Hodgkin's lymphoma natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The early stage of the Hodgkin's lymphoma is associated with the most favorable prognosis. The 5-year survival rate of patients with Hodgkin's lymphoma varies with the stage of the disease.
Prognosis
In 1998, an international effort[1] identified seven prognostic factors that accurately predict the success rate of conventional treatment in patients with locally extensive or advanced stage Hodgkin's lymphoma. Freedom from progression (FFP) at 5 years was directly related to the number of factors present in a patient. The 5-year freedom from progression for patients with zero factors is 84%. Each additional factor lowers the 5-year freedom from progression rate by 7%, such that the 5-year freedom from progression for a patient with 5 or more factors is 42%. The adverse prognostic factors identified in the international study are:
- Age = >45 years
- Stage IV disease
- Hemoglobin < 10.5 g/dl
- Lymphocyte count < 600/µl or < 8%
- Male
- Albumin < 4.0 g/dl
- White blood count = > 15,000/µl
Other studies have reported the following to be the most important adverse prognostic factors:
- Bulky disease (widening of the mediastinum by more than one third, or the presence of a nodal mass measuring more than 10 cm in any dimension.)
- Mixed-cellularity or lymphocyte-depleted histologies
- High erythrocyte sedimentation rate
- Large number of involved nodal sites
- The presence of B symptoms
- Age of 40 years or more
- Advanced stage
- Male sex
5-Year Survival
- Between 2004 and 2010, the 5-year relative survival of patients with Hodgkin's lymphoma was 87.7%.[2]
- When stratified by age, the 5-year relative survival of patients with Hodgkin's lymphoma was 90.5% and 52.8% for patients <65 and ≥ 65 years of age respectively.[2]
- The survival of patients with Hodgkin's lymphoma varies with the stage of the disease. Shown below is a table depicting the 5-year relative survival by the stage of Hodgkin's lymphoma:[2]
| Stage | 5-year relative survival (%), (2004-2010) |
| All stages | 85.3% |
| Localized | 90.8% |
| Regional | 92.1% |
| Distant | 76.2% |
| Unstaged | 80.7% |
- The survival of patients with Hodgkin's lymphoma also varies with the subtype of Hodgkin's lymphoma. Shown below is the 5-year relative survival by the subtype of Hodgkin's lymphoma:[2]
- Classical Hodgkin's lymphoma: 84.8%
- Lymphocyte-rich: 87.1%
- Mixed cellularity: 80%
- Lymphocyte-depleted: 56.6%
- Nodular sclerosis: 89.4%
- Classical Hodgkin's lymphoma not otherwise specified: 75.2%
- Nodular lymphocyte predominant Hodgkin's lymphoma: 95.3%
- Classical Hodgkin's lymphoma: 84.8%
- Shown below is an image depicting the 5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 1998 and 2010 of Hodgkin's lymphoma by stage at diagnosis according to SEER. These graphs are adapted from SEER: The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.[2]
References
- ↑ Hasenclever (1998-11-19). "A Prognostic Score for Advanced Hodgkin's Disease". New England Journal of Medicine. 339 (21). Unknown parameter
|coauthour=ignored (help); Check date values in:|date=(help) - ↑ 2.0 2.1 2.2 2.3 2.4 Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.