What are the International Conference on Malignant Lymphomas guidelines for the staging of Hodgkin lymphoma (Hodgkin disease)?

Updated: Sep 12, 2018
  • Author: Bradley W Lash, MD; Chief Editor: Emmanuel C Besa, MD  more...
  • Print

In 2014, the International Conference on Malignant Lymphomas, a multi-disciplinary team of researchers, representing major lymphoma clinical trial groups and cancer centers from North America, Europe, Japan and Australasia, published guidelines for the evaluation, staging, and response assessment. These guidelines were intended to be an update to the 2007 revised guidelines of the International Harmonization Project. [6] The revised recommendations for staging are as follows [120] :

  • PET-CT is preferred for pretreatment assessment and routine staging

  • Contrast-enhanced CT is more accurate for measurement of nodal size and is also preferred for radiation planning

  • Chest x-ray is not required

  • PET-CT is preferred for determining splenic involvement with cutoff for splenomegaly of more than 13 cm

  • Liver size is not a reliable measure of hepatic involvement; diffusely increased or focal uptake, with or without focal or disseminated nodules, supports liver involvement

  • Bone marrow aspirate/biopsy is not required for early-stage HL (stage I-IIA) if PET-CT was performed (an exception noted by NCCN is if PET-CT is negative but the patient has unexplained cytopenias [4] )

  • Bone marrow biopsy and aspirate is required for patients with advanced-stage HL (stage IIB-IV)

In addition, these guidelines offered consensus on further modifications to the Ann Arbor staging classification. See Table 2, below. [120]

Table 2. International Conference on Malignant Lymphomas Modification of Ann Arbor Staging (Open Table in a new window)


Area of Involvement

Extranodal (E) Status


Single node or adjacent group of nodes

Single extranodal lesions without nodal involvement


Multiple lymph node groups on same side of diaphragm

Stage I or II by nodal extent with limited contiguous extranodal involvement

II bulky*

Multiple lymph node groups on same side of diaphragm with bulk >10 cm



Multiple lymph node groups on both sides of diaphragm; nodes above the diaphragm with spleen involvement



Multiple noncontiguous extranodal sites



B symptoms: weight loss >10%, fever, drenching night sweats


*Stage II bulky disease is defined as limited or advanced on the basis of histology and a number of prognostic factors.

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!