PROGNOSTIC FACTORS FOR DISEASE PROGRESSION IN ADVANCED HODGKINS-DISEASE - AN ANALYSIS OF PATIENTS AGED UNDER 60 YEARS SHOWING PRO PROGRESSION IN THE FIRST 6 MONTHS AFTER STARTING PRIMARY CHEMOTHERAPY

The aim of this study was to determine whether a very high-risk group based on presenting characteristics could be identified in patients wi th advanced Hodgkin's disease who may benefit from high-dose chemother apy (HDCT). Between 1975 and 1992, 453 previously untreated patients a ged under 60 years who did not progress in the first 6 months after th e start of standard chemotherapy had their hospital notes reviewed. Th e outcomes analysed were early disease progression (in the 6- to 18-mo nth window following the start of chemotherapy) and disease progressio n in the whole of the follow-up period. A Cox regression analysis was used to investigate the combined effects of a number of presenting cha racteristics on these outcomes. Despite the presence of factors with s ignificant effects on the relative rate of progression, the absolute e ffects in a group identified as having the poorest prognosis were not especially poor. No group could be defined with a freedom from progres sion rate of less than 70% over 6-18 months, and the worst prognostic group, which included only 53 patients, had an overall freedom from pr ogression rate of 57% at 5 years. Four other reported prognostic indic es were evaluated using our data set, but none of the indices was more successful in identifying a very high-risk group. It has not been pos sible to define a sufficiently high-risk group of patients with Hodgki n's disease based on presenting characteristics for whom HDCT could be advised as part of primary treatment. The search for more discriminat ing prognostic factors identifying vulnerable patients with a high ris k of relapse must continue before a role can be found for HDCT followi ng conventional chemotherapy in patients without disease progression.