoLISTIC Consortium will guide individual patients and clinicians during initial diagnosis, relapse, and through survivorship in addition to serving as a strong basis for future health outcomes analyses, including patient preference and cost of care. The authors note limitations of the study include a lack of data in adults older than 65 who were treated in the clinical trials utilized for model development. Efforts are underway to identify other sources of information on older adults, as well as younger patients (adolescents and young adults), who are also often less represented in adult clinical trials.