Recognition of a chronic relapsing form of Hodgkin's disease in a population of patients demonstrating no second tumours.

Of 167 patients with Hodgkin's disease seen in a single centre between December 1972 and December 1982, only one has developed a myelodysplastic state. Between 1972 and 1977, therapy consisted of radiotherapy alone for early-stage disease, combined-modality treatment for intermediate-stage disease and chemotherapy alone using mustine, vinblastine, prednisone and procarbazine (MVPP) for advanced disease. Seventy-one per cent of these patients are disease-free at 5-10 years. From 1978, chlorambucil was substituted for mustine in the chemotherapy schedule (CLVPP). Combined-modality therapy has been used more frequently for patients with Stage III disease since 1978. Complete remission rates for patients treated with MVPP and CLVPP alone were 79% and 78%, respectively. Eight patients (5%) have been designated as a clinical subgroup of 'chronic relapsing' Hodgkin's disease. This chronic relapsing subgroup received substantially more chemotherapy than the remainder and one of these patients has developed a myelodysplastic state. Patients within the chronic relapsing group can be recognised and it is possible to obtain and maintain substantial remissions with fewer courses of chemotherapy than is currently the norm.