Hasenclever International Prognostic Score (IPS)

Predicts five-year freedom from progression of Hodgkin's disease.

Refer to the text below the calculator for more information on the IPS and its usage.


International Prognostic Score (IPS) is the most widely used risk stratification index for Hodgkin's lymphoma (HL). It stratifies patients with advanced stage classical Hodgkin’s lymphoma using 7 risk factors into 6 prognostic groups.


The scores stratify patients into 6 prognostic groups, which include five-year rates of freedom from progression of disease in the range of 42 to 84 percent. The prognostic score is also predictive of overall survival and the predictive effects were reproducible in a large (partial) validation sample.

IPS score % of patients 5-year FFP (%) 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 7 42 56

1Age
2Gender
3Albumin
4Hemoglobin
5Ann Arbor Stage
6White blood cell (WBC) count
7Lymphocyte count <0.6x109/L or <8% total white blood cell (WBC) count
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About IPS

IPS, also known as the Hasenclever Index, is a prognostic scoring system that stratifies patients with advanced stage classical Hodgkin’s lymphoma into 6 prognostic groups.

The score was developed and validated based on a set of patients being treated in the 1980s with regimens including ABVD, MOPP and ABVD, and similar hybrid regimens.

Hasenclever Index consists of 7 risk factors:

  • Serum albumin
  • Hemoglobin
  • Male sex;
  • Ann Arbor Stage IV;
  • Age ≥ 45 years;
  • White cell count ≥ 15 x109/L;
  • Lymphocyte count <0.6x109/L.

The scores stratify patients into 6 prognostic groups, which include five-year rates of freedom from progression of disease in the range of 42 to 84 percent. The prognostic score is also predictive of overall survival and the predictive effects were reproducible in a large (partial) validation sample.

IPS score % of patients 5-year FFP (%) 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 7 42 56

The Hasenclever IPS retains prognostic relevance among patients treated uniformly with ABVD/COPP or with the more intensive BEACOPP regimens.

The IPS remains prognostic for advanced-stage HL, but the range of outcomes has narrowed considerably. This improvement in outcome with ABVD should be acknowledged before consideration of alternate initial therapies and when comparing results from current trials with historic ones.

 

About the original study

The original score was developed by Hasenclever and Diehl in 1998 from a retrospective review of clinical variables and disease outcomes in 5,141 patients with advanced classical Hodgkin’s lymphoma from 25 centers. Data from additional 2,643 patients were used for partial validation.

The prognostic score was defined as the number of adverse prognostic factors present at diagnosis.

Using a Cox regression model the authors found that the 7 variables included in the final score had a similar negative impact on prognosis.

The factors incorporated into the prognostic score are well known and make biologic sense. Age and sex frequently influence the outcome of Hodgkin's lymphoma, and the disseminating potential of the disease is noted by stage IV. Inflammatory processes and effects driven by cytokine release are reflected in serum albumin, hemoglobin and white-cell count levels.

The IPS may be used to support enrolment criteria to clinical trials and decisions about treatment in newly diagnosticated individual patients with HL.

The IPS was further validated by Moccia et al. in 2012 on a more modern patient series with HL treated with ABVD between 1980 and 2010. From the validation study, the outcomes for each prognostic group had narrowed reflecting improved outcomes with better implementation of the ABVD regimen.

 

References

Original reference

Hasenclever D, Diehl V. A prognostic score for advanced Hodgkin's disease. International Prognostic Factors Project on Advanced Hodgkin's Disease. N Engl J Med. 1998; 339(21):1506-14.

Validation

Moccia AA, Donaldson J, Chhanabhai M, Hoskins PJ, Klasa RJ, Savage KJ, Shenkier TN, Slack GW, Skinnider B, Gascoyne RD, Connors JM, Sehn LH. International Prognostic Score in advanced-stage Hodgkin's lymphoma: altered utility in the modern era. J Clin Oncol. 2012; 30(27):3383-8.


Specialty: Oncology

Objective: Prognosis

Type: Score

No. Of Items: 6

Year Of Study: 1998

Abbreviation: IPS

Article By: Denise Nedea

Published On: June 10, 2024

Last Checked: June 10, 2024

Next Review: June 10, 2029