Introduction: With modern risk-adapted treatment modalities 80-90% of Hodgkin lymphoma (HL) patients can be cured, however, 30% of the patients may relapse after the first line treatment. Late relapses, that occurred 5 or more years after first diagnosis are rare. Neither clinical characteristics, nor risk factors, nor optimal treatment are well described for very late relapse (VLR) patients. Aim: To describe the incidence, clinical presentation, treatment and outcome of VLR in HL patients between 1970 and 2010 at our institute. Results: Of 669 consecutive HL patients treated at our institute between 1970 and 2010, 617 (92.2%) patients achieved complete remission after the first line treatment. Relapse occurred in 188 (28.1%) patients, 26 (3.8%) of them 5 or more years after the first diagnosis. VLR were more frequently observed in patients with mixed cellularity histological subtype and stage II/III disease at first diagnosis. In 15 (57.7%) patients, the histologic subtype remained the same at VLR, in 8 (30.8%) cases the region of the relapse was also identical. 24 (92.3%) patients with VLR received polychemotherapies, 5 (20.8%) of them also received involved-field radiotherapy. Primary diagnosis before the age of 20 and treatment with radiotherapy alone at first diagnosis was associated with a higher risk of VLR (p=0.009 and p=0.004 respectively). Compared to early relapse we observed superior OS after VLR. At a median of 244 (91 - 360) months of follow-up, 22 (84.6%) patients with VLR are still alive and disease free. In addition, relapse characteristics, therapeutic approaches, and changes in histologic subtype will be presented. Conclusion: VLR occurs in a small number of patients diagnosed with HL. Besides the rarity of these cases, with adequate treatment, late relapse of HL appears to have a favorable prognosis to early relapse HL cases. Subgroup analyses suggest that treatment with radiotherapy alone and first diagnosis before adulthood conveys worse prognosis. Continuous investigations are needed in this setting to determine further risk factors of VLR in HL.