STEP 6: Managing recurrent, residual or metastatic disease


Most cases of recurrent Hodgkin lymphoma or DLBCL are identified through routine follow-up or by the patient presenting with symptoms, or with abnormal ‘non-specific’ laboratory tests such as serum LDH.


Evaluate each patient for whether referral to the original multidisciplinary team is appropriate. Treatment will depend on the location and extent of disease, previous management and the patient’s preferences.

Combination chemotherapy regimens with autologous stem cell transplantation is considered in first relapse. In subsequent relapses or where autologous stem cell transplantation is not appropriate, clinical trials should be considered. Novel biologic agents may be indicated, in the case of Hodgkin lymphoma.

Advance care planning

Advance care planning is important for all patients but especially those with advanced disease. It allows them to plan for their future health and personal care by thinking about their values and preferences. This can guide future treatment if the patient is unable to speak for themselves.

Survivorship and palliative care

Survivorship and palliative care should be addressed and offered early. Early referral to palliative care can improve quality of life and in some cases survival. Referral should be based on need, not prognosis.


The lead clinician and team’s responsibilities include:

  • explaining the treatment intent, likely outcomes and side effects to the patient and/or carer and the patient’s GP.