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Improved estimation of tumour burden leads to better prognostic discrimination in classical hodgkin's disease in adults

Lookup NU author(s): Dr Brian Angus, Dr Fergus Jack, Professor Graham Jackson, Professor Stephen Proctor, Dr Penelope Taylor, Professor Anne Dickinson, Dr John Owen


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Whilst most patients with HD are cured with current therapy, 20 -30% ultimately die of their disease. "Bulk" Disease is known to be an adverse prognostic indicator, as are other parameters such as stage, age, Hb, lymphocyte count, β2m. Novel serum markers such as sCD30 look promising. Patients aged > 15 years diagnosed 1996 -1998, i.e. with a minimum of 1 year follow-up, were taken for the study from the Northern Region of England, with CT scans reviewed centrally. Tumour burden was measured based on the previously published methods. CT scans were available in 70 patients and the score could be calculated in 67, and was shown to correlate with Hb, ESR, albumin, sCD30, lymphocyte count, stage, β2m and "bulky" disease but not histological subtype, gender or EBV positivity. The strongest correlations were with sCD30, albumin and haemoglobin. Follow-up for the patients in this study was short but it is known that patients who failed to achieve a remission or relapse early carry very poor prognosis; we therefore used event free survival for our analysis. For the whole group this was 72%; on univariate analysis raised sCD30 (p = 0.038), raised β2m (p = 0.0028) and higher tumour burden score (p=0.02) were associated with significantly poorer prognosis, but multivariate analysis only retained β2m and tumour burden. Giving a score of 1 for tumour burden or raised β2m demonstrated that patients with both did significantly less well; a score of 0,1 or 2 gave an actuarial 3 year event free survival of 80%, 67% and 20% respectively (p = 0.0017). Because of the consistently strong correlation between tumour burden and sCD30 we decided to recalculate a prognostic score with sCDSO and β;m (i.e. substitute raised sCD30 for raised tumour burden). We found the scores 0,1 and 2 of 80%, 72% and 32% (p = 0.0007). Measuring the level of sCD30 and combining it with β2m levels gives an improved prognostic score for Hodgkin's disease at diagnosis.

Publication metadata

Author(s): Maltas J, Angus B, Jack F, Jackson GH, Proctor SJ, Taylor PRA, Dickinson AM, Oliver K, Owen JP

Publication type: Conference Proceedings (inc. Abstract)

Publication status: Published

Conference Name: 42nd Annual Meeting of the American Society of Hematology

Year of Conference: 2000

Pages: 226b-226b

ISSN: 0006-4971

Publisher: Blood: American Society of Hematology

Notes: Abstract no. 4706