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Medical and Pediatric Oncology 32:231 (1999)
Reappearance of Hodgkin Disease After 32 Years: Relapse or New Disease?
Atul Sharma, MD,1* Vinod Kochupillai, FRCP,1 Manisha Bhutani, MD,1 and
Sumeet Gujral, MD2
Key words: second malignant neoplasms; late complications in cancer; lymphoma
in adults
Over the last 3 decades, considerable improvement
has taken place in the management of Hodgkin disease
(HD) due to several factors, including better staging techniques, refinement in radiotherapy, and introduction of
combination chemotherapy. Overall long-term survival
of 80% is currently to be expected [1], and relapses after
3 years of first line therapy are uncommon. A long-term
study of HD conducted by the National Cancer Institute
had a median follow-up of 14 years. Only 3.5% of those
patients who relapsed did so after 10 years, and only one
patient relapsed after 11 years [2]. The Royal Marsden
Hospital, London, reported their experiences with 107
patients who were treated between 1964 and 1969 for
Stage I and II HD. The actuarial risk of relapse between
3 years and 12 years was 15.7%. Only one patient relapsed after 20 years [3], as did one other out of a total
366 reported in another study [4]. It is said that patients
with aggressive HD histology and systemic symptoms
may relapse early, whereas those without these features
may run an indolent course and relapse late. Such a possibility for late recurrence in HD has been considered by
Hung et al., who reported an HD relapse after 29 years
[5]. Occurrence of a second primary rather than a relapse,
however, cannot be ruled out entirely. In this report, we
document reappearance of HD in a 56-year-old female,
32 years after the first diagnosis, the longest interval ever
reported to our best knowledge.
The patient reported in June, 1994 with enlarged neck
nodes and low-grade fever of 1 week duration. Examination revealed a left supraclavicular 4 × 4 cm lymph
node and a right supraclavicular node of 2 × 1.5 cm.
Biopsy was reported as mixed cellularity HD. Computed
tomography (CT) scan of the abdomen showed paraaortic nodes (maximum diameter 2 cm); the chest CT scan
was normal. Bone marrow, biochemical, and hematologic parameters were normal. With the diagnosis of HD
Stage IIIA, she was given six cycles of cyclophosphamide, oncovin, procarbazine, and prednisone (COPP) using standard doses; complete response was documented
after 3 cycles. When she was seen in December, 1997,
she was free of disease 35 months postchemotherapy.
© 1999 Wiley-Liss, Inc.
Past history revealed that at the age of 24 years, in
1962 the patient had had fever, weight loss, and swelling
of a right supraclavicular gland. Lymph node biopsy was
reported as HD (subclassification not known). She received two doses of mechlorethamine (nitrogen mustard)
at intervals of 15 days for Stage I HD and remained
disease free for 32 years until she was seen by us. Because she had received only two doses of the drug, it is
possible that she never achieved complete remission;
hence, the possibility of disease recurrence, albeit so very
late, rather than a new process. Whatever the mechanism
responsible, the course of our patient emphasizes the
need for regular follow-up of HD patients for life. An
issue that can be debated is when HD can be considered
cured: Ever?
1. Hoppe RT, Coleman CN, Cox RS, et al. The management of
stage-I–II Hodgkin’s disease with irradiation alone or combined
modality therapy: the Stanford experience. Blood 1982;59:455.
2. Longo DL, Young RC, Wesley M, et al. Twenty years of MOPP
therapy for Hodgkin’s disease. J Clin Oncol 1986;4:1295–1306.
3. Duchesne CJ, Crow J, Ashley S, et al. Changing pattern of relapse
in Hodgkin’s disease. Br J Cancer 1989;60:227–230.
4. Dienstebeir Z, Hermanska Z, Zamecnik J, et al. Relapse in Hodgkin’s disease. Incidence of relapse in a group of 374 patients from
1 June 1968 to 31 March 1995. Vnitr-Lek. 1995;41:816–821.
5. Hung SJ, Jhung JW, Agnagnostu AA. Recurrence of Hodgkin’s
disease 29 years later. Cancer 1988;61:186–188.
Department of Medical Oncology, Institute Rotary Cancer Hospital,
All India Institute of Medical Sciences, New Delhi, India
Laboratory Oncology Unit, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
*Correspondence to: Atul Sharma, MD, Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical
Sciences, New Delhi-1110029, India. E-mail: atulshar@medinst.
Received 24 June 1998; Accepted 12 August 1998
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