Lee et al evaluated risk factors that could be used to identify patients with Hodgkin's disease at risk for disease progression after primary therapy. The authors are from Christie Hospital in Manchester, England.
Parameters:
(1) stage
(2) bulky tumor and/or B symptom
(3) lymphocyte count and/or bone marrow involvement
Stage
Bulky – B Symptoms
Other
Risk of Progression
III or IV
neither
NA
low
II
either or both
NA
low-intermediate
III or IV
either or both
lymphocyte count > 600 per µL and no bone marrow involvement
intermediate-high
III or IV
either or both
lymphocyte count <= 600 per µL and/or bone marrow involvement
high
Stages not included, and presumably very low risk:
(1) Stage I
(2) Stage II with neither bulky tumor nor B symptoms
Risk Group
Freedom from Disease Progression at 5 Years
low risk
88%
low-intermediate risk
80%
intermediate-high
72%
high risk
57% (80% at 1 year)
from Figure 1, page 111 and Figure 3, page 112
The rate of progression in the high risk group was not felt to be high enough to justify the use of high dose chemotherapy as part of primary therapy.
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