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    Childhood Hodgkin Lymphoma Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Diagnosis and Staging

    Table 2. Criteria Used for the Classification of Risk Groups in Childhood Hodgkin Lymphoma Clinical Trialsa

    Trial Low Risk Intermediate Risk High Risk
    E = extralymphatic.
    a Adapted from Kelly.[19]
    Children's Oncology Group
    AHOD0031[20] IA bulk or E; IB; IIA bulk or E; IIB; IIIA, IVA
    AHOD0431[21] IA, IIA with no bulk
    AHOD0831 IIIB, IVB
    C5942[22] IA, IB, IIA with no bulk, no hilar nodes and <4 sites IA, IB, IIA with bulk, hilar nodes or ≥4 sites; III IV
    C59704[23] IIB/IIIB with bulk, IV
    P9425/P9426[24] IA, IIA with no bulk IB, IIA, IIIA1 with bulk; IIIA2 IIB, IIIB, IV
    German Multicenter/Euronet
    GPOH-HD 95; GPOH-HD 2002;PHL-C1[4,25,26] 1A/B, IIA IE A/B;IIE A; IIB; IIIA IIE B; IIIE A/B; IIIB; IV
    Stanford/St. Jude/Dana-Farber Cancer Institute Consortium
    HOD05 IB, IIIA, IA/IIA with E, ≥3 sites or bulk
    HOD08 IA, IIA with no bulk, E and <3 sites
    HOD99 IIB, IIIB, IV

    Although all major research groups classify patients according to clinical criteria, such as stage and presence of B symptoms, extranodal involvement, or bulky disease, comparison of outcomes across trials is further complicated because of differences in how these individual criteria are defined.

    Response Assessment

    Further refinement of risk classification may be performed through assessment of response after initial cycles of chemotherapy or at its completion.

    Interim response assessment

    The interim response to initial therapy, which may be assessed on the basis of volume reduction of disease, functional imaging status, or both, is an important prognostic variable in both early- and advanced-stage pediatric Hodgkin lymphoma.[27,28] Definitions for interim response are variable and protocol specific, but can range from volume reductions of greater than 50% to the achievement of a complete response with a volume reduction of greater than 95% by anatomic imaging or resolution of FDG-PET avidity.[4,21,24]

    The rapidity of response to early therapy has been used in risk stratification to tailor therapy in an effort to augment therapy in higher-risk patients or to reduce the late effects while maintaining efficacy.

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