What are the NCCN guidelines for determining unfavorable factors for stage I-II Hodgkin lymphoma (Hodgkin disease)?

Updated: Sep 12, 2018
  • Author: Bradley W Lash, MD; Chief Editor: Emmanuel C Besa, MD  more...
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National Comprehensive Cancer Network (NCCN) guidelines define unfavorable factors for stage I-II as follows [4] :

  • Bulky mediastinal disease (Mediastinal mass ratio [MMR; maximum width of mass/maximum intrathoracic diameter] greater than 0.33) or bulky disease greater than 10 cm
  • B symptoms
  • Erythrocyte sedimentation rate (ESR) >50 mm/hr
  • More than two-three nodal sites of disease

The European Society for Medical Oncology (ESMO) guidelines recommend the slightly different definitions of risk factors from the European Organization for Research and Treatment of Cancer /Lymphoma Study Association (EORTC/LSA) and the German Hodgkin Study Group (GSHG), as outlined in Table 3, below. [5]

Table 3. Unfavorable Risk Factors for Stages I and II Hodgkin Lymphoma (Open Table in a new window)

Risk Factor





≥50 y



MC or LD

ESR or B symptoms

>50 mm/hr if A or >30 if B

>50 mm/hr if A or > 30 if B

Mediastinal mass*

MMR >0.33

MMR >0.35

Number of nodal sites



Extranodal lesions



* Mediastinal mass is measured on chest x-ray by the mediastinal mass ratio (MMR), which is the maximum width of the mass/maximum intrathoracic diameter.ESR = erythrocyte sedimentation rate; LD = lymphocyte depletion; MC = mixed cellularity.

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