Many investigators and many new clinical trials employ a clinical staging system that divides patients into four major groups that are also useful for the practicing physician:
Early favorable: Clinical stage I or II without any risk factors.
Early unfavorable: Clinical stage I or II with one or more of the following risk factors:
Large mediastinal mass (>33% of the thoracic width on the chest x-ray, ≥10 cm on CT scan).
Elevated erythrocyte sedimentation rate (>30 mm/h for B stage, >50 mm/h for A stage).
Three or more lymph node areas' involvement.
Advanced favorable: Clinical stage III or IV with zero to three adverse risk factors listed below. Patients with advanced favorable disease have a 60% to 80% freedom-from-progression at 5 years from treatment with first-line chemotherapy.[Level of evidence: 3iiiDiii]
Advanced unfavorable: Clinical stage III or IV with four or more adverse risk factors listed below. Patients with advanced unfavorable disease showed a 42% to 51% freedom-from-progression at 5 years from treatment with first-line chemotherapy.[Level of evidence: 3iiiDiii]. For patients with advanced-stage HL, the International Prognostic Factors Project has developed an International Prognostic Index with a prognostic score that is based on seven adverse factors:
Absolute lymphocytic count of <600/mm3 or a lymphocyte count that was <8% of the total WBC count.
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