VERY LATE RELAPSE IN HODGKIN DISEASE: OUTCOME OF PATIENT RELAPSING MORE THAN 24 YEARS AFTER PRIMARY CHEMO- AND RADIOTHERAPY ON RARE LOCATION
Keywords:
Hodgkin lymphoma, late relapse, risk factors, ABVD regimenAbstract
Late Hodgkin disease refers to a recurrence of the disease after a period of remission (absence of disease symptoms). It can occur as a de novo (new) malignant neoplasma or as a relapse of the old disease. In some cases, late Hodgkin disease may be a new disorder that is not related to the original disease. This can occur if the patient was not properly treated for the original disease, or if the patient's immune system was compromised and developed something new. In other cases, late Hodgkin disease may be a relapse of the original disease. This means that the disease has come back after a period of remission.
We present a case of a 27-year-old male with HD after 24 years of period of complete remission of the initial disease. This very rare relapse of HD was presented on gingivae like an extranodal involvement which is less commonly found than in other lymphomas. The histopathological analysis of the gingivae during the relapse showed presence of another subtype of Hodgkin disease - nodular lymphocyte predominant (NLPHL) on a rare location. It is important for patients to follow their treatment plan closely and to continue to see their healthcare provider for follow-up care after treatment. Our case illustrates that Hodgkin lymphoma can also appear in soft tissue masses such as gingivae and is more refractory to the standard therapeutical approach.
References
Juntikka T, Malila N, Ylostalo T, Merikivi M, Jyrkkio S. Epidemiology of classic and nodular lymphocyte predominant Hodgkin Lymphoma in Finland in 1996-2015. Acta Oncologica 2020; 59(5): 5: 574-581. doi: 10.1080/0284186X.2019.1711166.
Strobbe L, Valke LL, Diets IJ, van den Brand M, Aben K, Raemaekers JM, et al. A 20-year population-based study on the epidemiology, clinical features, treatment, and outcome of nodular lymphocyte predominant Hodgkin lymphoma. Ann Hematol 2016; 95(3): 417-423. doi: 10.1007/s00277-015-2578-6.
Provencio M, Salas C, Millán I, Cantos B, Sánchez A, Bellas C. Late relapses in Hodgkin lymphoma: a clinical and immunohistochemistry study. Leuk Lymphoma 2010; 51(9): 1686-91. doi: 10.3109/10428194.2010.500432.
Gerber NK, Atoria CL, Elkin EB, Yahalom J. Characteristics and outcomes of patients with nodular lymphocyte-predominant Hodgkin lymphoma versus those with classical Hodgkin lymphoma: a population-based analysis. Int J Radiat Oncol Biol Phys 2015; 92(1): 76-83. doi: 10.1016/j.ijrobp.2015.02.012.
Pinczés L, Miltényi Z, Illés Á. Young adults diagnosed with Hodgkin lymphoma are at risk of relapsing late: a comprehensive analysis of late relapse in Hodgkin lymphoma. J Cancer Res Clin Oncol 2018; 144(5): 935-943. doi: 10.1007/s00432-018-2613-9.
Andersen MD, Hamilton-Dutoit S, Modvig L, Vase M, Christiansen I, Christensen JH, et al. Late recurrence of lymphoid malignancies after initial treatment for Hodgkin lymphoma - A study from the Danish Lymphoma Registry. Br J Haematol 2022; 198(1): 50-61. doi: 10.1111/bjh.18180.
El-Galaly TC, Glimelius I. Late relapses in Hodgkin lymphoma-should we search for the needle in the haystack? Br J Haematol 2022; 198(1): 11-13. doi: 10.1111/bjh.18199.
Bröckelmann PJ, Goergen H, Kohnhorst C, von Tresckow B, Moccia A, Markova J, et al. Late Relapse of Classical Hodgkin Lymphoma: An Analysis of the German Hodgkin Study Group HD7 to HD12 Trials. J Clin Oncol 2017; 35(13): 1444-1450. doi: 10.1200/ JCO.2016.71.3289.
Deng A, Javad A, Uppal G, Kasner M. An unusual case of late recurrent Hodgkin Lymphoma presenting with soft tissue masses. Am J Hospital Med 2015; 7 (3).
Hapgood G, Zheng Y, Sehn LH, Villa D, Klasa R, Gerrie AS, et al. Evaluation of the Risk of Relapse in Classical Hodgkin Lymphoma at Event-Free Survival Time Points and Survival Comparison With the General Population in British Columbia. J Clin Oncol 2016; 34(21): 2493-2500. doi: 10.1200/JCO.2015.65.4194.
Vassilakopoulos TP, Kravvariti E, Panitsas F, Angelopoulou MK, Liaskas A, Kontopidou FN, et al. Very late relapses in Hodgkin lymphoma treated with chemotherapy with or without radiotherapy: linear pattern and distinct prognostic factors. Blood Cancer J 2022; 12(7): 102. doi: 10.1038/s41408-022-00674-w.
Saarinen S, Pukkala E, Vahteristo P, Mäkinen MJ, Franssila K, Aaltonen LA. High familial risk in nodular lymphocyte-predominant Hodgkin lymphoma. J Clin Oncol 2013; 31(7): 938-943. doi: 10.1200/JCO.2012.43.5958.
Hawkes EA, Wotherspoon A, Cunningham D. The unique entity of nodular lymphocyte-predominant Hodgkin lymphoma: current approaches to diagnosis and management. Leuk Lymphoma 2012; 53(3): 354-361. doi: 10.3109/10428194.2011.608455.
Markovic O, Andjelic B, Tarabar O, Todorovic M, Filipovic B, Stanisavljevic D, et al. Late relapse of Hodgkin’ lymphoma-is it different in clinical characteristics and outcome? J BUON 2017; 22(2): 481-486. PMID: 28534373
Gaudio F, Giordano A, Pavone V, Perrone T, Curci P, Pastore D, et al. Outcome of very late relapse in patients with Hodgkin’ lymphomas. Adv Hematol 2011; 2011: 707542. doi: 10.1155/2011/707542