NEW YORK - Tumor volume at the time of diagnosis predicts Hodgkin lymphoma outcomes better than other prognostic factors do, and may allow subsequent therapy to be adjusted appropriately, according to a report in the Oct. 15 of Cancer.

Gender, age, clinical stage and other factors are currently used to differentiate treatments for patients with Hodgkin lymphoma, the authors explain, but they all tend to have poor predictive ability.

Dr. Paolo G. Gobbi from the Universita di Pavia in Italy and colleagues evaluated the prognostic value of tumor burden in 351 patients with Hodgkin lymphoma in predicting clinical outcomes.

Tumor burden indexed to body surface area (rTB) was the strongest predictor for time to failure, disease-free survival, and clinical outcome within the first 12 months after diagnosis, the authors report, and it was the second strongest factor (after age) for predicting overall survival.

The team found that rTB was better than the three best prognostic models devised for Hodgkin lymphoma -- International Database on Hodgkin's Disease (IDHD), Memorial Sloan-Kettering Cancer Center (MSK), and International Prognosstic Factor Project on Advanced Hodgkin's Disease (IPFP) -- and better than an integrated index based on these three models in predicting time to treatment failure.

"Although the number of patients considered is too low to make firm statements," the investigators write, "a working hypothesis...may be to consider 70-80 cc/m² as the highest rTB for low-impact treatments, such as 6 cycles of VBM plus involved-field radiotherapy; 120-180 cc/m² for 4 cycles of ABVD plus extended-field radiotherapy; and 180-190 cc/m² for 6-8 cycles of ABVD or intense 6-8-drug, alternated or hybrid regimens."

Similar rTB cutoffs, "when they have been validated widely, may provide a criterion for indicating early high-dose therapies or other investigational treatments," Dr. Gobbi and colleagues add. "A multicenter, prospective study by the Italian Lymphoma Intergroup is starting to explore this matter more thoroughly."

Cancer 2004;101:1824-1834.