Hodgkin’s lymphoma (HL) is a cancer that begins in the white blood cells of the lymphatic system. While it is considered one of the most curable cancers, with high rates of long-term survival, the possibility of the disease returning (recurrence or relapse) is a significant concern for survivors. Modern medicine has established clear frameworks for managing this risk, and effective treatment protocols are available should the disease reappear.
Understanding the Likelihood and Timing of Relapse
The majority of individuals treated for Hodgkin’s lymphoma do not experience a recurrence. However, approximately 10% to 30% of patients will see the cancer return following initial treatment, with the relapse rate varying based on the stage of the disease. Patients diagnosed with limited-stage disease have a significantly lower relapse rate than those with advanced-stage HL.
The timing of a potential relapse is often predictable. Most recurrences happen, with up to 70% occurring within the first two years after completing initial therapy. The overall risk drops substantially after five years of continuous remission. Recurrences within the first 12 months are categorized as “early relapse,” which can be more challenging to treat than a “late relapse” occurring more than a year later.
Certain factors at diagnosis can increase the probability of a future relapse. These risk factors include advanced stage disease (Stage III or IV), a poor response to initial chemotherapy, or the presence of specific biological markers. Regular monitoring remains the most effective tool for managing the risk, aiming to detect any recurrence at the earliest stage.
Recognizing the Signs of Recurrence
The most common sign of recurrence is the painless swelling of lymph nodes, often felt in the neck, armpit, or groin. This swelling occurs when cancer cells multiply within the lymphatic tissue. Any persistent or newly noticed lump should be promptly brought to the attention of the oncology team.
A relapse is frequently associated with systemic symptoms known as “B-symptoms.” These symptoms include drenching night sweats, unexplained fevers that persist or recur, and the unintentional loss of more than 10% of body weight over six months. While these symptoms can also be caused by non-cancerous conditions, their reappearance in a survivor requires immediate medical evaluation.
Other, less specific symptoms can accompany a recurrence, such as persistent fatigue that does not improve with rest, or generalized itching without a rash. Because many of these signs are non-specific, survivors must maintain open communication with their medical providers about any change in their health status. The oncology team can then determine if these changes warrant further diagnostic testing to rule out a relapse.
Treatment Pathways After Relapse
When Hodgkin’s lymphoma returns, the treatment strategy is termed “salvage therapy,” aimed at achieving a second complete remission. The standard first approach for fit patients who relapse is a course of second-line chemotherapy regimens. These regimens differ from the initial treatment and are designed to eliminate cancer cells, preparing the body for a more intensive procedure.
Following successful salvage chemotherapy, the most established treatment is high-dose chemotherapy supported by an autologous stem cell transplant (ASCT). This process involves collecting the patient’s own healthy stem cells before delivering high-dose chemotherapy to eradicate the cancer. The stored stem cells are then reinfused to allow the bone marrow to recover its blood cell production. The goal of this intensive therapy is to offer the best chance for a durable, long-term remission.
If ASCT is not an option or if the disease returns afterward, newer targeted therapies have improved outcomes. One option is Brentuximab vedotin, an antibody-drug conjugate that targets the CD30 protein on HL cells, delivering a toxic payload directly to the cancer. Another class of drugs is the PD-1 inhibitors, such as nivolumab or pembrolizumab, which are immunotherapy agents that unleash the body’s immune system to attack the cancer. The choice of salvage therapy is customized based on the patient’s prior treatments, overall health, and the characteristics of the relapsed cancer.
Long-Term Surveillance and Survivorship
A structured, long-term surveillance plan is implemented for all Hodgkin’s lymphoma survivors to monitor health and detect any issues early. Follow-up appointments include physical exams, blood work, and periodic imaging scans. The frequency gradually decreases over time, typically starting every few months in the first few years and transitioning to an annual schedule later.
This ongoing care focuses on the early detection of a potential HL relapse and managing the long-term side effects of the original treatment. The chemotherapy and radiation used can increase the risk of developing secondary cancers, such as breast cancer, lung cancer, or leukemia. This risk is separate from HL relapse and requires specialized screening.
Survivorship care also addresses the elevated risk of cardiovascular disease, a known late effect of chest-area radiation and certain chemotherapy drugs. A survivorship care plan helps guide patients and their primary care providers on appropriate screening tests, such as mammograms and colonoscopies. It also encourages heart-healthy lifestyle choices, ensuring survivors receive preventive care to maintain their health over decades.