Risk Factor Adapted Treatment of Hodgkin’s Lymphoma: Strategies and Perspectives

Although modern therapy strategies have considerably improved the prognosis of Hodgkin’s lymphoma, in general the results for stages I, II, and IIIA with mediastinal tumor, spleen, or extranodal involvement and those for advanced stages IIIB and IV are not yet satisfactory. In a number of different trials large mediastinal tumor (Cosset et al. 1984; Lee et al. 1980; Mauch et al. 1982), E-stages (Kaplan 1980; Musshoff 1970; Pillai et al. 1985; Prosnitz et al. 1981), and massive splenic involvement (Desser et al. 1977) have been reported to be unfavorable prognostic indicators if found in localized or IIIA stages. In most trials involving advanced stages complete remission rates range between 50% and 90% with a 5-year survival rate of less than 60% (Bonadonna et al. 1975; Cosset et al. 1984; Hancock 1986; Longo et al. 1986). With respect to the possibility and necessity of therapy intensification for selected groups of patients, it is useful to examine likewise treated patients for heterogeneity of response. We therefore performed a prognostic risk factor analysis based on the data of patients registered in our trials.