Favorable prognosis after late relapse of Hodgkin's disease.

Background: Most relapses of Hodgkin's disease (HD) occur within the first 2 years after diagnosis, but they may develop after a longer observation period. The aim of this study was to define the incidence, clinical course, and prognostic factors for late relapse (LR) of Hodgkin's disease. For this purpose, the authors defined LR as relapse that occurred in patients who achieved a complete remission that lasted a minimum of 24 months.

Methods: During the years 1974-1994, 375 patients with newly diagnosed HD were treated at out institution. Of these patients, 223 remained free of disease for at least 2 years. In addition, 26 patients had been in complete remission for a minimum of 24 months after salvage treatment. Thus, 249 patients were identified as being at risk of LR, and they were the study subjects. The median age was 29 years. Fifty-nine percent of the patients had early stage disease (Stage I/II), and 48% underwent staging laparotomy. Ninety patients presented B symptoms at diagnosis, and 87 had bulky disease. Treatment consisted of radiotherapy for 68 patients, chemotherapy for 68, and combined modality therapy for 113.

Results: With a median follow-up of 125 months (range, 22-287 months), the authors observed LR in 25 patients (10%). The estimated relapse rate at 15 years was 13.4%. Relapse occurred after a median disease free interval of 45 months (range, 25-113 months), and it involved sites of previous disease in 70% of the patients. Age > 30 years and treatment with radiotherapy alone were the only significant independent predictors for an increased risk of LR. At a median of 79 months (range, 6-168 months) after therapy for LR, 20 patients were still alive and free of disease (1 of them after rescue treatment for second relapse), and 5 had died (3 of HD, 2 of second tumor). The estimated overall survival (OS) after LR was 82% at 8 years. OS was not significantly different for LR patients than for those who did not relapse.

Conclusions: The actual incidence of LR emphasizes the need for continuous follow-up of patients treated for HD. LR, if properly managed with conventional therapy, does not compromise survival.