Long-term follow-up of the patient with classical Hodgkin lymphoma
- Peter M Mauch, MD
Peter M Mauch, MD
- Professor of Radiation Oncology
- Harvard Medical School
- Jonathan W Friedberg, MD
Jonathan W Friedberg, MD
- Professor of Medicine
- James P Wilmot Cancer Center, University of Rochester
Patients with Hodgkin lymphoma (HL; formerly called Hodgkin's disease) are evaluated at the time of initial presentation to determine the stage of the disease, which is then used to determine whether the patient will be treated with radiotherapy, chemotherapy, or both. Patients are then reevaluated at regular intervals during and after treatment to assess the response and detect possible recurrence. (See "Staging and prognosis of Hodgkin lymphoma" and "Overview of the treatment of classical Hodgkin lymphoma in adults".)
This topic will review the long-term follow-up of patients treated with HL. The recommended approach to monitoring during and after therapy for HL and the treatment of relapsed disease will be reviewed separately. (See "Monitoring of the patient with classical Hodgkin lymphoma during and after treatment" and "Treatment of relapse of classical Hodgkin lymphoma after initial chemotherapy".)
FOLLOW-UP FOR RELAPSE
Relapse after initial treatment will occur in approximately 10 to 15 percent of patients with early-stage disease and up to 40 percent of patients with advanced-stage disease at diagnosis [1-3]. Following the completion of therapy and restaging after the documentation of complete response, patients are seen at periodic intervals to assess a possible relapse. When planning the post-treatment surveillance strategy, care should be taken to limit the number of computed tomography (CT) scans, particularly in younger individuals, given concerns about radiation exposure and the risk for second malignancies [4-6]. There is no role for routine positron emissions tomography (PET) or PET/CT imaging in the longitudinal follow-up of asymptomatic patients after response assessment . (See "Radiation-related risks of imaging studies".)
The majority (approximately 70 percent) of relapses occur within the first two years of diagnosis. After this point, the risk of relapse drops substantially. As an example, in one study of 1402 patients with HL followed for a median of 8.4 years, the risk of relapse within five years of diagnosis was 18 percent . The risk of relapse within the subsequent five years declined for patients who were relapse free at one year (10 percent), two years (5.6 percent), three years (3.5 percent), and five years (2.5 percent). After three years, the prognosis of patients with advanced-stage disease is comparable to that of early-stage disease.
Overall approach — Following the completion of therapy, the frequency and extent of visits depends upon the comfort of both the patient and physician. The value and cost-effectiveness of different screening components is described in the following section. Our general approach is as follows:
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- FOLLOW-UP FOR RELAPSE
- Overall approach
- History and physical
- Sites of relapse
- - After chemotherapy
- - After radiation therapy
- FOLLOW-UP FOR LONG-TERM COMPLICATIONS
- Routine testing
- Cardiac and vascular disease
- Screening for colorectal cancer
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS