Ann Arbor 

Stage

I

Involvement of a single LN or structure (spleen, thymus, Waldeyer’s ring)

II

> LN regions on the same side of the diaphragm

III

LNs on both sides of the diaphragm

IV

Extranodal involvement (beyond E)

Modifying factors

A

No symptoms

B

Fever, drenching night sweats, weight loss >10% in 6 months

X

Bulky disease > 1/3 widening of mediastinum at T5-6; nodal mass >10cm

E

Involvement of a single, continuous extranodal site

IPI factors (each scores 1)

Score

CR%

5 Yr survival

Age >60             

0-1 = low risk

87

73

ECOF Performance S >2

2 = intermediate risk

67

51

LDH >N

3 = high- intermediate risk

55

43

Extranodal sites >1

>4 = high risk

44

26

Stage ¾

IPI

FLIPI

Age >60

Stage III/IV disease

Raised LDH

Performance status

>2 nodal sites

Anaemia

>5 nodal sites

EORTC risk factors - used for early stage disease

Favourable

Unfavourable

Clinical stage I or II (max 3 nodal areas)

Age <50

ESR <50 or <30 with B symptoms

Mediastinal ratio <0.35

Clinical stage II with >4 nodal areas

Hasenclever index – late stage Hodgkins disease

Age >45

Male gender

Serum albumin <40 g/L

Hb <10.5

Stage IV disease

WC >15

Lymphopenia <0.6 or 8% of WC

Binet staging

A

up to 2 areas involved

B

3-5 areas involved

C

anaemia <10 +/or thrombocytopenia <10

Rai staging

Survival

0

No anaemia, thrombocytopenia or physical signs

10 years

I

Lymphadenopathy only

7-9 years

II

Splenomegaly +/or hepatomegaly with no LN involvement, anaemia or thrombocytopenia

III

Hb <11

5 years

IV

Plts <100

Class

I

Hb >10.5

Ca normal

No more than a solitary plasmacytoma

Paraprotein IgG<50 / IgA<30

Urine light chains <4

II

Neither I or III

III

Hb <8.5

Ca >3

More than 3 lytic lesions

Paraprotein IgG>70 / IgA>50

Urine light chains >12

A or B depending on the presence of renal failure

Stage

Parameters

Median survival (months)

I

B2M <3.5 and Alb >35

62

II

B2M <3.5 and Alb <35

Or

B2M 3.5-5.5

44

III

B2M >5.5

29

0

0.5

1

1.5

2

BM blasts

<5

5-10

11-20

>20

Karyotype

Good

-Y, del(5q), del (20q)

Intermediate

Others

Poor

Complex (>3) or Chr 7 anomalies

REABt no longer considered to part of MDS = AML with multilineage dysplasia

Cytopenias

Hb<10

N <1.8

plts <100

0 or 1 cell lines

2 or 3 cell lines

Age <60

Age >60

Treatment

Low risk = 0

11.8 years

4.8

Supportive care

Intermediate risk 1 = 0.5 – 1

5.2

2.7

Age <65 SCT work up (non ablative if >50)

Intermediate risk 2 = 1.5 – 2

1.8

1.1

Chemotherapy and SCT if respond (non responders have very poor prognosis

Poor risk = >2

0.3

0.5

Good risk

Standard

Poor

t(8:21)

inv(16)

t(15:17)

11q23

Normal karyotype

+21

+8

>15% blasts in marrow after first course of chemotherapy

-5 / del 5q

-7

abn (3q)

t(9:22)

Complex (5 or more abnormalities)

35% relapse

76% relapse