Prognostic factors in advanced stage Hodgkin's lymphoma: the significance of the number of involved anatomic sites

: Background: Advanced Hodgkin's lymphoma (HL) is curable by conventional chemotherapy in 60–70% of patients. The pretreatment identification of a sizeable subgroup of patients with sufficiently low failure‐free survival (FFS) to be eligible for investigational treatment is necessary. Objectives: To determine the prognostic significance of the number of involved sites (NIS) in patients with advanced HL and its relationship to the International Prognostic Score (IPS). Methods: A retrospective review of patients with advanced HL, defined as Ann Arbor stage (AAS) IB, IIB, III or IV, treated with anthracycline‐based regimens. The end‐point was FFS. Results: We identified 277 patients with a median age of 32 yr (14–78), 57% of whom were males. AAS was I in 4% of patients, II in 29%, III in 38% and IV in 29%. B‐symptoms were recorded in 81%. Most patients had nodular sclerosis (64%) and mixed cellularity (26%) histology. IPS was ≥3 in 44% of 242 evaluable patients. The NIS was ≥5 in 32% of the patients and 20% of all patients had both ≥5 involved sites and IPS ≥3. The 10‐yr FFS was 67%, being 76% vs. 50% for patients with ≤4 vs. ≥5 involved sites (P