The<unk>  <unk>  is a clinical tool developed by oncologists to aid in predicting the prognosis of patients with aggressive non-Hodgkin's lymphoma. Prior to 1993, when the<unk>  was developed, the primary consideration in assessing prognosis was the Ann Arbor stage alone, but this was increasingly found to be an inadequate means of predicting survival outcomes, and so other factors were studied.
A retrospective analysis was performed on 2031 patients with aggressive non-Hodgkin's lymphoma, of all ages, treated with a doxorubicin-based chemotherapy regimen such as CHOP between 1982 and 1987. Several patient characteristics were analyzed to determine whether they were associated with differences in survival, and the factors that emerged as significant were, in addition to the Ann Arbor stage: age, elevated serum lactate dehydrogenase (LDH), performance status, and number of extranodal sites of disease.
One point is assigned for each of the following risk factors:
Age greater than 60 years
Stage III or IV disease
Elevated serum LDH
ECOG/Zubrod performance status of 2, 3, or 4
More than 1 extranodal site
The sum of the points allotted correlates with the following risk groups:
Low risk (0-1 points) - 5-year survival of 73%
Low-intermediate risk (2 points) - 5-year survival of 51%
High-intermediate risk (3 points) - 5-year survival of 43%
High risk (4-5 points) - 5-year survival of 26%
Although the<unk>  has shown itself to be a useful clinical tool, widely used by oncologists and a mainstay of risk stratification in clinical trials for lymphoma, it should be kept in mind that it was developed prior to the use of rituximab, which is now included with anthracycline-based combination chemotherapy as of the standard of care in B-cell lymphomas (the majority of non-Hodgkin's lymphomas). Rituximab has dramatically improved the outcomes of lymphoma patients, and its effect on the<unk>  value of the<unk>  is uncertain.
International Prognostic Index
The GRACE risk score
Gleason score
Response Evaluation Criteria in Solid Tumors
Framingham risk score
Caprini score
Cluster of differentiation
Tumor marker