title: New prognostic score based on treatment outcome of patients with relapsed Hodgkin's lymphoma registered in the database of the German Hodgkin's lymphoma study group.
abstract: OBJECTIVE
  To evaluate salvage treatment outcome of patients with relapsed Hodgkin's disease (HD) and to distinguish different risk groups using identified prognostic factors.
  
  
  METHODS
  From 4,754 patients registered in the German Hodgkin's Lymphoma Study Group (GHSG) database between 1988 and 1999, 422 patients with early (n = 170) or late (n = 252) relapsed HD were identified. One hundred seven patients (25%) relapsed after radiotherapy (RT) for early stages, 133 patients (32%) after combined-modality therapy for intermediate stages, and 182 patients (43%) after chemotherapy (CT) and RT to initial bulky disease or residual lymphoma for advanced stages. At relapse, characteristics of these 422 patients (median age, 38 years; range, 17 to 77) were stage III/IV, 45%; B symptoms, 24%; elevated erythrocyte sedimentation rate, 29%; anemia, 13%; and Karnofsky performance score, less than 90 in 13%. At first relapse, salvage treatment was RT in 13%, CT in 54%, and high-dose chemotherapy (HDCT) with autologous stem-cell transplantation (ASCT) in 33%.
  
  
  RESULTS
  Median follow-up time after relapse was 45 months. Freedom from second failure (FF2F) and overall survival (OS) were 81% and 89% for relapse after RT, 33% and 46% for early relapse after CT, and 43% and 71% for late relapse after CT, respectively. In multivariate analysis, independent risk factors were time to relapse, clinical stage at relapse, and anemia at relapse. Four subgroups with significantly different FF2F and OS were identified. The prognostic score was predictive for patients who relapsed after RT, CT with conventional CT salvage, and CT with HDCT/ASCT.
  
  
  CONCLUSIONS
  In the GHSG database, time to relapse and clinical stage and anemia at relapse are relevant factors and can be used to form a prognostic score for HD patients at relapse.
authors.affiliation: First Department of Internal Medicine, University Hospital Cologne, Joseph-Stelman-Strasse 9, 50924 Cologne, Germany. andreas.josting@uni-koeln.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Josting
authors.forename: Jeremy
authors.initials: J
authors.lastname: Franklin
authors.forename: Michael
authors.initials: M
authors.lastname: May
authors.forename: Peter
authors.initials: P
authors.lastname: Koch
authors.forename: Maria K
authors.initials: MK
authors.lastname: Beykirch
authors.forename: Juergen
authors.initials: J
authors.lastname: Heinz
authors.forename: Christian
authors.initials: C
authors.lastname: Rudolph
authors.forename: Volker
authors.initials: V
authors.lastname: Diehl
authors.forename: Andreas
authors.initials: A
authors.lastname: Engert
mesh_terms: D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006689:Hodgkin Disease / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D016879:Salvage Therapy; D015996:Survival Rate; D016896:Treatment Outcome