Prognosis and survival for Hodgkin lymphoma

A prognosis is the doctor’s best estimate of how cancer will affect you and how it will respond to treatment. Survival is the percentage of people with a disease who are alive at some point in time after their diagnosis. Prognosis and survival depend on many factors.

The doctor will look at certain aspects of the cancer as well as characteristics of the person (such as age and sex). These are called prognostic factors. The doctor will also look at predictive factors, which influence how a cancer will respond to a certain treatment and how likely it is that the cancer will come back after treatment.

Prognostic and predictive factors are often discussed together. They both play a part in deciding on a prognosis and a treatment plan just for you. Only a doctor familiar with your medical history, the type, stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis and chances of survival.

Early-stage Hodgkin lymphoma (HL) includes stages 1 and 2. It may also include stage 2 bulky disease.

The 2 systems that doctors use for determining a prognosis for early-stage HL are the German Hodgkin Lymphoma Study Group (GHLSG) and the European Organizations for the Research and Treatment of Cancer (EORTC). These systems are very similar, but they define some prognostic factors differently.

Doctors will describe the prognosis for early-stage HL as favourable or unfavourable:

• Favourable means that none of the following factors are present.

• Unfavourable means that 1 or more of the following factors are present.

B symptoms are fever, drenching night sweats and unexplained weight loss. People with B symptoms have a less favourable prognosis than people without them.

HL can form a tumour, or mass, in the space in the chest between the lungs (called the mediastinum). If a tumour is larger than 10 cm or takes up more than one-third of the mediastinum, it is called bulky disease.

Bulky disease has a less favourable prognosis than smaller tumours.

GHLSG says that HL that has spread to 3 or more lymphatic sites has an unfavourable prognosis.

EORTC gives HL an unfavourable prognosis if HL has spread to 4 or more lymphatic sites.

The erythrocyte sedimentation rate (ESR) may also be called the sed rate. It is a measure of how far in millimetres (mm) red blood cells (also called erythrocytes) sink from the top of a test tube in 1 hour (hr). HL has an unfavourable prognosis if:

• the ESR is 50 mm/hr or higher in people who don’t have B symptoms
• the ESR is 30 mm/hr or higher in people who have B symptoms

GHLSG says that HL has an unfavourable prognosis if it has spread to 1 area outside the lymphatic system (called an extranodal site). Extranodal sites include the liver, lungs and bones. Spread to an extranodal site is rare in HL.

EORTC gives early-stage HL an unfavourable prognosis in people who are 45 or older.

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