Prognosis and survival for childhood Hodgkin lymphoma
If your child has Hodgkin lymphoma (HL), you will have questions about their 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 factors. Only a doctor familiar with your child’s medical history, the type, stage, risk group 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.
A prognostic factor is an aspect of the cancer or a characteristic of the child 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 following are prognostic and predictive factors for childhood HL.
The earlier the stage, the better the prognosis. Children with an advanced stage of disease (stage 3 or 4) have a poorer prognosis.
Presence of B symptoms
Children who have B symptoms at the time of diagnosis generally have a poorer prognosis. B symptoms are a fever over 38°C, drenching night sweats and unexplained weight loss.
Tumour bulk refers to the size of the cancer. A bulky tumour is a large tumour in a lymph node or group of lymph nodes. Tumour bulk is considered a negative prognostic factor. This means that the larger the tumour, the less favourable the prognosis.
Where the cancer is in the body at diagnosis
Childhood HL that is only in the lymph nodes has a more favourable prognosis than HL that has spread to extranodal sites (other organs or areas of the body, such as bone marrow, liver or lungs).
Children with HL in the chest (mediastinum) may need more intensive treatment for bulky disease.
Erythrocyte sedimentation rate (ESR)
Children with a higher ESR at diagnosis have a poorer prognosis.
Children with anemia (low red blood cell counts) at diagnosis have a poorer prognosis.
Response to treatment
Children who respond quickly to the first chemotherapy treatments tend to have a better prognosis. Treatment response is measured by PET-CT scan after 2 cycles of chemotherapy.