Regarding the prognostic factors and staging of Hodgkin lymphoma, all of the following statements are correct EXCEPT:

Explanation

## Prognostic Factors and Staging in Hodgkin Lymphoma ### International Prognostic Score (IPS) **Key Point:** The IPS is a validated prognostic model for advanced-stage Hodgkin lymphoma (stage III–IV). It incorporates seven adverse prognostic factors: | Factor | Threshold | Rationale | |--------|-----------|----------| | Age | ≥45 years | Older patients tolerate treatment poorly | | Gender | Male | Slight male predominance in poor prognosis | | Stage | IV | Disseminated disease | | Hemoglobin | <10.5 g/dL | Reflects disease burden and anemia | | Albumin | <4.0 g/dL | Marker of nutritional/systemic status | | Lymphocyte count | <600/μL or <8% of WBC | Reflects immune competence | | WBC | ≥15,000/μL | Marker of disease burden | **High-Yield:** Each factor present = 1 point. Score 0–1 = 84% 5-year OS; score 6–7 = 26% 5-year OS. ### Imaging in Staging and Response Assessment **Key Point:** While PET-CT (combining PET with CT) is highly valuable, **CT alone remains the standard for initial staging** in many guidelines. **PET is primarily used for response assessment after treatment**, not as the sole gold-standard for initial staging. **Clinical Pearl:** PET-CT is superior to CT alone for detecting residual disease and assessing treatment response, but initial staging typically uses CT (chest, abdomen, pelvis) ± PET depending on institutional protocols and guidelines. The statement that PET has "replaced" CT as the gold standard for **initial staging** is an overstatement. ### B Symptoms and Prognosis **Key Point:** B symptoms (fever, night sweats, weight loss >10% in 6 months) are associated with: - Advanced disease (stage III–IV) - Higher disease burden - Poorer prognosis - Influence on staging (B vs. A designation) ### Bulky Mediastinal Disease **Key Point:** Bulky mediastinal disease (typically defined as ≥10 cm or ≥1/3 of thoracic diameter) is an independent adverse prognostic factor and may influence treatment intensity. ### Why PET as Sole Gold Standard is Incorrect While PET-CT is increasingly used and is superior for response assessment, **CT remains the standard for initial staging** in most international guidelines (NCCN, ESMO). PET is complementary and particularly valuable for assessing treatment response, but it has not completely replaced CT for initial staging. The statement is therefore inaccurate. [cite:Harrison 21e Ch 110]