Hodgkin's disease: basing treatment decisions on prognostic factors

The purpose of this study was to review the current status of risk factor assessment in Hodgkin's disease (HD) clinically useful for managing this disease. Regarding database retrieval and selection a literature search restricted to English-language articles, abstracts, book chapters and reports published between 1980 and 1993 was conducted both electronically using MEDLINE and CANCERLIT and manually using the bibliographies of the retrieved database. Out of approximately 500 publications identified for analysis, 34 were selected as illustrative. Results showed that most patients with Hodgkin's disease are curable at the outset with standard radio- or chemo-therapy, depending on stage and other risk factors. However, up to 40% of patients will either fail at initial induction, or experience early or late relapses. Risk factors analysis at these various times provide a solid base for selecting the therapy best suited to optimize outcome for each individual patient. Patients with truly refractory disease pose a serious challenge to clinicians and are best managed in specialized centers conducting controlled clinical trials. In conclusion it appears that although approximately 75% of newly diagnosed patients with HD can expect long-term, disease-free survival, refractory patients exhibit a dismal survival. Improving their outcome will require innovative approaches.