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Hodgkins Lymphoma Case Studies

Case Studies: Classical Hodgkin Lymphoma: Is There a Cure?

Jonathon B. Cohen, MD, MS, discusses the available systemic options for the frontline treatment of advanced stage classical Hodgkin lymphoma.

Classical Hodgkin Lymphoma: Is There a Cure?

A 22-Year-Old Woman With Stage IV Classical Hodgkin Lymphoma

History & Physical

  • A 22-year-old female presented with right cervical nodes developing over several months
  • Initially evaluated by her OB/GYN who recommended observation. She subsequently developed neck pain while drinking wine
  • Referred for lymph node biopsy -> classical Hodgkin lymphoma
  • Past medical history: unremarkable
  • Social history: No tobacco use; occasional ETOH; Division 1 swimmer, NKDA
  • Family History:
    • Maternal grandfather – Squamous cell cancer
    • Maternal grandmother – Melanoma
    • Aunt – Breast Cancer
    • 2 healthy siblings

Laboratory Values

  • WBC 19.8 (85% PMN’s)
  • Hgb 12.0
  • Plts 571
  • ESR 30
  • Cr 0.76
  • Albumin 4.2
  • HIV/Hepatitis Negative

Staging PET/CT

  • Intrathoracic adenopathy
    • R cervical 2.3 x 1.9 (SUV 9.3)
    • L cervical 2.2 x 1.8 (SUV 8.8)
    • Ant Mediastinum 4.8 x 2.9 (SUV 21.3)
    • R axillary 2.8 x 2.8 (SUV 12.2)
  • Spleen SUV 2.9 with normal size
  • Diffuse uptake in the axial skeleton (SUVs 4.9-5.5)
  • Mediastinum SUV 1.8 / Liver 2.4

Pathology

  • Nodular sclerosis classical Hodgkin Lymphoma
  • Per IHC, Hodgkin cells express CD30, CD15, PAX5 (weak); negative for CD3, CD20, CD45

Treatment: A(BV)VD x 6

  • Interim PET/CT with Deauville 3
  • Tolerated well with GCSF support
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