Characteristics and Outcomes of Patients with Hodgkin Lymphoma with Paraneoplastic Manifestations

Paraneoplastic syndromes are rare in patients with Hodgkin Lymphoma (HL) and data on different manifestations and outcomes of patients with paraneoplastic manifestations is limited. We retrospectively analysed patients with HL and paraneoplastic manifestations treated at our center between 2018 and 2023. Details regarding the demographics, disease characteristics, paraneoplastic manifestations, treatment characteristics as well as outcomes were noted. Three-hundred ten patients with newly diagnosed HL were treated at our center during the study period of whom, 29 patients (9.3%) had a paraneoplastic manifestation. Paraneoplastic manifestations were concurrently diagnosed with HL in 86.2% of cases, while 2 patients each had a diagnosis of Paraneoplastic syndrome at relapse and prior to the diagnosis of HL respectively. Pruritis (31.1%) and hematological manifestations (27.6%), such as immune thrombocytopenia, were the most common paraneoplastic manifestations. Most patients received ABVD as initial therapy (n = 21; 72.4%) and the complete response rate for HL was 76.2%. During follow-up, 9 patients died (31%), primarily due to disease progression. With a median follow-up of 28 months, the median event-free survival was 39 months and median overall survival was not reached. Patients with a paraneoplastic manifestation had an inferior survival in comparison to patients without a paraneoplastic manifestation. Paraneoplastic manifestations can have a diverse presentation in patients with HL. Treatment can be a challenge given the different organ involvement which may prohibit use of different agents. This is the largest single series describing the different paraneoplastic manifestations in patents with HL and their outcome.