Prognostic Value of Pleural Effusion in Hodgkin's Lymphoma Patients

Background: There has been little investigation into the incidence or prognostic significance of a pleural effusion when present with the diagnosis of Hodgkin's Lymphoma. In our small clinical practice we had two patients with Hodgkin's lymphoma who presented with pleural effusion and subsequent poor outcomes, including relapse and eventual death. These events stemmed this retrospective study investigating the incidence of pleural effusion with the diagnosis of Hodgkin's disease and whether the presence of pleural effusion at the time of diagnosis would reveal any association with outcomes in a larger cohort of patients.

Procedure: A single centered retrospective chart review of 134 patients' age 0-50 with confirmed Hodgkin's lymphoma was performed. Charts were evaluated for the presence of any radiographic evidence of pleural effusion at the time of diagnosis, along with the patient's eventual outcome.

Result: 8/133 (6%) patients with Hodgkin's lymphoma had a pleural effusion at the time of diagnosis. Death is dependent on pleural effusion (p= 0.019) with 3 of 8 (37.5%) of patients that had pleural effusion who died.There is an 8.77 (CI 1.8 - 43.5) times greater odds of death for patients with pleural effusion versus those without pleural effusion.

Recurrence is dependent on pleural effusion (p= 0.0061) with 5/8 (62.5%) of patients that had pleural effusion who experienced recurrence.There is an 8.75 (CI 1.9 - 39.6) times greater odds of recurrence for patients with pleural effusion versus those without pleural effusion.

Of the 5 patients who had recurrence, as stated above 3 patients died, 1 patient was salvaged by stem cell transplant and another patient was recently diagnosed with relapse thus, clear outcome is yet to be determined

Conclusion: The presence of a pleural effusion at the time of diagnosis of Hodgkin's lymphoma is a rare finding, yet when present, was associated with death and recurrence. This finding may suggest a more aggressive initial treatment be required given the association with poor outcomes. An evaluation of a larger cohort of patients, along with a determination of the diagnostic stage, will be required to confirm prognostic potential.