Management of Hodgkin's disease in western India

The authors report a retrospective analysis of 441 patients with Hodgkin's disease seen at the Tata Memorial Hospital, Bombay, over a 4-year period from 1975 to 1978. Clinicopathologic features seem to vary from those reported in the western literature, but are similar to the patterns observed in Africa and South America. Thirty-three percent of all malignant lymphomas were Hodgkin's disease. Histologically, the mixed cell (MC) type (40%) and the lymphocytic predominant (LP) type (24%) were the most common, with 52% of patients presenting in Stages III and IV. The nodular sclerosis (NS) variant occurred in only 11% of the cases. Systemic symptoms were present in 24% of clinical Stage I patients, and increased steadily to 85% in Stage IV patients. Bone marrow biopsies in 242 patients were found to be of little value in Stages I and II. Thirty of 34 patients with positive bone marrow biopsy were in clinical Stages III B and IV, whereas 24 of 34 patients showed MC and LD patterns. Lymphangiography in 104 patients altered the clinical staging of Stages I and II in 27% of the cases with accuracy of 80%. Staging laparotomy performed in 93 patients altered the stage in 45% of clinical Stage I and 62% of Stage II patients. Splenic involvement was common in the presence of systemic symptoms (67%) and MC/LD histology (82%). The incidence of liver involvement was 16% in 15 patients with all, but one, associated with splenic pathology. The clinical stage and histopathologic variants of the disease bear an excellent correlation with a significant impact on treatment responses and total survival. The survival rates for Stage I were 81%, Stage II 76%, Stage IIIA 71%, and Stage IIIB and IV 46% at 48 months. The LP type had the best prognosis with 85% survival at 48 months, whereas the survival in the depleted variety was only 56%. Surprisingly, the MC type did better with a 64% survival, while the nodular sclerosis group had 59% surviving at 48 months.