Prognosis is the likely outcome of a disease along with the chance of recovery or recurrence. Hodgkin lymphoma (HL) is generally classified into the following three subgroups that are based on the Ann Arbor staging system and either the presence or the absence of certain prognostic factors. The subgroups are
- Early-stage favorable: Disease is stage I to II with no unfavorable risk factors
- Early-stage unfavorable: Disease is stage I to II with unfavorable risk factors
- Advanced-stage: Disease is stage III to IV.
Cure is the goal of treatment for patients with HL. More than 80 percent of all patients diagnosed with HL can be cured by current treatment approaches. The cure rate is higher, approaching 90 percent, in younger patients and those with early-stage favorable disease. Even if the disease recurs, many patients can be cured with further treatment.
Prognostic Factors for Early-Stage Hodgkin Lymphoma
Early-stage favorable Hodgkin lymphoma (HL) patients are designated as such if they have either stage I or stage II disease and no adverse or unfavorable risk factors. Sometimes, patients with early-stage favorable HL are given less intensive treatment regimens. However, the use of staging information to modify therapy varies.
Early-stage unfavorable HL risk factors include
- B symptoms—fever, drenching night sweats, unexplained weight loss greater than 10 percent of body weight over 6 months
- Extranodal disease—masses located outside of the lymph nodes or lymph system
- Bulky disease—a chest mass that is greater than one third of the chest diameter as visualized on x-ray OR any lymph node mass greater than 10 cm in diameter
- Three or more sites of lymph node involvement
- Erythrocyte sedimentation rate that is greater than or equal to 50 millimeters per hour (50 mm/hr).
Prognostic Factors for Advanced-Stage Classical Hodgkin Lymphoma
An international collaboration among several cancer research groups in North America and Europe evaluated thousands of patients with advanced-stage classical Hodgkin lymphoma (cHL) (stages III and IV) and identified seven unfavorable prognostic factors. These factors can provide a basis for recommending either more or less aggressive treatment, including stem cell transplantation for patients with high-risk disease. The International Prognostic Score (IPS) is defined by the number of adverse prognostic factors present at diagnosis. The IPS helps doctors to determine the course of treatment and the prognosis for patients with advanced-stage (stage III to IV) disease.
Advanced-stage classical Hodgkin lymphoma risk factors include
- Being male
- Age 45 or older
- Stage IV disease
- Albumin level below 4 g/dL (grams per deciliter)
- Hemoglobin level below 10.5 g/dL
- Leukocytosis: white blood cell count greater than 15,000/mm3
- Lymphocytopenia: lymphocyte count less than 8% of the white blood cell count and/or lymphocyte count less than 600/mm3.
Clinical trials to identify other prognostic indications for HL patients are under way.
- Download or order The Leukemia & Lymphoma Society's free booklet, Hodgkin Lymphoma