Severe pruritus should be a B-symptom in Hodgkin's disease

Pruritus was evaluated with respect to frequency, intensity, and prognostic significance in 360 patients with Hodgkin's disease. In order to discriminate severe from mild pruritus, the following criteria was used: (1) multiple excoriations; (2) ineffectiveness of local and systemic antipruritics; and (3) improvement with either radiotherapy or chemotherapy. Ninety of 360 patients had mild itching on admission and showed the same survival as the 249 nonitching cases; 21 patients presented with severe pruritus, which was also generalized, and showed a statistically shorter survival than that of mild and non-itching cases. This comparison was carried out between patients homologous with respect to sex, age, stage, A or B category, and histotype. Analysis of the data pointed out that the third requirement, i.e., improvement with antineoplastic therapy, is not substantial; moreover, for staging purposes, it is preferably replaced by the requisite of generalized pruritus. The intrinsically poor prognosis related to severe pruritus may be important for treatment, when this symptom occurs in early stages or without other systemic symptoms. The inclusion of severe pruritus among the Ann Arbor criteria for definition of the B-clinical category is proposed.