• Age: Survival is significantly better in younger compared with older patients.
• Sex: The prognosis is better in females than in males.
• Systemic symptoms: Fever, weight loss, and night sweats are associated with a more unfavorable prognosis.
• Complete remission: The life expectancy is longer in patients with complete remission (CR) than in those with partial remission (PR) or no remission (NR).
• Histopathology a. The prognosis in lymphocyte-predominant (LP), nodular sclerosis (NS), mixed cellularity (MC), and lymphocyte-depleted (LD) HD is proportional to the ratio of lymphocytes to abnormal cells: LP > NS > MC > LD.
b. Nodular, LPHD without diffuse type: This is an indolent, yet relapsing disease with patients rarely succumbing to their disease. Up to 10% of patients may develop non-Hodgkin lymphoma of B-cell origin.
c. Nodular, LPHD with diffuse type: Relapses are uncommon, but once a relapse occurs the HD is often more aggressive histologically, resulting in decreased survival.
d. Lymphocyte-depleted nodular sclerosing HD: This is associated with poor survival.
e. Lymphocyte-depleted HD (LDHD): This is the most aggressive type of HD. It is frequently seen in older patients and is more common in men than women; it often presents as stage III or IV disease. This type must be distinguished from large-cell non-Hodgkin lymphoma. LDHD responds to modern therapy, although, in the past, prognosis was very poor.
• Stage: Survival correlates with the anatomic extent of the disease; bulky mediastinal disease in nodal and extranodal sites carries an unfavorable prognosis.
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