Treatment outcome in children and adolescents with relapsed H odgkin lymphoma – results of the UK HD 3 relapse treatment strategy

Summary The purpose of this national retrospective study was to evaluate the outcome in children with relapsed or primary refractory Hodgkin lymphoma [ HL ] after a primary chemotherapy alone treatment strategy. Between 2000 and 2005 , 80 children with relapsed [ n  = 69] or primary refractory [ n  = 11] HL were treated on a standardized treatment protocol of 4–6 cycles of EPIC [etoposide, prednisolone, ifosfa3mide and cisplatin] chemotherapy. Radiotherapy was recommended to all relapsed sites. High dose therapy with stem cell rescue [ SCT ] was recommended for patients with poor response. The 5‐year overall survival [ OS ] and progression‐free survival from relapse was 75·8% [64·8–83·9] and 59·9% [48·3–69·7] respectively. Duration of first remission was strongly associated with OS ; risk of death was decreased by 53% [Hazard ratio ( HR ): 0·47, 95% confidence interval ( CI ): 0·19–1·18] for those with a time from end of treatment to relapse of 3–12 months (compared to <3 months) and reduced by 80% ( HR 0·20, 95% CI : 0·04–0·90) for those >12 months after end of treatment. Other poor prognostic factors included advanced stage disease at relapse and B symptoms at first diagnosis. The most important factor associated with salvage failure was time to relapse . Survival outcome in children with primary refractory HL is poor.