Late Relapse of Classical Hodgkin Lymphoma in German Hodgkin Study Group Trials
In an analysis of German Hodgkin Study Group trials reported in the Journal of Clinical Oncology, Bröckelmann et al found that the cumulative incidence of late relapse in patients with classical Hodgkin lymphoma was 6.9% at 20 years and that late relapse was more common among those with early-stage favorable vs unfavorable or advanced stage at initial diagnosis.
Study Details
The study involved 6,840 patients included in German Hodgkin Study Group trials HD7 to HD12. Patients who experienced a relapse at > 5 years into remission were compared with those with continued remission for > 5 years and with those with relapse ≤ 5 years after first diagnosis.
Incidence of Late Relapse
During median observation of 10.3 years, late relapse was observed in 141 patients. The cumulative incidence of late relapse was 2.5%, 4.3%, and 6.9% at 10, 15, and 20 years, respectively. The standardized incidence ratio for relapse compared with age- and sex-matched German reference data was 84.5 (95% confidence interval [CI] = 71.2–99.7). The 15-year cumulative incidence of late relapse was 5.3% in patients with early-stage favorable disease vs 3.9% among both those with early-stage unfavorable (subdistribution hazard ratio [HR] = 0.6, P = .02) and those with advanced-stage disease at initial diagnosis (subdistribution HR = 0.7, P = .04; overall P = .01).
Estimated 10-year overall survival was 95.8% in nonrelapse survivors vs 86.1% in those with late relapse (hazard ratio = 2.5, P < .001). Estimated 5-year survival after relapse was 73.4% in patients with late relapse vs 62.0% in those with earlier relapse (HR = 0.6, P = .01). Overall, 44% of patients with late relapse and 49% of those with earlier relapse received stem cell transplantation.
The investigators concluded: “Apart from treatment-associated adverse effects, survivors after initially successful therapy for [classical Hodgkin lymphoma] are at an 85-fold risk for recurrence of disease compared with the general German population. After risk-adapted treatment strategies, especially in early-stage favorable [Hodgkin lymphoma], regular clinical follow-up is recommended for timely detection of [late-relapse disease]. With adequate treatment, prognosis of [late-relapse Hodgkin lymphoma] is better compared with early relapses.”
The study was supported by German Cancer Aid.
Andreas Engert, MD, of the German Hodgkin Study Group, University Hospital of Cologne, is the corresponding author of the Journal of Clinical Oncology article.
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