Fig 4 Memorial Sloan Kettering risk criteria. The algorithm includes five factors: hemoglobin below the lower limit of normal, Karnofsky performance status of less than 80, less than one year from diagnosis to start of systemic therapy, corrected calcium above the upper limit of normal, and lactate dehydrogenase more than 1.5 times the upper limit of normal. Patients with a good risk have no risk factors; intermediate risk patients have one or two; and poor risk patients have three or more factors⁷³