12th Congress of the European Hematology ... - Haematologica

12 th Congress of the European Hematology Association
and were analyzed regardless of the disease mass (bulk). Evaluable
advanced stage patients, with clinical stages 2B-4, also irrespective of
tumor mass size, were 348 of them. Multivariate statistical analyses
show that of the seven IPI parameters, the scoring system backbone still
retains its prognostic significance: Hb and Alb levels. Patient's gender,
and a slightly modified range for age (50) and clinical stage
(eqally 3B and 4) of the disease, also remain important factors. Selective
statistics reveal that this importance is valid mostly due to factor's
impact on advanced stages of HD, whereas the evidently better prognosis
of early stage HD patients does not seem to be affected by these
parameters. The values for the chi-square tests are 45.9023 and 24.5866
for 3 degrees of freedom (gender, Hb, Alb) for the whole population
and the advanced disease subset respectively, and the p-values are highly
significant (0.00000 and 0.00002), when the analysis is performed on
standard IPI values. Modified values achieve even higher significance and
incorporate more parameters. Historical and timely stratified analysis,
reveals that the IPI concept is dominantly applicable to the patients treated
in the MOPP-like era. Early stage patients are also incomparable,
since by default their IPI consist of a maximum of only 6 prognostic factors.
Patients treated in the ABVD-like period are not influenced by all
of the IPI parameters. Realizing that onset manifestations did not have
statistical influence on the outcome of early stage disease patients, we
extended the analysis to the post-diagnostic period. Analyzing different
types of treatment engaged through the historical observation period, as
well as similar approaches, it is clearly evident that these patients benefit
from treatment modalities containing the gold standard and the
increasingly competitive newer chemotherapy regimen: ABVD and
BEACOPP. Interestingly enough, and possibly due to the low number of
entries, combined modality treatment did not show significant advantage
over chemotherapy alone in these early stage patients. On the other
hand, advanced stage disease course with a poor IPI could not be significantly
altered by employing even more aggressive treatment
approaches. Rough grouping of the standardly and contemporarily treated
subsets, show an evident difference of 25-40% in overall survival
(p