Late Relapses in Hodgkin's Disease: Are They a Distinct Entity?

It is claimed that late relapses of Hodgkin's disease have a good prognosis when retreated. A number of unfavourable outcomes led us to review our experience of 72 consecutive cases of Hodgkin's disease diagnosed and treated in a combined clinical haematology and radiation oncology unit between 1968 and 1984. 62 of 72 patients (86%) achieved a complete remission and of these, 35 patients (56%) relapsed, 18 occurring more than three years after diagnosis. Thus, 4 patient groups were identified: 10 patients with refractory disease, 27 patients who went into complete remission and have not relapsed, 17 patients who relapsed within 3 years of diagnosis (early relapse) and 18 patients who relapsed more than 3 years from diagnosis (late relapse). Patients who relapsed were retreated with well accepted protocols of chemotherapy and/or radiotherapy with surprisingly poor results. There was no significant difference between the survival from relapse of patients who relapsed early compared to those who relapsed late. Late relapses are not uncommon in Hodgkin's disease and the prognosis may be less favourable than generally perceived. The risk of relapse was almost constant with time and brings into question the concept of early and late relapse.