Hodgkins Disease

Relapse After Early Stage, Favorable Hodgkin Lymphoma: Disease Characteristics And Outcomes With Conventional Or High-Dose Chemotherapy

While the majority of patients with early stage favorable Hodgkin’s lymphoma are cured of their disease, a small subset unfortunately have relapse.  In this background, investigators wanted to retrospectively review some of the characteristics that potentially confer better outcomes.  Patient data from German Hodgkin’s study group HD10 and HD13 were reviewed.  Cox proportional hazards regression was used to compare progression free survival after relapse defined as a second progression free survival treated with either autologous stem cell transplantation or chemotherapy and perform sensitivity analyses with overall survival from relapse and Kaplan Meyer statistics.

Data from 174 patients were reviewed.  53 were in the HD10 trial and 121 patients in the HD13 trial.  Most relapses were after 1 year. 85 patients, 49%, received chemotherapy well 41%, 70 patients, received autologous stem cell transplantation.  11 patients, 6%, only received radiotherapy while 4 patients, only received palliative treatment.  The most common chemotherapy regimen was BEACOPP, administered to 68% of patients.  The second most common regimen included doxorubicin, bleomycin, vinblastine and dacarbazine, in 19%, and 13% of patients received other regimens.  Patients who were over the age of 60, had a significantly shorter PFS, hazard ratio 3.0 with a P-value = 0.0029.  These patients were predominantly treated with chemotherapy and NOT stem cell transplantation, n= 33/49, 67% while only 8 patients, 60% in this age group, received transplant.

After adjusting for age and a disadvantage of transplant after the more historic HD10 trial, a significant difference in the efficacy of chemotherapy versus transplant for second PFS was NOT observed, hazard ratio 0.70, P-value = 0.39.  For patients who were in the HD13 trial, under the age of 60, the 2-year, second PFS rate was 94% with chemotherapy versus 83% with transplant.  Additional sensitivity analyses including overall survival confirmed his observations.

The authors concluded that ” after contemporary treatment of early-stage Hodgkin’s lymphoma, relapse mostly occurred after 12 months from first diagnosis and treatment regimens such as BEACOPP are frequently administered and may constitute a reasonable treatment option for select patients with relapse after early stage Hodgkin’s lymphoma: