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Very late relapses in Hodgkin lymphoma treated with chemotherapy with or without radiotherapy: linear pattern and distinct prognostic factors
Hodgkin lymphoma (HL) is curable in most cases by modern chemotherapy with/without radiotherapy (CT"‰Â±"‰RT). Most treatment failures represent either primary refractory disease or early relapses within 1 year (PR/ER). Relapses >1 year from treatment completion are considered "late relapses" (LR) associated with better outcomes [1]. The relapse rate gradually drops after the first year [2] and patients with sustained complete remission (CR) for >5 years are generally considered "cured". However, relapses after >5 years (very late relapses (VLRs)) occasionally occur, and, until recently, VLRs after CT"‰Â±"‰RT had been evaluated in rather small patient series [3,4,5,6,7,8,9,10,11]. In 2005, we initially analyzed the incidence of VLRs-those occurring >5 years from initial treatment initiation-and searched for relevant prognostic factors. In 2017, the German Hodgkin Study Group (GHSG) analyzed the incidence of VLRs in 4935 patients mainly treated with CT"‰Â±"‰RT within the HD7-HD12 trials, reporting a linear pattern of continuous relapses up to 20 years [12]. However, it continuous to be unclear if this linear trend continues beyond 20 years without reaching a plateau and if baseline prognostic factors or treatment regimens or RT strategies affect the risk of VLR.