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.
Specialty: Hematology Oncology