Prognostic factors for disease progression in advanced Hodgkin's disease: an analysis of patients aged under 60 years showing no progression in the first 6 months after starting primary chemotherapy

Abstract

Summary The aim of this study was to determine whether a very high-risk group based on presenting characteristics could be identified in patients with advanced Hodgkin's disease who may benefit from high-dose chemotherapy (HDCT). Between 1975 and 1992, 453 previously untreated patients aged under 60 years who did not progress in the first 6 months after the start of standard chemotherapy had their hospital notes reviewed. The outcomes analysed were early disease progression (in the 6-to 18-month window following the start of chemotherapy) and disease progression in the whole of the follow-up period. A Cox regression analysis was used to investigate the combined effects of a number of presenting characteristics on these outcomes. Despite the presence of factors with significant effects on the relative rate of progression, the absolute effects in a group identified as having the poorest prognosis were not especially poor. No group could be defined with a freedom from progression rate of less than 70% over 6-18 months, and the worst prognostic group, which included only 53 patients, had an overall freedom from progression rate of 57% at 5 years. Four other reported prognostic indices were evaluated using our data set, but none of the indices was more successful in identifying a very high-risk group. It has not been possible to define a sufficiently high-risk group of patients with Hodgkin's disease based on presenting characteristics for whom HDCT could be advised as part of primary treatment. The search for more discriminating prognostic factors identifying vulnerable patients with a high risk of relapse must continue before a role can be found for HDCT following conventional chemotherapy in patients without disease progression.

A prognostic model for prolonged event-free survival after autologous or allogeneic blood or marrow transplantation for relapsed and refractory Hodgkin's disease

“…[26][27][28][29][30][31][32][33][34][35] 3 (7) 5 (28) a Number of the following factors: KPSo90, chemotherapy resistant disease, X3 prior chemotherapy regimens.…”

“…[20][21][22][23][24][25] Prognostic models based on presentation features in HD patients have been proposed for predicting the outcome. [26][27][28][29][30][31][32][33][34][35] These models have proven quite useful for predicting the outcome in newly diagnosed HD patients, however, not all HD patients have these prognostic factors evaluated at diagnosis, which can be difficult to obtain in patients referred for BMT often years after diagnosis. There have been three prognostic scoring systems reported in the last 3 years for auto BMT patients.…”

Plasma levels of tumour necrosis factor and its soluble receptors correlate with clinical features and outcome of Hodgkin's disease patients

“…Overall survival rates at 2 years in the low-, intermediate-and high-risk groups were 100%, 93%, and 71% respectively (log-rank test P < 0.01) (Figure 2). Using our data set, we evaluated the importance of the TNF ligand receptor-based prognostic index along with five other reported prognostic indices for HD (Wagstaff et al, 1988;Straus et al, 1990;Proctor et al, 1991;Hasenclever et al, 1995;Lee et al, 1997). The TNF ligand receptor-based prognostic index was the only index to have a significant prognostic impact for FFP survival ( Figure 3K).…”

“…The TNF ligand receptor-based prognostic index was the only index to have a significant prognostic impact for FFP survival ( Figure 3K). Using the same indices for analysis of overall survival, only the simplified Manchester index (low-and high-risk groups) (Lee et al, 1997) and the index derived from the current TNF, p55 and p75 plasma levels analysis were found to have significant predictive values (Log-rank test P < 0.005 and P < 0.01, respectively) ( Figure 3H and L).…”

“…The most common factors that have been found to be associated with an unfavourable outcome include advanced stage, presence of extranodal disease and bulky tumour, mixed cellularity or lymphocyte depletion histology, age above 45 years, presence of B symptoms, male gender, elevated serum levels of LDH, P2-microglobulin, alkaline phosphatase and low serum albumin levels. However, despite the presence of several prognostic indices for HD, there is no agreement on the definition of sufficiently high-risk groups of patients for whom the prognosis is especially poor and for whom up-front high-dose therapy should be advised (Wagstaff et al, 1988;Straus et al, 1990; Proctor et al, 1991;Hasenclever et al, 1995;Lee et al, 1997). Thus, the search for more discriminating prognostic factors identifying vulnerable patients with a high risk of resistance or relapse is still an open challenge.…”