In Decision Analysis

Improvements achieved in the management and treatment of Hodgkin's lymphoma have been so important in the last 10-15 years that very few are expected in the near future. The proportion of patients cured of the disease is 90% or more in early stages and 80% or more in advanced stages. As a consequence, hematologists progressively change their objectives from better survival alone, to better survival and less late treatment-related toxicity. This concept forms the basis of most treatment strategies worldwide. Treatment strategies are usually based on the combination of known prognostic factors. In order to help investigators in selecting patients who should be offered a given treatment or to participate in a given controlled clinical trial, other approaches have been developed. Among these, decision analysis represents a tool that has been applied since the late 70s.46-48 It is based on the use of definitions of patient risk groups (based on combinations of various prognostic factors) and on data derived from the literature. Applications have been made taking into consideration exploratory laparo-tomy and splenectomy, the use of stem cell transplantation, or the probability of late complications such as secondary malignancy, cardiac mortality, etc.49-55

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