Early stage Hodgkin lymphoma risk stratification

Risk stratification of stage I and II Hodgkin lymphoma

Trial or recommendationRisk factors for early stage Hodgkin lymphoma
European Organization for the Research and Treatment of Cancer (EORTC), H10 study protocol1
  • ≥ 4 nodal areas, OR
  • Age ≥ 50 years, OR
  • Mediastinal mass ≥ 0.35 maximum transverse thoracic diameter
  • ESR ≥ 30 mm/h in the presence of B symptoms, OR
  • ESR ≥ 50 mm/h in the absence of B symptoms
European Society for Medical Oncology (ESMO), 2007 recommendations2
  • large mediastinal mass (> 1/3 thoracic width on CXR OR > 7.5 cm on CT), OR
  • extranodal involvement, OR
  • massive spleen involvement (diffuse infiltration or > 5 splenic nodules), OR
  • ESR > 50 mm/h in the absence of B symptoms, OR
  • ESR > 30 mm/h in the presence of B symptoms, OR
  • ≥ 3 lymph node areas involved, OR
  • age > 60 years
German Hodgkin lymphoma Study Group (GHSG), HD16 protocol3
  • Mediastinal mass > 1/3 maximum transverse thoracic diameter, OR
  • ≥ 3 lymph node areas, OR
  • Extranodal involvement, OR
  • ESR ≥ 30 mm/h in the presence of B symptoms, OR
  • ESR ≥ 50 mm/h in the absence of B symptoms
National Cancer Institute of Canada (NCIC) and Eastern Cooperative Oncology Group (ECOG), HD6 trial4
  • ≥ 4 disease sites, OR
  • Age ≥ 40 years, OR
  • ESR ≥ 50 mm/h, OR
  • Classical Hodgkin lymphoma histological subtype not either lymphocyte predominant or nodular sclerosing
Note: Patients with bulky adenopathy (palpable nodal mass > 10cm diameter) or mediastinal mass > 1/3 chest wall diameter were classified as very unfavourable, and not eligible for this study. This study did not include patients with B symptoms.
National Cancer Research Institute (UK) (NCRI), RAPID trial5
  • mediastinal mass > 1/3 thoracic diameter, OR
  • Bulky disease at any other site (nodal mass with diameter > 10 cm)

Early stage Hodgkin lymphoma (Ann Arbor stage I or II) can be stratified into favorable and unfavorable categories. Various risk stratifications have been used in cooperative group studies, to identify groups suitable for less intensive treatment. The table above summarises some of the systems used in recent clinical trials of early-stage Hodgkin lymphoma. Clinicians should follow the relevant trial protocol, or follow local treatment guidelines.

CT computed tomography
CXR chest X-ray
ESR erythrocytes sedimentation rate