case_images: PMC11815334_01
case_images: Relevant laboratory parameters improved after administration of BV. (A) HgB (red) and platelet counts (blue) improved after BV administration and normalized over time. The horizontal red dotted line indicates the lower threshold of normal HgB and blue dashed line indicates the lower threshold of normal platelet values. (B) Total bilirubin (black) levels declined after BV administration and normalized over time. The horizontal dotted line indicates the upper threshold of normal total bilirubin level. In both graphs, vertical dotted lines indicate time of treatment initiation. Shaded period reflects the period of active lymphoma-directed therapy.
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case_images: Laboratory evaluation showed white blood cell (WBC) 4.76 x 109/L [normal range: 4-10 x 109/microL], hemoglobin (HgB) 89 g/L [114-144 g/L], platelet (Plt) 228 x 109/L [150-450 x 109/microL], alkaline phosphatase (Alk Phos) 316 unit/L [34-104 unit/L], aspartate aminotransferase (AST) 29 unit/L [13-39 unit/L], alanine transferase (ALT) 26 unit/L [7-52 unit/L], and total bilirubin (bili) 22.23 micromol/L [1.71-17.1 micromol/L] (Figure 1). Laboratory workup showed WBC 5.8 x 109/L, HgB 53 g/L (Grade 4), Plt 22 x 109/L (Grade 4), Alk Phos 281 unit/L, AST 124 unit/L (Grade 3), ALT 73 unit/L, and bili 345.43 micromol/L (Grade 4) (Figure 1). Her symptoms and laboratory parameters improved significantly (Figure 1) and she was discharged to continue therapy using sequential BV-AVD with two lead-in doses of BV, followed by six cycles of AVD, and finishing with four doses of BV.
case_images: Bone marrow trephine biopsy showing findings consistent with cHL. (A, B) H&E stains (40x and 400x, respectively, original magnification) showing a hypercellular marrow with diminished trilineage hematopoiesis and extensive infiltration by numerous atypical large cells with prominent nucleoli most consistent with Hodgkin/Reed-Sternberg (HRS) cells. No hemophagocytes were observed. (C-E) Immunohistochemical stains at 400x, original magnification, showing malignant cells staining strongly positive for CD30 (C) and CD15 (D). MUM1 expression was also positive (not shown). PAX5 expression was weak but highlighted malignant cells (E). HRS cells lacked expression of CD45, CD20, and CD3 (not shown). (F) Epstein-Barr virus-encoded RNA (EBER) in situ hybridization highlighting malignant cells (400x, original magnification).
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case_images: Hodgkin lymphoma with a complex karyotype (Figure 2). Her IPS was 4, predicting a 5-year rate of freedom from progression of 51% and an OS rate of 61%.
case_images: Abdominal imaging shows response during and after treatment with sequential BV-AVD. Baseline CT abdomen and pelvis showing hepatosplenomegaly which improved during interim and end of treatment PET/CT scans. Interim PET/CT showed a Deauville score of 4 and end-of-treatment PET/CT showed a score of 1, confirming complete remission. Color scale for PET/CT scans denotes standardized uptake values (SUVs).
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case_images: Subsequent PET/CT scans showed that she eventually achieved complete remission (Figure 3), which has been sustained for 2 years.