Lymphocyte Depleted Hodgkin’s Lymphoma Presented with Haemolytic Anemia: A Case Report and Literature Review

Abstract

Hodgkin's lymphoma accounts for ten per cent of all lymphomas. Lymphomas represent the third most frequent neoplasia on a worldwide scale and constitute 3 % of malignant tumors. In the United States, there are about 8,000 new cases every year. This case report describes a case of lymphocyte-depletion Hodgkin's lymphoma (LDHL) manifested by anemia. LDHL is the least common of the types of Hodgkin's disease, comprising less than 1 % of all cases of this cancer. A 19-year-old Indian male presented with complaint of huge asymptomatic swelling in the right lateral part of neck since 8 months. All the lymph nodes of the right side submandibular, submental, cervical and axillary lymph nodes were rubbery in consistency, tender and were palpable. The CBC revealed hemoglobin of 7.4 gm/dL and ESR count was highly raised up to 125 mm/first hour. Direct Coomb's test detected multiple antibodies IgG type, which was consistent with the diagnosis of Haemolytic anemia. Ultrasonography of the neck showed enlarged discrete lymph nodes on the right side of the neck. For further evaluation patient was subject for ultrasonography of the abdomen which revealed there was of enlargement of both spleen and liver. Lymph node FNAC revealed classic LDHL. Anemia and swelling resolved after completion of chemotherapy with adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) after 6 cycles. The literature review and our case report discuss the optimal management of this Hodgkin's lymphoma. To our knowledge, this is the first case of LDHL with Haemolytic Anemia treated with only ABVD regime.

Autoimmune Cytopenias in Children with Hodgkin’s Lymphoma

“…Mixed cellularity and nodular sclerosis subtypes of HL are reported as the most frequent subtypes in patients with AIHA whereas autoimmune thrombocytopenia is observed with all histologic subtypes both with limited and extensive disease [2,6,9]. In our patients, the subtypes were mixed cellularity in one patient with immune thrombocytopenia and nodular sclerosis with AIHA in another case.…”

“…Immune neutropenia, AIHA and ITP were reported in patients with HL [1][2][3]. Some researchers suggest that AIC are likely autoimmune paraneoplastic syndromes of the patients with HL [4,6,7]. Paraneoplastic autoimmune syndromes may be observed preceding lymphoma and/or concomitantly with diagnosis.…”

“…Paraneoplastic autoimmune syndromes may be observed preceding lymphoma and/or concomitantly with diagnosis. It is also possible to say that they may be seen after treatment as a sign of relapse [5,6]. The sporadic case reports and reviews showed that HL with autoimmune cytopenia is more commonly seen in males and is more likely to have mixed cellularity and nodular sclerosis histopathology [6,7].…”

“…It is also possible to say that they may be seen after treatment as a sign of relapse [5,6]. The sporadic case reports and reviews showed that HL with autoimmune cytopenia is more commonly seen in males and is more likely to have mixed cellularity and nodular sclerosis histopathology [6,7]. Herein three patients associated with immune thrombocytopenia and/or immune hemolytic anemia which were published separately, are evaluated together.…”

<p>Abdominal Lymphocyte-Depleted Hodgkin Lymphoma: A Rare Presentation</p>

“…One of the frequently raised questions is whether LDcHL should be treated more aggressively with dose-intensive chemotherapy. The literature suggest that six cycles of chemotherapy consisting of doxorubicin (Adriamycin), bleomycin, vinblastine and dacarbazine (ABVD) is the appropriate standard regimen and involved field radiotherapy (IFRT) with an intermediate dosage (25–40 Gy) targeting the Waldeyer’s ring and cervical lymph nodes should be the first line of treatment for patients with HL 8. Some authors conclude that chemotherapy alone with ABVD without radiotherapy can be an option in the treatment of non-bulky Hodgkin disease 9…”