Online tool and alternative risk group analyses. (A) Screenshot of the A-HIPI risk group online tool. Users may select individualized percentile cutoffs for defining low- and high-risk disease. The application will provide dynamic outcomes based on the user-defined individualized risk groups. See interactive app at https://rtools.mayo.edu/holistic_ahipi/. (B) Risk groups based on deviation from average patient or clinical thresholds. The right-skewed distribution of A-HIPI risk scores greatly limited the applicability of these approaches. The standard-risk approach of the average patient was limited by the asymmetric distribution of patients because the majority of patients were considered average risk, and only ∼20% of patients were considered increased or high risk (approach 1). Proposed cutoffs based on clinical thresholds of PFS5 <70 and PFS5 >90 only identified 15% and <1% of the population, respectively (approach 2). 5y, 5-year; A-HIPI, advanced-stage Hodgkin lymphoma international prognostic index; PFS5, 5-year progression-free survival.