Staging and prognosis of Hodgkin's lymphoma based on Ann Arbor staging criteria

staging and prognosis

Staging for Hodgkin lymphoma is based on Ann Arbor staging system (1).

• Ann Arbor staging system with Cotswold modifications for Hodgkin's lymphoma
  
  
  • stage I: involvement of one lymph-node region or lymphoid structure (eg spleen, thymus, Waldeyer's ring)
    
    
  • stage II: two or more lymph-node regions on the same side of the diaphragm
    
    
  • stage III: lymph nodes on both sides of the diaphragm.
    • stage III (1): with splenic, hilar, coeliac, or portal nodes.
    • stage III (2): with para-aortic, iliac, or mesenteric nodes
      
      
  • stage IV: involvement of extranodal site(s) beyond that designated E (see below).

modifying features

• A: no symptoms.
• B: fever, drenching night sweats, weight loss greater than 10% in six months.
• X: bulky disease: greater than a third widening of mediastinum or greater than 10 cm maximum diameter of nodal mass.
• E: involvement of single, contiguous, or proximal extranodal site (1)

Prognostic factors are used to allocate early stage patients to into favourable or unfavourable sub groups according to European Organisation for the Research and Treatment of Cancer (EORTC); German Hodgkin's Study Group (GHSG).

• favourable prognosis - stage I-II Hodgkin lymphoma
  • EORTC
    • large mediastinal adenopathy
    • ESR <50 without B symptoms
    • ESR <30 with B symptoms
    • age <=50
    • 1-3 lymph node sites involved
  • GHSG
    • no large mediastinal adenopathy
    • ESR <50 without B symptoms
    • ESR <30 with B symptoms
    • no E-disease
    • 1-2 lymph node sites involved
      
      
• unfavourable prognosis - stage I-II Hodgkin Lymphoma
  • EORTC- presence of one or more of the following
    • no large mediastinal adenopathy
    • ESR >=50 without B symptoms
    • ESR >= 30 with B symptoms
    • age >50
    • >=4 lymph node sites involved
  • GHSG - presence of one or more of the following
    • large mediastinal adenopathy
    • ESR >=50 without B symptoms
    • ESR >= 30 with B symptoms
    • E-disease
    • >=3lymph node sites involved (2)

Reference:

• (1) Yung L, Linch D. Hodgkin's lymphoma. Lancet. 2003;361(9361):943-51
• (2) Guidelines for the First Line Management of Classical Hodgkin Lymphoma (2014). British Committee for Standards in Haematology (BCSH)