Prognosis and survival for Hodgkin lymphoma

If you have Hodgkin lymphoma (HL), you may have questions about your prognosis. A prognosis is the doctor’s best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many risk factors. Only a doctor familiar with your medical history, the type, stage and characteristics of your cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis.

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. They both play a part in deciding on a treatment plan and a prognosis.

The stage of HL is an important factor in determining a prognosis and planning treatment. But how far the HL has spread and the organs or areas of tissue it affects can be different within each stage. So doctors use the following factors to help them estimate a prognosis for early and advanced HL. These factors are called unfavourable (adverse) risks because they mean there is a greater risk that the HL will come back (relapse) after it is treated.

Early HL includes stages 1 and 2. Doctors classify early HL as favourable or unfavourable based on the following 5 factors. Some of the International Prognostic Score (IPS) factors for advanced HL may also be used. Favourable HL means that the person doesn’t have any of these factors. Unfavourable HL means that the person has one or more of these factors.

Doctors will add the letter A to the stage when the person doesn’t have B symptoms. The letter B means that the person has B symptoms. So early HL includes stages 1A, 1B and 2A.

B symptoms are generalized symptoms that affect the whole body:

• unexplained fever
• drenching night sweats
• unexplained weight loss of more than 10% of body weight over the last 6 months

Bulky (large) chest tumours often have a less favourable prognosis because they don’t tend to respond as well to treatment as smaller tumours. Doctors may describe the following as bulky:

• a tumour in the chest that is at least one-third as wide as the chest on a chest x-ray
• a tumour that is 10 cm or more across on a CT scan

HL that is only in lymph nodes has a more favourable prognosis than HL that has spread to other organs or areas of the body, such as the bone marrow, liver or lungs. Doctors may refer to areas other than the lymph nodes as extranodal sites.

HL that is in 3 or more areas of lymph nodes has a less favourable prognosis.

The following are unfavourable risk factors:

• ESR of 50 mm/h or higher in people who don’t have B symptoms
• ESR of 30 mm/h or higher in people who have B symptoms

Advanced HL includes stage 3 and 4. Some doctors also include people with B symptoms or people with bulky tumours in this category.

The International Prognostic Score (IPS) helps doctors predict a prognosis and determine treatment for people with advanced HL. It is based on the following 7 unfavourable risk factors.

Stage 4 HL has a less favourable prognosis than stage 2B or stage 3.

People who are 45 or older have a less favourable prognosis.

Men have a less favourable prognosis than women.

A hemoglobin level of less than 105 g/L is less favourable.

An albumin level of less than 40 g/L is less favourable.

A white blood cell count of 15,000/mm³ or more is less favourable.

A lymphocyte count of less than 600/mm³ or less than 8% of the total white blood cell count is less favourable.