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Answer 3
  1. Gender. Males have a slightly worse outcome than females treated for Hodgkin’s disease,5 which may reflect sex hormone-induced differences in the metabolism of chemotherapy agents. Involvement of the mediastinum is not associated with a worse prognosis, nor is the nodular sclerosis subtype of Hodgkin’s disease. Age older than 40 or 45 years is associated with worse prognosis, but this patient is younger than 40 years. Weight loss of more than 10% of body weight is an adverse feature, but this patient had lost only 5 lb in a month, which is not likely to be greater than 10% of the body weight of a 38-year-old man. Bulky lymphadenopathy (> 10 cm or > one third of the thoracic diameter) is also an adverse feature, but this patient does not meet criteria for bulky disease.

    5. Hasenclever D, Diehl V. A prognostic score for advanced Hodgkin’s disease. International Prognostic Factors Project on Advanced Hodgkin’s Disease. N Engl J Med 1998; 339:1506-14.

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