Outcome in Hodgkin's disease: a 20-year cohort of patients

We reviewed the long-term survival, treatment-related mortality and morbidity of a continuous cohort of patients with Hodgkin's disease diagnosed and staged at the Haematology unit of the Belfast City Hospital between January 1973 and October 1992. The analysis included a comparison of the survival of those patients who were entered into BNLI (British National Lymphoma Investigation) trials compared to those not entered during this 20 year period. In addition univariate and multivariate analysis of prognostic factors was performed. The complete remission rate (CR) was 79.6% with a 15 year survival of 55.3%. On multivariate analysis in which deaths due to active Hodgkin's disease only were considered age > 50 emerged as the most significant prognostic factor (P < 0.0007), the presence of B symptoms also having independent significance (P = 0.008). Trial status did not have any independent prognostic significance. Eighty one deaths occurred: active Hodgkin's disease (50), second malignancy (9), treatment-related (10), unrelated (9), unknown (3). This long-term follow up study provides useful information additional to the data produced by clinical trials which are biased by selection criteria. The occurrence of Haemophilus Influenzae meningitis in a patient 17 years following splenectomy highlights the need for appropriate vaccination of patients splenectomised for Hodgkin's disease.