Predicting outcomes in Hodgkin lymphoma

This review discussed factors that help to determine prognosis (outcome) in Hodgkin lymphoma.

Hodgkin lymphoma is generally considered to be a curable form of cancer. However, it is important to have methods to predict outcomes in order to avoid either over-treating or under-treating patients.

The current article reviewed different factors that could be used in predicting outcomes in Hodgkin lymphoma patients.

Early-stage Hodgkin lymphoma (stage I or II) is grouped based on the presence or absence of certain risk factors. Patients with unfavorable disease have one or more of the following factors: high erythrocyte sedimentation rate in the blood (a sign of inflammation), fever, weight loss, night sweats, bulky disease (a large tumor in the chest), older age, number of lymph node areas involved, cancer in other organs, and 3 or more areas of disease.

In advanced Hodgkin lymphoma there are seven factors known to predict treatment failure-free survival. Patients who are over the age of 45, who are male, or who have stage IV disease are at risk of treatment failure. Low levels of red blood cells, lymphocytes (a type of white blood cell) or albumin (a protein) and high levels of leukocytes (another white blood cell) also increase the risk. Each of these risk factors decreases the freedom from treatment failure rate by 7% to 8%.

High levels of CD30 (a protein) in the blood has been associated with a poor outcome. High levels of interleukin-10 (a factor that blocks activation of the immune system) has been found in 35% to 45% of patients. This has been associated with a poor response to treatment.

Patients who relapse within the first year after treatment tend to have a higher risk of further progression. Other risk factors in patients who have relapsed include cancer beyond the lymph nodes, higher cancer stage, fever, night sweats, and weight loss. Patients who relapse after a stem cell transplant tend to have a poorer prognosis.

Recently PET scans have been explored as a way to predict outcomes. A PET scan uses a radioactive substance to image the organs and tissues of the body. In one study, patients underwent a PET scan after two cycles of chemotherapy. Patients who did not have any cancer activity on the PET scan had a 3-year freedom from treatment failure rate of 95%. In patients who did have cancer activity on the PET scan, the 3-year rate was 28%. Studies are now examining whether PET scan activity can be used to direct treatment choice.

This study reviewed current and future methods for predicting prognosis in Hodgkin lymphoma patients.