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Annals of Oncology 4:657-662, 1993
© 1993 European Society for Medical Oncology

research-article

Late relapses in Hodgkin's disease: Outcome of patients relapsing more than twelve months after primary chemotherapy

L. Salvagno, M. Sorarù, S. M. L Aversa, A. Bianco, V. Chiarion Sileni, G. L. Pappagallo and M. V. Fiorentino

Division of Medical Oncology, Centro Oncologico Regionale Padua, Italy

Correspondence to: Luigi Salvagno, M.D. Divsione di Oncologia Medica Ospedale Civile V.Giustinami 2 35100 Padova, Italy

Background: Patients with Hodgkin's disease whose initial complete remissions (CR) after primary chemotherapy were longer than 1 year are thought to have better prognoses than patients whose initial remissions were shorter than 1 year. However, only a few studies have analyzed the long-term survival in addition to the results of retreatment in patients relapsing after CR lasting more than 1 year.

Patients and methods: We analyzed the data of 40 patients with Hodgkin's disease who were treated in a single institution and whose CR were gl1 year after primary chemotherapy. Therapy at relapse was not standardized: of 36 patients evaluable for response, 29 received second-line chemotherapy and 7 received radiotherapy alone.

Results: Sixty-five percent of the patients obtained CR (median duration: 21 months). Sixty-eight percent of the complete responders relapsed again; however, long-lasting third and fourth remissions were observed. All of the 7 patients whose retreatment consisted of radiotherapy alone obtained CR, but only 1 is in continuous CR. The presence of nodular sclerosing histologic subtype, the absence of extranodal involvement and the use of hybrid MOPP/ABVD or ABVD alone as salvage treatment are independently associated with a higher CR rate and a higher probability of 5-year survival. The 5-year survival for all 40 patients is 49%. For the patients obtaining CR, the 5-year survival and the 5-year relapse-free survival are 76% and 25%, respectively. However, the survival curve continues to fall in the succeeding years because of third and fourth relapses and the occurrence of secondary acute leukemia and non-Hodgkin's lymphoma.

Conclusions: A high percentage of patients relapsing more than 12 months after primary chemotherapy can obtain second CR. Even if most of our patients eventually relapse, third and fourth CRs are not uncommon. However, the long-term survival is low and it is further diminished by secondary leukemia and non-Hodgkin's lymphoma.

Hodgkin's disease, late relapses, salvage treatment


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