title: Patterns and timing of initial relapse in patients subsequently undergoing transplantation for Hodgkin's lymphoma.
abstract: OBJECTIVE
  To evaluate the patterns and timing of initial recurrence in patients with Hodgkin's lymphoma (HL) who subsequently underwent high-dose chemotherapy with autologous stem cell transplantation to enhance our understanding of the natural history of this disease and its modern treatment strategies and to direct approaches to disease surveillance.
  
  
  METHODS
  The records of 69 patients with HL who had undergone high-dose chemotherapy with autologous stem cell transplantation in our center between May 1992 and June 2006 were analyzed. The initial diagnosis had been made between April 1982 and January 2005 at a median patient age of 33 years (range, 19-65). The patients were segregated according to the initial stage (Stage I-II vs. III-IV).
  
  
  RESULTS
  Early-stage HL patients developed a relapse at a median of 2.1 years (range, 0.5-10.3), with 91% of relapses at the initial disease site, 71% of which (65% overall) were only in previously involved sites. Advanced-stage HL patients developed a relapse at a median of 1.5 years (range, 0.6-10.5), with 97% at the initial site, 71% of which (69% overall) were only in previously involved sites. Single-site relapses occurred in 47% of early- vs. 26% of advanced-stage patients, and extranodal relapses occurred in 12% of early- vs. 31% of advanced-stage patients.
  
  
  CONCLUSIONS
  Almost all patients with HL who develop relapse and subsequently undergo high-dose chemotherapy with autologous stem cell transplantation initially developed recurrence in previously involved disease sites. Early-stage HL relapses often occurred in single sites, and advanced-stage disease relapses were more likely in multiple and extranodal sites. The interval to recurrence was brief, suggesting that the frequency of screening should be the greatest in the early post-therapy years.
authors.affiliation: Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY 14642, USA.
authors.forename: Sughosh
authors.initials: S
authors.lastname: Dhakal
authors.forename: Tithi
authors.initials: T
authors.lastname: Biswas
authors.forename: Jane L
authors.initials: JL
authors.lastname: Liesveld
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Friedberg
authors.forename: Gordon L
authors.initials: GL
authors.lastname: Phillips
authors.forename: Louis S
authors.initials: LS
authors.lastname: Constine
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D013997:Time Factors; D055815:Young Adult