title: 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.
abstract: BACKGROUND
  High-dose chemotherapy has an established role in recurrent or refractory Hodgkin's lymphoma (HL) although a significant proportion of patients subsequently relapse. This manuscript describes the clinical characteristics of such patients and documents their further management at two major UK cancer centres.
  
  
  METHODS
  Between 1987 and 1996 one hundred patients with recurrent or refractory HL received high-dose chemotherapy (HDCT) with autologous haematopoietic rescue. All had recurred within 12 months of initial therapy or had two or more recurrences.
  
  
  RESULTS
  With a median follow-up of 2 years, 56 patients are currently progression-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 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 was a survival advantage for those who achieved a symptomatic response (13 vs. 4 months median, P = 0.0001). A trend towards longer survival was seen for those whose disease recurred beyond six months following high-dose chemotherapy and in those who received 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 with intrapulmonary disease for the first time occurring frequently. It is possible to administer further chemotherapy after failure of HDCT, and both objective as well as subjective benefit can be achieved. A few patients appear to get long-term benefit from further treatment.
authors.affiliation: ICRF Department of Medical Oncology, School of Medicine and Dentistry, St. Bartholomew's and Royal London Hospitals, Queen Mary and Westfield College, Smlithfield, London,UK.
authors.forename: J
authors.initials: J
authors.lastname: Shamash
authors.forename: S M
authors.initials: SM
authors.lastname: Lee
authors.forename: J A
authors.initials: JA
authors.lastname: Radford
authors.forename: A Z
authors.initials: AZ
authors.lastname: Rohatiner
authors.forename: J
authors.initials: J
authors.lastname: Chang
authors.forename: G R
authors.initials: GR
authors.lastname: Morgenstern
authors.forename: J H
authors.initials: JH
authors.lastname: Scarffe
authors.forename: D P
authors.initials: DP
authors.lastname: Deakin
authors.forename: T A
authors.initials: TA
authors.lastname: Lister
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D011237:Predictive Value of Tests; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis; D014182:Transplantation, Autologous; D017211:Treatment Failure