Late relapse after treatment for clinical stage I and II Hodgkin's disease

Despite the excellent outcome for patients with early stage Hodgkin's disease, late relapses do occur. The recognition of the pattern and incidence of late relapse and subsequent outcome is more important to ensure the provision of optimal care of patients with early stage Hodgkin's disease.

A review of 731 patients with clinical stage (CS) I and II Hodgkin's disease treated at Princess Margaret Hospital over a 19-year period was undertaken to examine the characteristics of patients who relapsed more than 4 years after the commencement of initial therapy (late relapse).

The actuarial survival for all patients was 76% at 10 years and disease free survival was 65%. There were 206 patients with relapse, and in 35 patients the relapse occurred late (4.0-15.3 years after initial therapy). From the time of relapse the 10-year survival was 46% after early relapse and 68% after late relapse. No prognostic factors predicting specifically for late relapse after treatment for CS I and II Hodgkin's disease were identified in this study, although by multivariate logistic regression analysis there was an increased proportion of large mediastinal masses in the late relapse group.

Late relapse is associated with a better survival than relapse occurring within the first 4 years from the time of diagnosis.