Prognostic factors for children with Hodgkin's disease treated with combined-modality therapy

Ron S. Smith, Qing Chen, Melissa M. Hudson, Michael P. Link, Larry Kun, Howard Weinstein, Amy Billett, Karen J. Marcus, Nancy J. Tarbell, Sarah S. Donaldson

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95 Scopus citations


Purpose: Evaluation of pretreatment factors to identify children at high risk for relapse after combined-modality therapy for Hodgkin's disease. Patients and Methods: From 1990 to 2000, 328 pediatric patients with clinical stage I to IV Hodgkin's disease were treated with chemotherapy and low-dose involved-field radiotherapy on prospective, collaborative, risk-adapted protocols at three institutions. Pretreatment factors were analyzed by univariate and multivariate analysis for prognostic significance for 5-year disease-free survival (DFS) and overall survival (OS). Results: With a median follow-up of 59 months (range, 8 to 125 months), the 5-year DFS and OS for all patients were 83% and 93%, respectively. Several factors were associated with inferior DFS and OS by univariate analysis. By multivariate analysis, male sex; stage IIB, IIIB, or IV disease; bulky mediastinal disease; WBC more than 13.5 × 10 3/mm3; and hemoglobin less than 11.0 g/dL were significant for inferior DFS. A prognostic index was developed incorporating the five significant factors from the multivariate analysis, assigning each a score of 1. The 5-year DFS and OS for children with a prognostic score of 0 to 1 were 94% and 99%; score 2, 85% and 96%; score 3, 71% and 92%; and score 4 or 5, 49% and 72%, respectively. There was a significant difference in DFS among each of these groups, with significantly worse OS in those with a score of 4 to 5. Conclusion: A prognostic index that was based on five pretreatment factors correlated with inferior DFS by multivariate analysis stratified patients by outcome; this may be useful in assigning children with Hodgkin's disease to risk-adapted therapy.

Original languageEnglish (US)
Pages (from-to)2026-2033
Number of pages8
JournalJournal of Clinical Oncology
Issue number10
StatePublished - May 15 2003

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Smith, R. S., Chen, Q., Hudson, M. M., Link, M. P., Kun, L., Weinstein, H., Billett, A., Marcus, K. J., Tarbell, N. J., & Donaldson, S. S. (2003). Prognostic factors for children with Hodgkin's disease treated with combined-modality therapy. Journal of Clinical Oncology, 21(10), 2026-2033.