Hodgkin’s Disease Recurrent

When Hodgkin lymphoma returns after treatment, it’s called recurrent or relapsed disease. While this can be concerning, many people can achieve another remission and may even be cured with further treatment.

Table of contents

• What is Recurrent Hodgkin’s Disease
• When Relapses Typically Occur
• Diagnosis of Relapsed Disease
• Treatment Options
• Stem Cell Transplantation
• Treatments Under Investigation
• Outlook and Success Rates

What is Recurrent Hodgkin’s Disease

Recurrent Hodgkin’s disease means the cancer has returned after treatment and a period of remission, which is a time when the disease was not present or detectable.^[1] This is sometimes also called relapsed Hodgkin lymphoma.^[4]

When doctors talk about recurrent disease, they may also use the term refractory. This describes when the lymphoma does not respond to treatment, meaning the cancer cells continue to grow, or when the response to treatment does not last very long.^[1]

For patients who experience relapse or have refractory disease, secondary therapies are often successful in providing another remission and may even cure the disease.^[1]

When Relapses Typically Occur

For classical Hodgkin lymphoma, most relapses typically occur within the first three years following diagnosis, although some relapses occur much later.^[1] According to research, relapse can occur in up to 30% of people with the advanced stages of Hodgkin lymphoma and in 5 to 10% of those in the earlier stages of the disease where it has not spread.^[4]

Despite the high cure rate for Hodgkin lymphoma with first-line therapy, approximately one-third of patients will not have a complete response to frontline treatment or will subsequently relapse. Only 50% of these patients will be effectively salvaged with conventional therapies.^[5]

Diagnosis of Relapsed Disease

If doctors suspect a Hodgkin lymphoma relapse, they may carry out various tests to confirm whether the disease has returned.^[4]

Blood tests measure the levels of blood cells people have, as lymphoma can cause low blood counts and other abnormalities in the blood that may indicate the disease has returned.^[4]

Scans include CT scans or ultrasounds to look for enlarged lymph nodes and to check if the cancer has spread to other areas of the body.^[4]

Biopsy is a procedure that involves taking a sample from a lymph node to test for lymphoma. This helps doctors confirm the presence of cancer cells.^[4]

The test results will help doctors identify if the Hodgkin lymphoma has returned, and if it has, what type and stage the lymphoma is and the best treatment strategy to use.^[4]

Treatment Options

A number of treatment options are available for patients with relapsed or refractory Hodgkin lymphoma. The type of treatment prescribed for individual patients depends on several factors, including the timing of the relapse, age and overall health of the patient, scope of disease, and previous therapies received.^[1]

The current standard secondary treatment for the majority of patients consists of combination therapy, usually followed by stem cell transplantation. Involved site radiation therapy, which directs radiation to specific areas where the disease is located, may also be used.^[1]

To treat recurrent Hodgkin lymphoma, people will usually have second-line chemotherapy treatment. This involves different drugs from the chemotherapy they may have received as part of the initial treatment.^[4]

There are a variety of single-agent and combination therapy regimens that may be used for relapsed or refractory Hodgkin lymphoma, including:^[1]

• Brentuximab vedotin (Adcetris)
• Bendamustine (Treanda)
• Nivolumab (Opdivo)
• Pembrolizumab (Keytruda)
• DHAP (dexamethasone, cisplatin, and cytarabine)
• ESHAP (etoposide, methylprednisolone, cisplatin, and cytarabine)
• GVD (gemcitabine, vinorelbine, and liposomal doxorubicin)
• ICE (ifosfamide, carboplatin, and etoposide)
• IGEV (ifosfamide, gemcitabine, and vinorelbine)

You may be given the same combination of chemotherapy drugs that was originally used to treat the Hodgkin lymphoma if it responded well to them the first time they were given. You may also be offered a different combination of chemotherapy drugs.^[8]

Radiation therapy may be offered to treat Hodgkin lymphoma that comes back or remains in only one lymph node area if you have not already received radiation therapy. It may be given alone or with chemotherapy, and may also be used in preparation for a stem cell transplant.^[8]

Stem Cell Transplantation

Hodgkin lymphoma patients who fail to achieve complete remission following frontline therapy or who relapse after achieving complete remission are often treated with second-line chemotherapy regimens, followed by a bone marrow or stem cell transplant. A transplant of bone marrow or stem cells is needed to restore healthy bone marrow.^[1]

A stem cell transplant is the main treatment used for Hodgkin lymphoma that does not completely go away after treatment with chemotherapy or radiation therapy. It may also be offered if the disease comes back soon after the original treatment is finished.^[8]

A stem cell transplant uses high-dose chemotherapy to kill all of the cells in the bone marrow. Healthy stem cells are given to replace the ones in the bone marrow that were destroyed.^[8]

In an autologous type of transplant, the stem cells are taken from your own bone marrow or blood. This is the most common type used for recurrent Hodgkin lymphoma.^[8]

In an allogeneic type of transplant, stem cells are collected from another person. If the Hodgkin lymphoma remains after an autologous stem cell transplant, an allogeneic stem cell transplant may be an option for some people.^[8]

Treatments Under Investigation

Although the cure rate in Hodgkin lymphoma is already high, research continues to look for ways to treat the minority of patients who are refractory to treatment and those who relapse. Many promising therapies are currently under investigation in clinical trials.^[1]

Drugs under investigation include the following:^[4]

• Anti-CD30-CAR T cells
• Atezolizumab (Tecentriq)
• Bortezomib (Velcade)
• Carfilzomib (Kyprolis)
• Everolimus (Afinitor)
• Ibrutinib
• Itacitinib
• Ipilimumab
• Lenalidomide
• Mocetinostat
• Pralatrexate
• Romidepsin
• Ruxolitinib

People can speak with a doctor about the latest research and treatments for recurrent Hodgkin lymphoma, whether any new treatments are available, or if they are interested in joining a clinical trial.^[4]

Outlook and Success Rates

While recurrent disease is a serious concern, many people can still achieve positive outcomes. For patients who relapse or become refractory, secondary therapies are often successful in providing another remission and may even cure the disease.^[1]

However, the outlook varies depending on several factors. The prognosis is particularly poor for those patients with chemotherapy refractory disease, who are unable to obtain even transient disease control, and for patients who relapse following high dose chemotherapy and autologous stem cell transplant.^[5]

Several factors can affect prognosis in relapsed disease. A remission duration of less than 1 year, advanced stage or extranodal disease (cancer that has spread outside the lymph nodes) at relapse, and B symptoms (fever, night sweats, and weight loss) at relapse have all been reported as negative prognostic factors.^[5]

For patients in first relapse undergoing autologous stem cell transplant, a negative PET scan (positron emission tomography scan) suggestive of a complete remission has been identified as an important positive indicator.^[5]

Your healthcare team will work with you to develop a treatment plan based on your needs and work with you throughout the process. The treatments offered will depend on where the Hodgkin lymphoma is in the body, how long since it was first treated, and the treatments that were used.^[8]