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

Question

Accepted Answer

B. Positron emission tomography (PET) has replaced conventional imaging (CT) as the gold standard for initial staging and response assessment in Hodgkin lymphoma. ## 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]

Answer

A. B symptoms (fever, night sweats, unintentional weight loss) are associated with advanced disease and poorer prognosis

Answer

C. The presence of bulky mediastinal disease (>10 cm) is an independent adverse prognostic factor in Hodgkin lymphoma

Answer

D. The International Prognostic Score (IPS) uses seven adverse prognostic factors, including age ≥45 years, male gender, stage IV disease, and hemoglobin <10.5 g/dL

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)

Imaging in Staging and Response Assessment

B Symptoms and Prognosis

Bulky Mediastinal Disease

Why PET as Sole Gold Standard is Incorrect

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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