In the current retrospective study, the authors investigated the prognostic significance of total serum cholesterol values at the time of diagnosis in patients with Hodgkin's disease (n = 179). Cholesterol values were significantly lower in these patients than in age- and sex-matched controls. Subgroups with advanced stages (P less than or equal to 0.01), poor response to therapy (P = 0.04), and relapse after complete response (P = 0.026) (but not with bulky disease) had lower cholesterol values. By univariate analysis (cut-point value, 140 mg/dl), the 5-year survival rate was 2.5 times higher in patients with normal cholesterol values than in hypocholesterolemic patients (P less than 0.00009). Hypocholesterolemia was retained as an adverse, independent prognostic factor by multivariate Cox regression analysis. The authors concluded that total serum cholesterol values at the time of diagnosis may be a parameter with unrecognized significance in Hodgkin's disease.