Development and Validation of a Novel Geriatric Risk Score for Prognostication in Older Patients With Hodgkin Lymphoma: A Multicenter Retrospective Study

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Abstract
Outcomes in older patients with Hodgkin lymphoma (HL) are compromised by the interplay of patient frailty and disease aggressiveness; however, current stratification tools, including the International Prognostic Score (IPS) and Comprehensive Geriatric Assessment (CGA), lack sufficient prognostic discrimination in the older HL population. We developed and validated a prognostic model integrating metabolic tumor burden and geriatric assessment. In this retrospective study across 14 centers in China between 2006 and 2024, we enrolled 306 patients aged ≥ 60 years with histologically confirmed HL. Patients were randomly partitioned into training ( n = 250) and validation ( n = 56) cohorts. Among the 306 patients, 98 deaths and 130 progression events were recorded during follow‐up. We analyzed 21 candidate variables. The least absolute shrinkage and selection operator (LASSO) analysis and multivariable Cox regression identified five independent predictors for 5‐year overall survival (OS): age > 73 years, baseline 18F‐FDG PET/CT‐derived total lesion glycolysis (TLG) > 200, hemoglobin ≤ 101 g/L, activities of daily living (ADL) dependence, and lymphocyte‐depleted classical Hodgkin lymphoma (LDCHL). A weighted Geriatric Risk Score stratified patients into low‐, intermediate‐, and high‐risk groups. In the validation cohort, the Geriatric Risk Score showed higher discriminatory accuracy than the CGA for both OS (C‐index, 0.770 [95% CI, 0.674–0.867] vs. 0.671 [0.581–0.762]) and PFS (0.761 [0.668–0.853] vs. 0.635 [0.535–0.735]). Among advanced‐stage (Ann Arbor stage III–IV) patients, it also outperformed the IPS‐7 and IPS‐3. By integrating metabolic tumor burden and geriatric assessment, the Geriatric Risk Score improves risk stratification over existing tools in older patients with HL.

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