Background:High-dose chemotherapy has an established role inrecurrent or refractory Hodgkin's lymphoma (HL) although a significantproportion of patients subsequently relapse. This manuscript describes theclinical characteristics of such patients and documents their furthermanagement at two major UK cancer centres.
Patients and methods:Between 1987 and 1996 one hundred patientswith recurrent or refractory HL received high-dose chemotherapy (HDCT) withautologous haematopoietic rescue. All had recurred within 12 months of initialtherapy or had two or more recurrences.
Results:With a median follow-up of 2 years, 56 patients arecurrently progression-free. There were six treatment-related deaths. Onepatient died of pneumonia in remission. Thirty-seven patients have relapsed,intrapulmonary disease being seen for the first time in 53% andrecurrence at previous sites of disease in 81%. Following recurrence,therapy was determined by circumstances: either one agent at a time was used(single sequential approach) or multiagent chemotherapy was chosen. There wasa survival advantage for those who achieved a symptomatic response (13 vs. 4months median, P = 0.0001). A trend towards longer survival was seenfor those whose disease recurred beyond six months following high-dosechemotherapy and in those who received combination chemotherapy.
Conclusions:These results confirm that HDCT with autologoushaematopoietic support is inadequate for about half the patients who receiveit for high-risk HL. Relapse in the site of prior disease is the most likelypattern with intrapulmonary disease for the first time occurring frequently.It is possible to administer further chemotherapy after failure of HDCT, andboth objective as well as subjective benefit can be achieved. A few patientsappear to get long-term benefit from further treatment.