How does the definition of early-stage favorable Hodgkin lymphoma (Hodgkin disease) differ among guidelines?

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

In general, the management of Hodgkin lymphoma depends on the subtype. Most clinicians divide classical Hodgkin lymphoma into the following three general groups:

  • Early-stage favorable
  • Early-stage unfavorable
  • Advanced-stage disease

However, favorable disease is defined differently by different groups. The two most commonly used definitions are that of the European Organization for the Research and Treatment of Cancer (EORTC) and the German Hodgkin Study Group (GHSG).

The EORTC definition uses the following patient criteria [39] :

  • Limited-stage disease
  • Age younger than 50 years
  • No bulky mediastinal adenopathy
  • Erythrocyte sedimentation rate (ESR) less than 50 mm/h
  • No B symptoms (or an ESR < 30 mm/h with B symptoms)
  • Three or fewer sites of involvement

The GHSG definition uses the following criteria [40] :

  • No more than two sites of disease
  • No extranodal extension
  • No bulky mediastinal disease
  • ESR < 50 mm/h (or < 30 mm/h if B symptoms present)

With either definition, any patient with early-stage disease who does not meet the above criteria is considered to have early-stage unfavorable disease. In general, patients with early-stage favorable disease are treated with less intense chemotherapy and radiation regimens than those that are used for early-stage unfavorable disease.

Advanced-stage disease is generally treated with chemotherapy alone, with radiation therapy reserved for selected patients.


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