Researchers from around the world have been gathering data on Hodgkin's patients to determine the best course of treatment for advanced disease. Two thirds of patients with advanced Hodgkin's are cured with current approaches to treatment. Prediction of patient outcome at diagnosis is important to avoid overtreating some patients and to identify others in whom standard treatment is likely to fail (to perhaps get them into clinical trials).
A 1998 paper in the New England Journal of Medicine highlighted the work of the International Prognostic Factors Project for Advanced Hodgkin's Disease (Hodgkin's Lymphoma). Below I attempt to outline the results of the paper for the lay person.
The researchers collected data from 25 centers and study groups on a total of 5141 patients treated with combination chemotherapy with and without radiation. Complete data was available from 1618 patients and the data from the rest was used to verify the results.
The prognostic score is calculated by the number of yes questions to the following at Hodgkin's diagnosis:
- Is the patient male?
- Is the patient 45 years or older?
- Does the patient have stage IV disease?
- Does the patient have a serum albumin level of less than 4 grams per deciliter? (normal value between 3.9 and 5 g/dl)
- Does the patient have a hemoglobin level of less than 10.5 grams per deciliter?
- Does the patient have leukocytosis (a white cell count of 15,000 or more)?
- Does the patient have lymphocytopenia (a lymphocyte count of less than 600 per cubic millimeter, a count that is less than 8 percent of the white cell count, or both)?
The yes answers are counted and the number of patients in the study that achieved freedom from progression of disease (FFPD - having the disease stopped and reversed - most likely remission so I'll use that word) based on their score was presented:
- Score 0, Remission Rate 84%
- Score 1, Remission Rate 77%
- Score 2, Remission Rate 67%
- Score 3, Remission Rate 60%
- Score 4, Remission Rate 51%
- Score 5 or higher, Remission rate 42%
The conclusion was that the scoring may be useful in designing trials for treating advanced Hodgkin's and making some individual therapeutic decisions. But the study could not find a set of factors for patients at very high risk - patients who might benefit from clinical trials with approaches differing from current combination chemotherapy / radiation protocols.
Now before everyone starts using this to determine happiness or doom & gloom you must weigh the facts:
- This data must be studied and validated
- The percentages are for the group of people - "your results may be different" - see The Median isn't the Message
- Other factors including the determination of antigens on Reed-Sternberg cells may be better factors than the seven above
The authors are working to find the best factors in treatment determination. Finding out whether people should get less invasive/toxic treatment or more aggressive treatments will hopefully lead to an effective treatment for every particular case that arises.
A Prognostic Score for Advanced Hodgkin's Disease by Hasenclever, Diehl, et. al, New England Journal of Medicine, Nov 19, 1998 Volume 339, Number 21
Editorial - Prognostic Factors in Advanced Hodgkin's Disease -- Can They Guide Therapeutic Decisions? by Pauline Brice, M.D., New England Journal of Medicine, Nov 19, 1998 Volume 339, Number 21 (References)
Further Reading on Adult Hodgkin's Lymphoma:
Adult Hodgkin's Lymphoma: Diagnosis
Hodgkin's Lymphoma: Treatment
Adult Hodgkin's Lymphoma: Chemotherapy
Adult Hodgkin's Disease: Resources
Adult Hodgkin's Disease: Introduction
For Information on Childhood Hodgkin's lymphoma:
Childhood Hodgkin's Information Pages
Hodgkin's Disease, Peter M. Mauch (Editor), James O. Armitage (Editor), Volker Diehl (Editor), June 1999.
• Section IV: Staging and Initial Evaluation