EHA 2016

Very late relapse in Hodgkin’s lymphoma

Dr Paul Bröckelmann - University Hospital of Cologne, Cologne, Germany

This conference, among others, I was presenting data on very late relapse in Hodgkin lymphoma which was a retrospective analysis performed by the German Hodgkin’s Study Group in patients initially treated within our first line trials.

Can you tell us more about that?

Basically we tried to evaluate how many patients do suffer from a very late relapse which we defined as being a relapse after five years because usually this is when you would consider a patient cured from the disease since most of the relapses do occur between the first and second year. What we did is we analysed a set of more than 6,000 patients who were followed up very recently and we identified 169 patients suffering from a late relapse. The cumulative incidence at twenty years was around 8% and with the standardised incidence ratio compared to the German general population of about 97 which is a hundredfold increased risk of developing a second episode of Hodgkin lymphoma.

Just to check, these aren’t a second cancer but they are, in fact, a relapse not a secondary lesion?

This is indeed a very important point because it’s rather hard to distinguish whether this is a second cancer, which might be related to therapy as well, or whether this is a reoccurrence of the disease since the patient might have persisting disease after first line treatment, or whether there might be an immune dysregulation which favours the development of Hodgkin’s. We are trying to look into tissue samples from those patients which are analyses which might be done in the future and we are still working on this to better identify.

Are there any subsets of patients within those analysed that had increased chances of developing relapse or recurrence?

Looking at risk factors for the development of a very late relapse we found that patients with a male sex and also with a lymphocyte predominance subtype seemed to be at increased risk which also holds true for patients diagnosed with early stage favourable Hodgkin lymphoma at first diagnosis compared to patients in advanced stages or early stage unfavourable Hodgkin lymphoma.

When it comes to taking this information forwards to clinics, to practitioners, how can you see that affecting standards of care with surveillance or with five year check-ups?

From my point of view it’s rather important to just follow your patient clinically, have regular appointments and make sure you’re evaluating these patients for long-term toxicity of first-line treatment which is all sorts of organ damage and second cancers. But also keep in mind that it’s possible to have reoccurrence of Hodgkin lymphoma after more than five years and really take signs seriously and evaluate them properly to start adequate treatment if a second relapse develops.

That answers all the questions I’ve prepared, is there anything else you’d like to add?

Maybe just a brief comment on the prognosis in patients with very late relapse, compared to patients with early relapse it seems that the progression free survival after diagnosis of relapse is comparing favourably so the progression free survival is significantly better which also holds true for the overall survival in these patients. When looking at treatment characteristics we found that these patients with a very late relapse are often treated with first line chemotherapy regimens, BEACOPP or ABVD variants instead of high dose chemotherapy and this is just a brief input.