Reappearance of Hodgkin disease after 32 years: Relapse or new disease?
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BRIEF REPORT 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, MD 2 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 tech- niques, 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 re- lapsed 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 pos- sibility 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. Exami- nation 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 paraaor- tic nodes (maximum diameter 2 cm); the chest CT scan was normal. Bone marrow, biochemical, and hemato- logic parameters were normal. With the diagnosis of HD Stage IIIA, she was given six cycles of cyclophospha- mide, oncovin, procarbazine, and prednisone (COPP) us- ing standard doses; complete response was documented after 3 cycles. When she was seen in December, 1997, she was free of disease 35 months postchemotherapy. 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 re- ceived 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. Be- cause 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? REFERENCES 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 Hodg- kin’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. 1 Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India 2 Laboratory Oncology Unit, Institute Rotary Cancer Hospital, All In- dia Institute of Medical Sciences, New Delhi, India *Correspondence to: Atul Sharma, MD, Department of Medical On- cology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi-1110029, India. E-mail: atulshar@medinst. ernet.in Received 24 June 1998; Accepted 12 August 1998 Medical and Pediatric Oncology 32:231 (1999) © 1999 Wiley-Liss, Inc.
Transcript of Reappearance of Hodgkin disease after 32 years: Relapse or new disease?
BRIEF REPORTReappearance of Hodgkin Disease After 32 Years: Relapse or New Disease?
Atul Sharma, MD,1* Vinod Kochupillai, FRCP,1 Manisha Bhutani, MD,1 andSumeet Gujral, MD2
Key words: second malignant neoplasms; late complications in cancer; lymphomain adults
Over the last 3 decades, considerable improvementhas taken place in the management of Hodgkin disease(HD) due to several factors, including better staging tech-niques, refinement in radiotherapy, and introduction ofcombination chemotherapy. Overall long-term survivalof 80% is currently to be expected [1], and relapses after3 years of first line therapy are uncommon. A long-termstudy of HD conducted by the National Cancer Institutehad a median follow-up of 14 years. Only 3.5% of thosepatients who relapsed did so after 10 years, and only onepatient relapsed after 11 years [2]. The Royal MarsdenHospital, London, reported their experiences with 107patients who were treated between 1964 and 1969 forStage I and II HD. The actuarial risk of relapse between3 years and 12 years was 15.7%. Only one patient re-lapsed after 20 years [3], as did one other out of a total366 reported in another study [4]. It is said that patientswith aggressive HD histology and systemic symptomsmay relapse early, whereas those without these featuresmay run an indolent course and relapse late. Such a pos-sibility for late recurrence in HD has been considered byHung 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, wedocument reappearance of HD in a 56-year-old female,32 years after the first diagnosis, the longest interval everreported to our best knowledge.
The patient reported in June, 1994 with enlarged necknodes and low-grade fever of 1 week duration. Exami-nation revealed a left supraclavicular 4 × 4 cm lymphnode and a right supraclavicular node of 2 × 1.5 cm.Biopsy was reported as mixed cellularity HD. Computedtomography (CT) scan of the abdomen showed paraaor-tic nodes (maximum diameter 2 cm); the chest CT scanwas normal. Bone marrow, biochemical, and hemato-logic parameters were normal. With the diagnosis of HDStage IIIA, she was given six cycles of cyclophospha-mide, oncovin, procarbazine, and prednisone (COPP) us-ing standard doses; complete response was documentedafter 3 cycles. When she was seen in December, 1997,she was free of disease 35 months postchemotherapy.
Past history revealed that at the age of 24 years, in1962 the patient had had fever, weight loss, and swellingof a right supraclavicular gland. Lymph node biopsy wasreported as HD (subclassification not known). She re-ceived two doses of mechlorethamine (nitrogen mustard)at intervals of 15 days for Stage I HD and remaineddisease free for 32 years until she was seen by us. Be-cause she had received only two doses of the drug, it ispossible that she never achieved complete remission;hence, the possibility of disease recurrence, albeit so verylate, rather than a new process. Whatever the mechanismresponsible, the course of our patient emphasizes theneed for regular follow-up of HD patients for life. Anissue that can be debated is when HD can be consideredcured: Ever?
REFERENCES
1. Hoppe RT, Coleman CN, Cox RS, et al. The management ofstage-I–II Hodgkin’s disease with irradiation alone or combinedmodality therapy: the Stanford experience. Blood 1982;59:455.
2. Longo DL, Young RC, Wesley M, et al. Twenty years of MOPPtherapy for Hodgkin’s disease. J Clin Oncol 1986;4:1295–1306.
3. Duchesne CJ, Crow J, Ashley S, et al. Changing pattern of relapsein Hodgkin’s disease. Br J Cancer 1989;60:227–230.
4. Dienstebeir Z, Hermanska Z, Zamecnik J, et al. Relapse in Hodg-kin’s disease. Incidence of relapse in a group of 374 patients from1 June 1968 to 31 March 1995. Vnitr-Lek. 1995;41:816–821.
5. Hung SJ, Jhung JW, Agnagnostu AA. Recurrence of Hodgkin’sdisease 29 years later. Cancer 1988;61:186–188.
1Department of Medical Oncology, Institute Rotary Cancer Hospital,All India Institute of Medical Sciences, New Delhi, India2Laboratory Oncology Unit, Institute Rotary Cancer Hospital, All In-dia Institute of Medical Sciences, New Delhi, India
*Correspondence to: Atul Sharma, MD, Department of Medical On-cology, Institute Rotary Cancer Hospital, All India Institute of MedicalSciences, New Delhi-1110029, India. E-mail: [email protected]
Received 24 June 1998; Accepted 12 August 1998
Medical and Pediatric Oncology 32:231 (1999)
© 1999 Wiley-Liss, Inc.
