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Erythrocyte Sedimentation Rate Predicts Early Relapse and Survival in Early-Stage Hodgkin Disease

Michel Henry-Amar, MD; Samuel Friedman, MD; Marcel Hayat, MD; Reinier Somers, MD; Jokobus H. Meerwaldt, MD; Patrice Carde, MD; J. M. V. Burgers, MD; José Thomas, MD; M. Monconduit, MD; E. M. Noordijk, MD; D. Bron, MD; René Regnier, MD; B. E. de Pauw, MD; Alain Tanguy, MD; Jean-Marc Cosset, MD; Noëlle Dupouy; Maurice Tubiana, MD, EORTC Lymphoma Cooperative Group*
[+] Article, Author, and Disclosure Information

Requests for Reprints: Michel Henry-Amar, Institut Gustave Roussy, rue Camille Desmoulins, 94805 Villejuif cedex, France.

Current Author Addresses: Drs. Henry-Amar, Hayat, Carde, Cosset, and Tubiana, and Ms. Dupouy: Institut Gustave Roussy, rue Camille Desmoulins, 94805 Villejuif cedex, France.

Dr. Friedman: NordRx Consultants Limited, 1252 Speers Road, Oakville, Ontario, Canada L6L 5N9.

Drs. Somers and Burgers: Antoni van Leeuwenhoekhuis, Plesmanlaan 121, 1066 CS Amsterdam, The Netherlands.

Dr. Meerwaldt: Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA Enschede, The Netherlands.

Dr. Thomas: St. Rafaël Ziekenhuis, 3000 Leuven, Belgium.

Dr. Monconduit: Centre Henri Becquerel, rue d'Amiens, 74038 Rouen cedex, France.

Dr. Noordijk: University Hospital, Building 1 K1-P, P.O. Box 9600, 2300 RC Leiden, The Netherlands.

Drs. Bron and Regnier: Institut Jules Bordet, rue Heger Bordet 1, 1900 Brussels, Belgium.

Dr. de Pauw: Academisch Ziekenhuis, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.

Dr. Tanguy: Centre François Baclesse, Route de Lion-sur-Mer, 14021 Caen cedex, France.

From Institut Gustave Roussy, Villejuif, France; Antoni van Leeuwenhoek Ziekenhuis, Amsterdam, The Netherlands; Rotterdamsch Radiotherapeutisch Instituut, Rotterdam, The Netherlands; St. Rafaël Ziekenhuis, Leuven, Belgium; Centre Henri Becquerel, Rouen, France; University Hospital, Leiden, The Netherlands; Institut Jules Bordet, Brussels, Belgium; Academisch Ziekenhuis, Nijmegen, The Netherlands; Centre François Baclesse, Caen, France.*For a listing of group chairpersons and other participants, see Appendix. For current author addresses, see end of text.

© 1991 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1991;114(5):361-365. doi:10.7326/0003-4819-114-5-361
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Objective: To assess the value of an elevated (> 30 mm/h) Westergren erythrocyte sedimentation rate (ESR) for predicting early relapse and survival after therapy in patients with clinical stage I or II Hodgkin disease.

Interventions: We studied 772 patients with early-stage Hodgkin disease who had participated in two separate multicenter clinical trials. Both trials used modern field radiotherapy and, in some patients, multi-agent chemotherapy.

Main Results: The ESR patterns were based on pretherapy and post-therapy assessments: pattern 1, always normal (n = 261); pattern 2, elevated before therapy but normal immediately after therapy (n = 121); pattern 3, elevated before therapy but normal within 3 months after therapy (n = 89); pattern 4, always elevated (n = 48); pattern 5, normal before therapy but oscillating between normal and elevated after therapy (n = 150); pattern 6, elevated before therapy but oscillating between normal and elevated after therapy (n = 130). By multivariate analysis, independent of whether or not patients received chemotherapy in the initial therapy protocol, ESR patterns 4, 5, and 6 were shown to be the best predictors for early relapse and survival when patients were stratified according to the type of chemotherapy received and the number of involved nodal areas. Patients with ESR pattern 4 had a relative risk for death seven times that of patients with patterns 1, 2, or 3. Early relapse was the second most important factor predicting death, irrespective of ESR; patients with early relapse and ESR patterns 1, 2, or 3 had a relative risk for death of 4.5, and those with early relapse and ESR patterns 4, 5, or 6 had a relative risk for death of 15. Whether or not chemotherapy was given initially did not change the relative risk, which shows that ESR, not initial therapy, was the predictor for early relapse and death due to Hodgkin disease.

Conclusion: An unexplained elevated ESR after therapy, especially after modern radiotherapy, independent of other factors, strongly suggests the presence of aggressive and resistant Hodgkin disease. An elevated ESR is predictive of early relapse and poor prognosis; its presence justifies early aggressive therapy.





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