In the evolving landscape of cancer research, an innovation from RWJBarnabas Health–Rutgers Cancer Institute, Tufts Medical Center, and The University of Manchester is helping reshape how clinicians approach early-stage Hodgkin lymphoma. The team has developed a data-driven tool that empowers patients and clinicians to make more informed choices and individualized treatment decisions—an important shift for a disease that is highly curable but often carries long-term consequences. Known as the Early-Stage cHL International Prognostic Index (E-HIPI), the model is the first validated risk prediction model for adults diagnosed with early-stage Hodgkin lymphoma. It estimates a patient’s likelihood of remaining progression-free at 2 years—an important benchmark that strongly correlates with long-term cure—and opens the door to more personalized care strategies.
The findings, published in the New England Journal of Medicine’s NEJM Evidence, mark a milestone in lymphoma research. Leading the effort is Andrew “Andy” M. Evens, DO, MBA, MSc, Deputy Director for Clinical Services at Rutgers Cancer Institute and Chief Physician Officer at the Jack & Sheryl Morris Cancer Center. A hematologist-oncologist who has spent more than 2 decades specializing in lymphoma, Dr. Evens has long been focused on improving both cure rates and long-term outcomes. “I’ve had a unique interest in Hodgkin lymphoma for many years—over 2 decades now,” he said, pointing to his work in both novel therapies and prognostic modeling.
A National Leader in Cancer Care
Rutgers Cancer Institute is the only NCI-Designated Comprehensive Cancer Center in New Jersey, a distinction held by just 1% to 2% of cancer centers across the United States. For more than 20 years, the institute has maintained that designation, reflecting sustained excellence in research, clinical care, and community outreach.
But its impact extends far beyond a single campus. In partnership with RWJBarnabas Health, the institute leads a robust, statewide oncology service line that includes 15 hospitals, approximately 50 ambulatory practices, and more than 300 oncology physicians, along with over 100 advanced practice providers. At the center of this system is a large oncology nurse navigation program, with more than 70 nurse navigators helping guide patients through diagnosis, treatment, and survivorship. These navigators play a critical role in connecting patients to complex care pathways—particularly as new tools like E-HIPI introduce more nuanced decision-making into clinical practice.
Why a Prediction Model for Early-Stage Hodgkin Lymphoma Is Needed
Hodgkin lymphoma care represents one of oncology’s success stories, as advances in chemotherapy and radiation have driven cure rates to between 80% and 90%. Yet those successes have revealed a new challenge.
The disease is most commonly diagnosed in adolescents and young adults, often in their twenties and thirties—patients who may live for many decades after treatment. For many of these survivors, the effects of therapy can persist long after the cancer is gone. “These patients are young, and we’re able to cure the majority of them,” Dr. Evens explained. “But what about 10, 20, 30 years later?”
These late effects of treatment can include cardiovascular disease, pulmonary complications, infections, and even secondary malignancies linked to initial therapies. As a result, the goal of care has evolved. It is no longer enough to simply cure the disease; clinicians must also carefully consider how today’s treatment decisions will shape a patient’s long-term health.
This is where predictive modeling becomes essential. Rather than applying a one-size-fits-all treatment approach, clinicians can begin to quantify risk at the individual level—potentially reducing overtreatment for some patients while ensuring others receive appropriately aggressive care.
A Global Effort to Personalize Care
The idea for E-HIPI emerged from a simple yet ambitious question: What if researchers could combine all available data on Hodgkin lymphoma from around the world into a single, comprehensive resource? That notion led to the creation of the HoLISTIC consortium, short for the Hodgkin Lymphoma International Study for Individual Care. “We had the idea to literally synthesize the world’s data [on] Hodgkin lymphoma,” Dr. Evens said. The idea, he said, was to use both trial-based and long-term real-world data to capture not only short-term treatment outcomes, but also survivorship trends.
The consortium now includes nearly 30,000 individual patient cases from across the globe. More than 20,000 of those come from pivotal clinical trials conducted over the past 2 decades, while the remainder come from cancer registries that capture real-world patient data and long-term outcomes. This combination is critical. Clinical trials provide high-quality, controlled data, but often lack long-term follow-up. Registries, by contrast, track patients for years or even decades, offering insights into survivorship and later effects of treatment. By integrating both, HoLISTIC provides a uniquely comprehensive view of Hodgkin lymphoma—one that reflects not just how treatments work in ideal settings, but how patients actually fare over time.
How the Model Works
At its core, E-HIPI is designed to be both rigorous and practical.
Researchers began by analyzing nearly 20 pretreatment variables, including patient characteristics, disease stage, and laboratory values. Using a statistical framework known as Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD), they identified the 4 factors most strongly associated with outcomes.
Those variables are:
By entering these values into an online calculator, clinicians can generate a patient-specific estimate of 2-year progression-free survival.
Importantly, the model relies on continuous data—rather than broad categories—to improve precision. “Instead of just saying above or below a certain cutoff, we’re using the exact values,” Dr. Evens said, noting that this approach enhances the model’s ability to guide individual care. For most patients who remain progression-free at 2 years, the likelihood of long-term cure is very high.
