Early response to chemotherapy as a prognostic factor in Hodgkin's disease

In 164 patients with Hodgkin's disease staged between 1973 and 1979 the response to the 3 initial cycles of multiagent chemotherapy was evaluated as a prognosticator of survival. Treatment of localized disease (Stages I, II, III1) consisted of 3 cycles of chemotherapy followed by subtotal nodal irradiation, including the splenic area in non splenectomized patients. Treatment of extended disease (Stage III2 and IV) consisted of 6 cycles followed by low‐dosage radiotherapy of initial bulky disease. Five‐year actuarial survival was 88% in Stage I, 80% in II, 100% in III1, 45% in III2 and IV. Chemotherapy‐induced complete remission after 3 cycles (CH → CR) was associated with a favorable prognosis. Five‐year survival of Stage III2 and IV patients was better in those who reached CH → CR than in those who did not (75% versus 25%; P < 0.01). This relationship between CH → CR and five‐year survival was confirmed in patients with localized disease, as shown in Stage II patients (respectively 97% versus 63%; P < 0.05). Therefore the response to initial chemotherapy provides a new prognostic factor that may serve to delineate a “high‐risk” group of patients. The latter deserve aggressive therapy while those in the favorable group would benefit from a less aggressive combined regimen that would minimize long‐term complications.