From the Guidelines
Hodgkin lymphoma is staged using the Ann Arbor staging system, which categorizes the disease into four stages (I-IV) based on the extent and spread of cancer, with additional modifiers including "A" and "B" categories to indicate the presence or absence of systemic symptoms. The staging system is crucial for determining the prognosis and treatment of the disease. According to the study 1, the Ann Arbor staging system is used to classify Hodgkin lymphoma into stages I-IV, with stage I indicating involvement of a single lymph node region or lymphoid structure, stage II involving two or more lymph node regions on the same side of the diaphragm, stage III representing involvement of lymph node regions on both sides of the diaphragm, and stage IV indicating disseminated disease with extralymphatic organ involvement.
The staging system also includes modifiers such as "A" and "B" categories, which indicate the presence or absence of systemic symptoms such as unexplained weight loss, fevers, or drenching night sweats. The study 1 notes that patients with Hodgkin lymphoma are usually classified into three groups: early-stage favorable, early-stage unfavorable, and advanced-stage disease. The classification of patients into these groups is based on the presence or absence of unfavorable prognostic factors, such as large mediastinal adenopathy, B symptoms, numerous sites of disease, or significantly elevated erythrocyte sedimentation rate (ESR).
Some key points to consider when staging Hodgkin lymphoma include:
- The Ann Arbor staging system is the standard system used to stage Hodgkin lymphoma
- The system categorizes the disease into four stages (I-IV) based on the extent and spread of cancer
- Additional modifiers, such as "A" and "B" categories, are used to indicate the presence or absence of systemic symptoms
- The staging system is crucial for determining the prognosis and treatment of the disease
- Unfavorable prognostic factors, such as large mediastinal adenopathy, B symptoms, numerous sites of disease, or significantly elevated ESR, can affect the classification of patients into early-stage favorable, early-stage unfavorable, or advanced-stage disease. As noted in the study 1, the International Prognostic Score (IPS) is used to determine clinical management and predict prognosis for patients with stage III to IV disease.
From the Research
Stages of Hodgkin Lymphoma
The stages of Hodgkin lymphoma are typically classified using the Ann Arbor staging system, which includes the following stages:
- Stage I: The disease is limited to one lymph node group (e.g., neck, underarm, groin, etc.) or one extralymphatic organ or site (e.g., lung, liver, bone marrow, etc.) 2
- Stage II: The disease is limited to two or more lymph node groups on the same side of the diaphragm or the disease is in a single lymph node group and a nearby extralymphatic organ or site 2
- Stage III: The disease is in lymph node groups on both sides of the diaphragm, which may also be accompanied by disease in a nearby extralymphatic organ or site 2
- Stage IV: The disease has spread widely through one or more organs that are not part of a lymphatic area, such as the liver, bone marrow, or lungs 2
Treatment Options Based on Stage
Treatment options for Hodgkin lymphoma vary based on the stage of the disease:
- Early-stage Hodgkin lymphoma: Patients with early-stage Hodgkin lymphoma commonly receive combined-modality therapies that include abbreviated courses of chemotherapy followed by involved-field radiation treatment 2
- Advanced-stage Hodgkin lymphoma: Patients with advanced-stage Hodgkin lymphoma commonly receive a more prolonged course of combination chemotherapy, with radiation therapy used only in selected cases 2
- Favorable early-stage Hodgkin lymphoma: The category of favorable early-stage Hodgkin lymphoma includes patients with Ann Arbor stages I or II disease with no bulky disease or B symptoms, and the overall 10-year survival rate of patients with favorable early-stage HL exceeds 90% 3
Prognostic Factors
Prognostic models to identify patients at high or low risk for recurrence have been developed, and these models, along with positron emission tomography, are used to provide optimal therapy 2 The International Prognostic Score is used to define the risk of patients with advanced-stage Hodgkin lymphoma, with a score of ≤ 2 indicating a lower risk and a score of > 2 indicating a higher risk 4