Moving Beyond Outdated Risk Models
Until now, risk assessment in early-stage Hodgkin lymphoma has relied on classification systems developed decades ago, including those from the European Organisation for Research and Treatment of Cancer and the German Hodgkin Study Group. “These were developed in the 1970s,” Dr. Evens explained.
At that time, staging often involved invasive surgical procedures, treatments were less refined, and imaging technologies were far less advanced. While these systems still provide some general guidance, they lack the precision needed for modern, individualized care. Most importantly, they do not offer patient-specific predictions.
“They’re mainly separating risk into low and high,” Dr. Evens said. “It’s hard to apply that to an individual patient or have any idea what my predicted outcome would be.” E-HIPI addresses that gap by delivering personalized estimates—marking a significant advancement over traditional approaches.
A Tool for Every Care Setting
One of the most impactful aspects of E-HIPI is its accessibility. The online risk calculator is free and available online, allowing clinicians in any setting to generate individualized predictions. For smaller hospitals or community cancer programs, where advanced analytics and large patient volumes may not be available, this tool can be transformative. “Some hospitals might only treat 2 or 3 Hodgkin lymphoma patients a year,” Dr. Evens noted. In contrast, large academic centers may see hundreds of cases and have access to extensive datasets and research infrastructure. E-HIPI helps bridge that gap by delivering high-level insights in a simple, user-friendly format. “This is a very simplified, easily accessible tool to help accurately prognosticate outcomes for individual patients,” he said.
Enhancing Patient Conversations
Beyond its technical capabilities, E-HIPI is already changing how clinicians communicate with patients. By providing a clear, individualized estimate of progression-free survival, the tool helps ground discussions about treatment options in data, while still allowing room for shared decision-making. “It will inform the 2-year progression-free survival, which is a strong indicator of cure,” Dr. Evens said. For patients navigating a new cancer diagnosis, that level of specificity during patient conversations can be both reassuring and empowering.
Early feedback from clinicians has been overwhelmingly positive. Many report that the tool enables more transparent, nuanced conversations—particularly when weighing the tradeoffs between treatment intensity and long-term risk.
From Snapshot to Road Map: The Future of E-HIPI
The current version of E-HIPI represents just the first step. Dr. Evens and his team are already working on a second iteration that will incorporate treatment variables, including the type and number of chemotherapy cycles and the use of radiation.
“We’re going to overlay different treatment options with those pretreatment clinical variables,” he explained. Rather than prescribing a single “best” approach, the model will show how different choices may influence outcomes, allowing for more personalized decision-making.
A third phase, planned for the near future, will focus on survivorship. Using long-term data from thousands of patients, the model will begin to predict late effects, such as cardiovascular disease or secondary cancers. Ultimately, the goal is to create a tool that spans the entire cancer journey. “At any point, someone will be able to see not just their likelihood of cure, but also their prediction for survivorship and quality of life,” Dr. Evens said.
Accelerating Research and Clinical Trials
In addition to improving patient care, E-HIPI is poised to play a key role in research. The platform includes features for risk stratification and comparison, allowing investigators to identify specific patient populations for clinical trials. This could lead to more targeted studies and more efficient drug development. “It will help inform future clinical trial development and make sure we’re targeting the right patients at the right time with the right treatment,” Dr. Evens said. In this way, E-HIPI functions not only as a clinical decision tool, but also as a research engine, helping accelerate progress across the field.
Addressing Disparities in Young Patients
One of the most pressing challenges in Hodgkin lymphoma is understanding disparities among adolescent and young adult patients, typically defined as those between the ages of 18 and 30 years. Despite overall high cure rates, this group often experiences worse outcomes—and the reasons remain unclear. “We don’t fully understand why patients in this age group don’t do as well,” Dr. Evens said. Possible explanations include biological differences in the disease, as well as social and access-related factors. Untangling these influences will be critical for improving outcomes. By leveraging large, diverse datasets, models like E-HIPI may help identify patterns that would otherwise remain hidden, paving the way for more equitable care.
A Blueprint for the Future of Oncology
Beyond Hodgkin lymphoma, the implications of this work extend to oncology as a whole. The methods used to build E-HIPI—combining large-scale data, applying rigorous statistical modeling, and prioritizing accessibility—can be applied to virtually any cancer type. “Our hope is that there is more data sharing and amalgamation of data,” Dr. Evens said. “That’s how we’re going to have the most impactful models for patients at the bedside.” He emphasized the importance of global collaboration, noting that the most powerful insights come from combining datasets across institutions and countries. “It needs to be done not just across North America, but [it must] involve the world,” he said.
For Evens, E-HIPI represents more than a single innovation—it is part of a broader shift toward precision medicine, survivorship-focused care, and patient empowerment. As predictive tools become more sophisticated, they will enable clinicians to tailor treatments with greater accuracy, balancing efficacy with long-term safety. Equally important, they will give patients a clearer understanding of their own prognosis, helping them make informed decisions about their care. Together, these advances signal a new era in oncology—one in which data, collaboration, and personalization converge to improve not just survival, but quality of life.
Rania Emara is the Managing Editor of Oncology Issues and the Assistant Director of Editorial Content and Strategy for the Association of Cancer Care Centers in Rockville, Maryland. Rachel Morrison Brown, MPH, MS, is a medical writer at Penumbra, Inc. and a former editorial coordinator for the Association of Cancer Care Centers.
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