Christina Wedelin

Prognostic factors in hodgkin's disease with special reference to age

A series of 182 patients with Hodgkins disease, diagnosed between January 1973 and December 1978 was used to identify prognostic factors with special reference to age. There were 118 men and 64 women (mean age, 47 years; r = 15–92). During the same period 57 elderly patients who were never referred, were reported to the Local Cancer Registry. The diagnosis had been established shortly before death or at autopsy. The 182 patients under study were evenly distributed in Stages I‐IV. Nodular sclerosis (38%) and mixed cellularity (38%) were the most common histologic subtypes. The 5‐year survival probability estimate was 28% in patients above 50 years as compared to 74% in the remainder. Survival was significantly better in patients with Stage I‐II disease and lymphocyte predominance/nodular sclerosis histopathology. Age was the main prognostic factor in the whole series as well as in patients older than 50 years. However, in young patients advanced clinical stage and B‐symptoms were related to a poor prognosis. Biologic indicators such as ESR, hemoglobin and albumin were intimately linked to the extent of disease and did not add prognostic information besides that given by the clinical stage. It is concluded that the prognosis in elderly remains poor and appears to be partly unrelated to those factors which determine the prognosis in the young, assumingly reflecting a depressed host‐response and/or a decreased tolerance to intensive treatment. Cancer 53:1202‐1208, 1984.

Longitudinal studies of blood lymphocyte capacity in Hodgkin's disease

Blood lymphocyte functional capacity and serum immunoglobulins were studied in 40 patients with Hodgkins disease (HD) admitted to Radiumhemmet, Stockholm, before treatment and in complete remission 2–56 months following termination of radiotherapy (total nodal irradiation [TNI]; n = 29) or chemotherapy (MOPP; n = 11). Lymphocyte studies included determination of total lymphocyte and T‐cell counts and evaluation of spontaneous DNA synthesis during the first day of culture and mitogen‐(concanavalin A, pokeweed mitogen) and antigen (purified protein derivative, PPD)‐induced activation on the third day. Blood lymphocyte and T‐cell counts decreased dramatically following TNI. A slow restitution was seen, but pretreatment levels were not reached even four years following therapy. The responses to ConA and PPD but not PWM were significantly reduced shortly after TNI. The mitogen response did not increase with time as did the PPD response. Lymphocyte counts and lymphocyte stimulation, which were severely depressed before treatment of patients in the chemotherapy group, remained unchanged 2–36 months after termination of therapy. A significant reduction of IgM levels was observed regardless of the mode of treatment. Splenectomy prevented the profound reduction of blood lymphocyte and T‐cell counts following therapy but did not influence the other immunologic variables under study.

Lymphocyte abnormalities predicting a poor prognosis in Hodgkin's disease. A long-term follow-up

Two hundred sixty‐two adult patients with Hodgkins disease (HD) were studied. Incorporation of carbon‐14‐thymidine was measured in unstimulated monocytedepleted lymphocyte cultures, and in cultures activated by concanavalin A (Con‐A) before institution of therapy in all patients. Total blood lymphocytes and T‐cell subsets were enumerated in the last 108 patients. Patients had significantly decreased total (CD3+, CD4+, CD8+) and relative (CD3+, CD4+) T‐cell counts compared with healthy controls. Stage IV patients tended to have lower total lymphocyte and subset counts than remaining patients. However, significantly reduced total lymphocyte and CD8+ counts were only observed in comparison to patients in clinical stage II. Thirty‐three percent of patients had an increased spontaneous and a decreased Con‐A‐induced blood lymphocyte DNA synthesis. Functional lymphocyte abnormalities were related to advanced clinical stage, high age, mixed cellularity, and lymphocyte depletion histopathology and presence of B symptoms. The 10‐year survival of patients in this group was 36%, compared with 62% for the remainder. In a multivariate analysis of the whole series lymphocyte DNA synthesis was besides age the strongest predictor of prognosis. In univariate analyses of the second patient series total lymphocyte, T‐cell and subset counts were related to prognosis. These relatively simple lymphocyte functional tests may help to identify young HD patients for whom intensive cytoreductive therapy with or without autologous stem cell support may be the best therapeutic option.

Familial longevity and prognosis in Hodgkin's disease

The authors studied the influence of familial longevity on the prognosis in 98 patients with Hodgkins disease (HD) followed for a long period of time. The survival of parents and grandparents to patients older than 50 years of age who died from progressive HD was significantly shorter than that of ancestors to survivors in the same age group. The excess death rate among relatives to the deceased patients was mainly caused by tuberculosis, which suggests a T‐cell defect. The prognostic information achieved by analyzing duration of life of ancestors was superior to that given by the clinical stage. No association between familial longevity and prognosis was observed in young patients (<50 years of age). These findings are consistent with the hypothesis that HD in the elderly may be a separate clinical entity, and may also have important implications as to the understanding and treatment of HD in the elderly.

Clinical and laboratory findings in untreated patients with Hodgkin’s disease with special reference to age

During a 6-yr period 258 adult patients (≥15 yr) with biopsy verified Hodgkin’s disease (HD) were reported to the Stockholm-Gotland Oncologic Center. In 57 elderly patients (mean age 74 yr) the diagnosis was established shortly before death or at autopsy. One hundred and eighty-two of remaining 201 patients (118 men and 64 women, mean age 47 yr) were investigated. They were evenly distributed in stages I–IV and 43% had B symptoms. NS, 38% and MC, 38% were the most common histological subtypes in contrast to LP, 14% and LD, 10%. Stage II disease and NS histopathology dominated among patients below 50 yr. Patients with hilar/mediastinal lymphomas were often young and had NS histopathology with B symptoms. The diagnosis was established within 3 months after the first symptom in 52% while 15% had symptoms for more than one year. Eleven patients reported a previous malignancy which is similar to the expected number of 13.8. The results support the concept that in unselected patient series HD seems to be at least as common among elderly as in young people. In the investigated series advanced disease and MC and LD histopathology did not dominate among patients above 50 yr which has been reported previously.