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Prognostic Factors for Children With Hodgkin’s Disease Treated With Combined-Modality Therapy

From the Departments of Radiation Oncology and Pediatrics, Stanford University School of Medicine, Stanford, CA; Departments of Hematology-Oncology and Radiation Oncology, St Jude Children’s Research Hospital, Memphis, TN; Department of Pediatric Oncology and Division of Radiation Oncology, Children’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School; and Division of Pediatric Hematology-Oncology and Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Address reprint requests to Ron S. Smith, MD, Department of Radiation Oncology, Mayo Clinic, Immanuel-St Joseph’s Hospital, 1025 Marsh St, PO Box 8673, Mankato, MN 56002; email: smith.ron{at}mayo.edu.

Purpose: Evaluation of pretreatment factors to identify children at high risk for relapse after combined-modality therapy for Hodgkin’s disease.

Patients and Methods: From 1990 to 2000, 328 pediatric patients with clinical stage I to IV Hodgkin’s disease were treated with chemotherapy and low-dose involved-field radiotherapy on prospective, collaborative, risk-adapted protocols at three institutions. Pretreatment factors were analyzed by univariate and multivariate analysis for prognostic significance for 5-year disease-free survival (DFS) and overall survival (OS).

Results: With a median follow-up of 59 months (range, 8 to 125 months), the 5-year DFS and OS for all patients were 83% and 93%, respectively. Several factors were associated with inferior DFS and OS by univariate analysis. By multivariate analysis, male sex; stage IIB, IIIB, or IV disease; bulky mediastinal disease; WBC more than 13.5 x 10³/mm³; and hemoglobin less than 11.0 g/dL were significant for inferior DFS. A prognostic index was developed incorporating the five significant factors from the multivariate analysis, assigning each a score of 1. The 5-year DFS and OS for children with a prognostic score of 0 to 1 were 94% and 99%; score 2, 85% and 96%; score 3, 71% and 92%; and score 4 or 5, 49% and 72%, respectively. There was a significant difference in DFS among each of these groups, with significantly worse OS in those with a score of 4 to 5.

Conclusion: A prognostic index that was based on five pretreatment factors correlated with inferior DFS by multivariate analysis stratified patients by outcome; this may be useful in assigning children with Hodgkin’s disease to risk-adapted therapy.

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