Rapidly Progressing Refractory Hodgkin Lymphoma: A Case Report and a Possible Explanation

Area of Science:

• Oncology
• Hematology
• Immunology

Background:

• Hodgkin lymphoma is generally curable, but some patients present with refractory disease.
• Advanced stage classical nodular sclerosis subtype Hodgkin lymphoma can be challenging to treat.
• Rapid progression and unfavorable prognosis are significant clinical concerns.

Purpose of the Study:

• To report an unusual case of rapidly progressing, refractory classical nodular sclerosis Hodgkin lymphoma.
• To investigate the potential role of aberrant T-cell antigen expression in treatment resistance.
• To suggest potential therapeutic strategies for refractory Hodgkin lymphoma.

Main Methods:

• Case presentation of a 66-year-old male with refractory advanced stage classical nodular sclerosis Hodgkin lymphoma.
• Review of treatment regimens including ABVD, DHAP, and IGEV.
• Histological examination of lymph node biopsy, skin lesion, and autopsy for aberrant antigen expression.

Main Results:

• The patient exhibited refractory disease despite multiple treatment lines.
• Histological analysis revealed aberrant CD4 T-cell antigen expression on Hodgkin and Reed/Sternberg cells.
• The patient experienced acute kidney and respiratory failure, succumbing to the disease.

Conclusions:

• Aberrant T-cell antigen expression may be linked to inferior outcomes in Hodgkin lymphoma.
• Further investigation of T-cell associated antigens is recommended for non-responsive patients.
• Consideration of intensified treatment or targeted therapy, such as brentuximab vedotin, is warranted.