Prognostic factors in Hodgkin's disease: implications for modern treatment (review)

This review outlines the major prognostic factors as derived from the analysis of recent prospective trials. Disease extent, systemic symptoms, age, sex, and achievement of complete remission lasting longer than 12 months following chemotherapy, as well as certain treatment-related complications (e.g. acute leukemia), constitute the major variables affecting survival. Bulky lymphoma and inadequate primary irradiation are factors which have influence on relapse-free but not necessarily on total survival. Recent reports provide no evidence that minimalizing treatment (except salvage treatment), will demonstrably reduce treatment-related complications. Optimal treatment, giving patients the best chance to enter first durable complete remission, still seems to represent the best strategic approach. However, in given patient subsets, the impact of various treatment strategies on the 5-, 10-, and 15-year results is now being balanced against delayed morbidity, such as organ damage and second malignancies, produced by the intensity of treatment or the prolonged delivery of certain drugs.