Hodgkin’s Lymphoma – Staging and Prognostic Factors

Costwold Modified Ann-Arbor Staging

I: 1 Lymph Node (LN) region (I) or 1 Extralymphatic site (IE)

II: On the same side of diaphragm – ≥2 LN region (II) or Localized Extralymphatic extension + ≥1 LN region (IIE)

III: On both the sides of diaphragm – LN regions (III) ± Spleen involvement (IIIS) ± Localized Extralymphatic extension (IIIE) or both (IIISE)

IV: Noncontiguous involvement of ≥1 Extralymphatic site with or without LN involvement

Annonations

A: Asymptomatic or Absence of B symptoms

B: B symptoms – ≥1 in last 6 months:

1. Weight loss > 10%
2. Unexplained persistent or recurrent fever
3. Drenching night sweats

X: Bulky disease (≥6 cm in diameter or mass > 1/3 of mediastinal diameter)

E: Extension to a single Extralymphatic organ adjacent to a known involved site.

International Prognostic Score (IPS)

Mnemonic: HALSWAM

1. Hemoglobin: <10.5 gm/dl
2. Age: ≥ 45 years
3. Lymphocytopenia: Lymphocyte count < 8% of WBC or <600/cu.mm
4. Stage: IV
5. WBC: >15,000/cu.mm
6. Albumin: <4 gm/dl
7. Male gender

Interpretation:

• None: 84% FFP (Free From Progression) at 5 yrs

Presence of each factor depresses the curve plateau by ~8%.

• 1: 77%
• 2: 67%
• 3: 60%
• 4: 51%
• 5+: 42%