title: A population-based study of the outcome for patients with first relapse of Hodgkin's lymphoma.
abstract: BACKGROUND
  Our aims were to evaluate the response to salvage treatment in relation to initial treatment and to evaluate prognostic factors at the time of relapse in an unselected population of relapsing patients with Hodgkin's lymphoma (HL).
  
  
  METHODS
  In total, 124 patients younger than 60 yr of age with initial diagnosis of HL in Sweden relapsed between 1985 and 1995.
  
  
  RESULTS
  Fifty-eight patients relapsed after initial treatment with radiotherapy (RT) only, 62 after combination chemotherapy (CT), of whom 30 had received additional involved-field RT, and four after a short course of CT followed by extended-field RT. For 37 patients among the 58 relapsers after initial RT treated according to the recommendations of the National guidelines, the 5-yr Hodgkin-specific survival (HLS) was 85%, overall survival (OS) 73% and event-free survival (EFS) 62%, which is not inferior to survival in patients with primarily advanced stages. It was poorer in the 21 patients who initially had received RT only, even though they had been recommended for more extensive treatment. For patients initially treated with a full course (6-8 cycles) of CT the 5-yr HLS was 60%, OS 58% and EFS 22%. Bulky disease and age at diagnosis strongly affected survival in a multivariate analysis.
  
  
  CONCLUSIONS
  Patients initially treated with RT who relapse have a favourable outcome, provided they have been treated according to the recommendations of the guidelines at the time of diagnosis. Initially bulky disease and, as a consequence, additional RT as part of the initial treatment negatively affect survival at relapse in patients initially treated with a full course of CT.
authors.affiliation: Department of Oncology and Regional Oncological Centre, University Hospital of Uppsala, Sweden. Rose-Marie.Amini@genpat.uu.se
authors.forename: Rose-Marie
authors.initials: RM
authors.lastname: Amini
authors.forename: Bengt
authors.initials: B
authors.lastname: Glimelius
authors.forename: Anita
authors.initials: A
authors.lastname: Gustavsson
authors.forename: Tor
authors.initials: T
authors.lastname: Ekman
authors.forename: Martin
authors.initials: M
authors.lastname: Erlanson
authors.forename: Eva
authors.initials: E
authors.lastname: Haapaniemi
authors.forename: Gunilla
authors.initials: G
authors.lastname: Enblad
mesh_terms: D000293:Adolescent; D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy / Q000517:prevention & control* / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016019:Survival Analysis; D013548:Sweden