Patterns of relapse and subsequent management following high-dose chemotherapy with autologous haematopoietic support in relapsed or refractory Hodgkin's lymphoma: A two centre study

Background: High-dose chemotherapy has an established role in recurrent or refractory Hodgkin's lymphoma (HL) although a significant proportion of pat ients subsequently relapse. This manuscript describes the clinical characte ristics of such patients and documents their further management at two majo r UK cancer centres. Patients and methods: Between 1987 and 1996 one hundred patients with recur rent or refractory HL received high-dose chemotherapy (HDCT) with autologou s haematopoietic rescue. All had recurred within 12 months of initial thera py or had two or more recurrences. Results: With a median follow-up of 2 years, 56 patients are currently prog ression-free. There were six treatment-related deaths. One patient died of pneumonia in remission. Thirty-seven patients have relapsed, intrapulmonary disease being seen for the first time in 53% and recurrence at previous si tes of disease in 81%. Following recurrence, therapy was determined by circ umstances: either one agent at a time was used (single sequential approach) or multiagent chemotherapy was chosen. There was a survival advantage for those who achieved a symptomatic response (13 vs. 4 months median, P = 0.00 01). A trend towards longer survival was seen for those whose disease recur red beyond six months following high-dose chemotherapy and in those who rec eived combination chemotherapy. Conclusions: These results confirm that HDCT with autologous haematopoietic support is inadequate for about half the patients who receive it for high- risk HL. Relapse in the site of prior disease is the most likely pattern wi th intrapulmonary disease for the first time occurring frequently. It is po ssible to administer further chemotherapy after failure of HDCT, and both o bjective as well as subjective benefit can be achieved. A few patients appe ar to get long-term benefit from further treatment.