Criteria

Lugano staging classification[34]

Staging with definition:

  • Stage I: involvement of one lymph node or a group of adjacent nodes; or involvement of single extranodal lesions without nodal involvement

  • Stage II: involvement of 2 or more nodal groups on the same side of the diaphragm; or stage I or II nodal extent with limited contiguous extranodal involvement

  • Stage II (bulky): as above for stage II, but with bulky disease (i.e., a single nodal mass ≥10 cm in greatest diameter or greater than a third of the transthoracic diameter at any level of thoracic vertebrae)

  • Stage III: involvement of lymph node on both sides of the diaphragm (includes involvement of lymph node above the diaphragm and the spleen)

  • Stage IV: involvement of additional noncontiguous extranodal site(s) (i.e., beyond extranodal site[s], contiguous or proximal to known nodal site)

Note: Tonsils, Waldeyer ring, and spleen are considered nodal tissue.

Sub-classification suffixes:

  • A: no B symptoms

  • B: presence of B symptoms (e.g., unexplained fever, drenching night sweats, weight loss >10% of body weight within 6 months of diagnosis)

International Prognostic Score (IPS)[43]

The International Prognostic Score (IPS) is a prognostic tool used to predict 5-year freedom from progression in patients with advanced HL, based on the following adverse prognostic factors:

  • Low albumin level (<4 g/dL)

  • Low hemoglobin level (<10.5 g/dL)

  • Male sex

  • Age ≥45 years

  • Stage IV disease

  • Leukocytosis

  • Lymphocytopenia.

A point is given for each factor that is present. The IPS score is the sum of the points (e.g., 0 to 7). Higher score indicates lower risk of freedom from progression. The IPS score can be used for risk stratification and to guide treatment in patients with advanced HL.

Prognostic criteria for favorable early-stage HL

Several groups have published prognostic criteria for favorable early-stage (stage I to II) classical HL to distinguish from unfavorable early-stage disease, in order to optimize treatment and minimize toxcity.[44] 

  • European Organisation for Research and Treatment of Cancer (EORTC) favorable prognosis criteria:

    • Mediastinal tumor ratio (MTR) <0.35

    • Erythrocyte sedimentation rate (ESR) <50 mm/hour if no B symptoms; ESR <30 mm/hour if B symptoms are present

    • Involvement of ≤3 nodal sites

    • Age <50 years

  • German Hodgkin Study Group (GHSG) favorable prognosis criteria:

    • Mediastinal mass ratio (MMR) <0.33

    • ESR <50 mm/hour if no B symptoms; ESR <30 mm/hour if B symptoms are present

    • Involvement of ≤2 nodal sites

    • No extranodal disease

  • National Comprehensive Cancer Network (NCCN) favorable prognosis criteria:

    • MMR <0.33

    • ESR <50 mm/hour and no B symptoms

    • Involvement of ≤3 nodal sites

    • Tumor bulk ≤10 cm (on CT scan)

Deauville criteria

The Deauville criteria can be used to assess interim and end-of-treatment response in patients with HL.[40] It is a five-point scale for fluorodeoxyglucose (FDG) uptake at involved sites relative to the mediastinum and liver, as visualized on PET/CT scan:

  • No FDG uptake: score = 1

  • FDG uptake ≤ mediastinum: score = 2

  • FDG uptake > mediastinum but ≤ liver: score = 3

  • FDG uptake moderately higher than liver: score = 4

  • FDG uptake markedly higher than liver and/or new lesions: score = 5

  • New areas of FDG uptake unlikely to be related to lymphoma: score = X

Patients with a negative PET/CT (i.e., Deauville score 1 to 3) are considered to have a complete metabolic response.[40]​ Patients with a positive PET/CT (i.e., Deauville score 4 or 5) are considered to have a partial metabolic response.

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