Timedependent Covariates

Similarly, prognostic factors for outcome after relapse have been reported according to initial treatment type or to the treatment given for relapse or refractory disease. In relapsing patients after initial treatment with radiotherapy alone who are given chemotherapy, the extent of disease at relapse, the type of relapse (nodal or extranodal), histologic subtype, and older age at relapse have been shown of prognostic value. In contrast, time to relapse usually does not correlate with outcome. In relapsing patients after initial chemotherapy alone or combined-modality therapy, two factors have consistently been associated with poor outcome: the response to initial treatment (complete remission, partial remission, no remission) and the duration of initial remission. These factors were independent of the type of second-line treatment. Other factors reported are the extent of disease at relapse, extranodal relapse, B symptoms at relapse, histologic subtype, stage IV at original diagnosis, and age and performance status. In relapsing patients undergoing highdose chemotherapy and stem cell transplantation for relapse or refractory disease, several factors have shown to influence the prognosis: the response to initial treatment, the duration of initial remission, the number of failed treatments before the given relapse, and response to high-dose chemotherapy before transplantation. Other factors also reported are the extent of disease before transplantation, extranodal relapse, pleural involvement or multiple pulmonary nodules at relapse, B symptoms at relapse, increased serum lactic dehydrogenase (LDH) before transplantation, and poor performance status.

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