Researchers from RWJBarnabas Health, Rutgers Cancer Institute, Tufts Medical Center, and The University of Manchester have developed and validated the first individualized risk prediction model for adults diagnosed with early-stage classic Hodgkin's lymphoma. The Early-stage Hodgkin International Prognostication Index (E-HIPI) estimates two-year progression-free survival and is designed to support more personalized treatment planning for clinicians and patients.
The findings were published in the New England Journal of Medicine Evidence and presented at the 18th International Conference on Malignant Lymphoma by co-first and corresponding author Andrew M. Evens, DO, MBA, MSc, Deputy Director for Clinical Services for the Rutgers Cancer Institute and Chief Physician Officer of the Jack & Sheryl Morris Cancer Center.
Model Development and Validation
The E-HIPI model was developed using data from over 3,000 adult patients enrolled in four pivotal international phase III clinical trials. To ensure accuracy, it was tested and validated in two real-world registry cohorts that included more than 2,300 people with early-stage classic Hodgkin's lymphoma.
The model uses routinely available and objective clinical measures—including patient sex, tumor size, and exact values of common laboratory results such as hemoglobin and albumin levels—to help predict an individual patient's chance of staying cancer-free for two years.
"Early-stage classic Hodgkin's lymphoma is a highly curable cancer, particularly among young adults. However, despite high survival rates and significant advances in treatment, we've lacked a validated tool to assess outcomes and estimate a patient's individual risk of relapse," said Dr. Evens, who is also System Director of Medical Oncology and Oncology Lead at RWJBarnabas Health Medical Group.
Superior Performance Over Existing Systems
The E-HIPI model demonstrated strong and consistent performance across all datasets and outperformed the widely used European Organization for Research and Treatment of Cancer (EORTC) favorable/unfavorable classification. To facilitate real-world implementation, the research team developed interactive online risk calculators to support shared decision-making between clinicians and patients.
"We rigorously developed and validated our model based on an established checklist for predictive modeling," said Angie Mae Rodday, PhD, investigator in the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center and lead statistician for the National Cancer Institute's funded project. "When we compared our model to existing classification systems, it had better performance and was more strongly related to patient outcomes."
Clinical Impact and Implementation
Susan K. Parsons, MD, MRP, medical director of the adolescent and young adult cancer survivorship program at Tufts Medical Center and co-senior author of the study, emphasized the model's potential to enhance patient-clinician communication. "We hope that this model will enhance communication between patients and clinicians, and promote a greater understanding of the short- and long-term risks and benefits of different treatment options for early-stage classic Hodgkin's lymphoma," she said.
The online calculator developed as part of this work is accurate, accessible, easy-to-use and completely free for patients and clinicians. In addition to informing personalized treatment, the E-HIPI provides modernized risk stratification for the design of future clinical trials and research studies.
International Collaboration Through HoLISTIC Consortium
This research was made possible through the HoLISTIC (Hodgkin Lymphoma International Study for Individual Care) Consortium, a global effort combining data from seminal randomized clinical trials and cancer registries enriched with long-term patient follow-up. The Consortium's shared resources enabled the development and validation of the E-HIPI model and will continue to support its refinement as new data emerge.
"This research is a powerful example of what can be accomplished through international scientific collaboration," said John Radford, MD, FMedSci, Professor of Medical Oncology at The University of Manchester and co-senior author of the study. "Through the HoLISTIC Consortium, we brought together patient-level data from pivotal clinical trials and global cancer registries to develop a predictive model that is both rigorous and widely applicable."
Building on Previous Success
The E-HIPI builds on the success of the previously established A-HIPI (Advanced-stage Hodgkin lymphoma International Prognostication Index), which was also developed by investigators at RWJBarnabas Health, Rutgers Cancer Institute, Tufts Medical Center, and other centers worldwide. A-HIPI is designed to predict five-year progression-free and overall survival in adults with advanced-stage classic Hodgkin's lymphoma.
Together, these complementary models represent a significant step forward in advancing precision medicine across the full spectrum of Hodgkin's lymphoma care. Investigators are actively pursuing next steps to further enhance individualized predictions by integrating different treatment regimens into the models and estimating the risk of post-acute and late consequences that may occur years after therapy completion.
