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Prognosis and survival for Hodgkin lymphoma
People with Hodgkin lymphoma (HL) may have questions about their prognosis and survival. Prognosis and survival depend on many factors. Only a doctor familiar with a person’s medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis.
A prognosis is the doctor’s best estimate of how cancer will affect a person, and how it will respond to treatment. A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together, and they both play a part in deciding on a treatment plan and a prognosis.
The stage of HL is an important factor in determining prognosis and planning treatment. However, because the extent of the disease may vary considerably within each stage, risk factors (also called adverse prognostic factors) have been identified for limited or early HL (stage I and II) and advanced HL (stage III and IV).
Prognostic factors for early Hodgkin lymphoma
Stage I and II HL are divided into favourable and unfavourable groups based on prognostic factors.
Early favourable HL
Early favourable HL means that no factors listed below are present.
Early unfavourable HL
Early unfavourable HL means that one or more of the following factors are present:
- bulky disease
- larger than one-third the width of the chest
- at least 10 cm in its greatest dimension in areas other than the chest
- presence of extranodal disease (in areas other than the lymph nodes)
- 3 or more areas of lymph node involvement
- erythrocyte sedimentation rate (ESR) of 50 mm/h or higher
- mixed cellularity HL
- presence of B symptoms
- unexplained fever over 38°C
- drenching night sweats
- unexplained weight loss – loss of more than 10% of original body weight within the last 6 months
Prognostic factors in advanced Hodgkin lymphoma
The International Prognostic Factors Project (IPFP) has developed an international prognostic score (IPS) based on 7 adverse factors for advanced (stage III and IV) HL. The factors that are present are combined to give a single score between 0 and 7.
Advanced favourable HL
Advanced favourable HL means that 0 to 3 factors listed below are present.
Advanced unfavourable HL
Advanced unfavourable HL means that 4 or more of the following factors are present:
- stage IV disease
- age 45 years or older
- male sex
- albumin level less than 4.0 g/dL
- hemoglobin level less than 10.5 g/dL
- white blood cell (WBC) count at least 15,000/mm3
- lymphocyte count less than 600/mm3 or less than 8% of the total WBC count