Michel Henry Amar

Since the beginning of the twentieth century, the concept has emerged that Hodgkin's lymphoma evolves through successive clinical stages associated with increasing disease spread and worsening clinical outcome. The validity of this concept has progressively been confirmed leading to the conception of staging classifications based on anatomic extent of the disease. In 1971, a consensus was reached at the Ann Arbor Workshop on the Staging of Hodgkin's lymphoma.1 Thereafter, the so-called Ann Arbor classification was universally adopted and its prognostic significance confirmed through numerous publications, in particular one in which more than 14,000 cases from 20 cooperative groups or institutions were combined.2 It is still used for the evaluation of patients presenting with the disease.

As time and data accumulated, it became obvious that the Ann Arbor staging could not be the sole prognostic tool in daily practice. In 1988, a modification of the Ann Arbor classification was advised by specialists attending the Cotswolds meeting in England.3 The major modification concerned the designation of the disease extent and bulk. However, this classification is not generally used.

A variety of other clinical and biological characteristics have been used and claimed to be of prognostic significance. Some of these characteristics, combined with others, have been applied to retrospective series and demonstrated their prognostic value. They are presently used by several cooperative groups or institutions in the design of clinical trials. An extensive review of the literature has been published by Specht and Hasenclever in 1999.4 Therefore, we will focus on the definition of prognostic factors and end points. We will also give examples specific for early and advanced stages. We will then discuss some issues that develop when using prognostic factors in the management of Hodgkin's lymphoma.

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