Pretreatment factors associated with an adverse outcome in one or more studies include the following:
- Advanced stage of disease.
- Presence of B symptoms.[23,24]
- Presence of bulky disease.
- Extranodal extension.
- Elevated erythrocyte sedimentation rate.
- Leukocytosis (white blood cell count 11,500/mm3 or higher).
- Anemia (hemoglobin lower than 11.0 g/dL).
- Male gender.[24,27]
- Response to initial treatment with chemotherapy.[21,28,29]
Prognostic factors identified in selected multi-institutional studies include the following:
- In the Society for Paediatric Oncology and Haematology (Gesellschaft für Pädiatrische Onkologie und Hämatologie [GPOH]) GPOH-95 study, B symptoms, histology, and male gender were adverse prognostic factors for event-free survival on multivariate analysis.
- In 320 children with clinically staged Hodgkin lymphoma treated in the Stanford-St. Jude-Dana Farber Cancer Institute consortium, male gender; stage IIB, IIIB, or IV disease; white blood cell count of 11,500/mm3 or higher; and hemoglobin lower than 11.0 g/dL were significant prognostic factors for inferior disease-free survival and overall survival (OS). Prognosis was also associated with the number of adverse factors.
- In the CCG-5942 study, the combination of B symptoms and bulky disease was associated with an inferior outcome.
- One single-institutional study showed that African American patients had a higher relapse rate than Caucasian patients, but OS was similar.
The rapidity of response to initial cycles of chemotherapy also appears to be prognostically important and is being used in the research setting to determine subsequent therapy.[28,29,31] Positron emission tomography (PET) scanning is being evaluated as a method to assess early response in pediatric Hodgkin lymphoma. Fluorodeoxyglucose-PET avidity after two cycles of chemotherapy for Hodgkin lymphoma in adults has been shown to predict treatment failure and progression-free survival.[32,33,34] Further studies in children are required to assess the role of early response based on PET. The value of PET avidity to predict outcome and whether improved outcome can be achieved by altering the therapeutic strategy based on early PET response is to be determined.
Although prognostic factors will continue to change because of risk stratification and choice of therapy, parameters such as disease stage, bulk, systemic symptomatology, and early response to chemotherapy are likely to remain relevant to outcome.
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