PATTERNS OF SURVIVAL IN PATIENTS WITH HODGKINS-DISEASE - LONG FOLLOW-UP IN A SINGLE-CENTER

Background: Prolonged remission can now be induced in the majority of patients with Hodgkin's disease with chemotherapy and/or irradiation. However, there is a significant proportion of patients in whom this ap proach fails, either at presentation or subsequently. Survival is the definitive endpoint to assess treatment efficacy. In this study, the s urvival patterns of a large group of consecutive patients treated in a single institution are presented. Results: The overall median surviva l was 18.3 years. Clinical remission (complete remission plus good par tial remission) was induced in 443 (85%); the median survival of patie nts in remission has not been reached. Fifty-eight patients achieved r esponses less than clinical remission with initial therapy (partial re sponse) or had progressive disease, the median survival of this group being 1.4 years. With further therapy, remission was subsequently indu ced in 10; 5 are still alive, 5 have died between 1.9 years and 14.3 y ears. Twenty patients died before completion of therapy. Recurrence ha s been documented in 147 of the patients in remission (following initi al therapy) over a median follow up period of 13 years (minimum 5 year s). One hundred forty-three of these patients were retreated following recurrence (105 chemotherapy, 28 radiotherapy, 6 combined modality tr eatment and 4 surgery). Second remission was induced in 109/143 (76%). There was a trend towards better second remission induction in patien ts whose first remission was longer than 1 year (p = 0.06). The median duration of second remission was inferior to first remission duration (p < 0.001). There was no correlation between duration of first remis sion and survival following recurrence (p = 0.8) or with duration of s econd remission (p = 0.54). There was no significant difference in dur ation of second remission between patients who were initially treated with radiotherapy or chemotherapy (p = 0.3). The median survival follo wing second remission was 12.0 years, being the same for patients with initially localized disease (stages I and II) treated with radiation alone and for patients with advanced Hodgkin's disease (stages III and IV) treated with chemotherapy. Survival after recurrence is significa ntly better for patients under 50 years at the time of recurrence (p < 0.001). Second recurrence was documented in 46 patients, third remiss ion being reinduced in 22, the median survival of the latter being 5.1 years. Conclusion: These results illustrate the importance of prolong ed follow up in defining the clinical course of patients with HD and a re vital for planning experimental chemotherapy at the time of treatme nt failure of recurrence.