Treatment decisions in a man with Hodgkin lymphoma and Guillian-Barré syndrome: a case report

Journal of Medical Case Reports

Yasuhiro Oki¹  Craig Kovitz¹  Jeffrey T Yorio¹  Caren L Hughes² 

[1] Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA;Division of Pharmacy, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA

关键词: Paraneoplastic;    Chemotherapy;    Hodgkin lymphoma;    Guillian-Barre;   

Others  :  1180868
DOI  :  10.1186/1752-1947-8-455

 received in 2014-09-03, accepted in 2014-11-18,  发布年份 2014

【 摘 要 】

Introduction

Guillain-Barre syndrome, or acute inflammatory demyelinating polyneuropathy, has been described in the presence of malignancies such as lymphoma. Guillain-Barre syndrome/acute inflammatory demyelinating polyneuropathy causes paresthesias and weakness, which can make the treatment of lymphoma with chemotherapy challenging. Given the rarity of this co-presentation it is not known if the effects of Guillain-Barre syndrome should be considered when selecting a treatment regimen for Hodgkin lymphoma. To the best of our knowledge, the impact of these treatment modifications has not been previously reported.

Case presentation

We report the case of a 37-year-old Caucasian man with a diagnosis of stage IIB classical Hodgkin lymphoma with concomitant Guillain-Barre syndrome. Our patient originally presented with an enlarged cervical lymph node and quickly developed distal paresthesia and progressive weakness of all four extremities. He was diagnosed with Hodgkin’s lymphoma and initiated on treatment with doxorubicin, bleomycin, vinblastine, and dacarbazine. Doses of bleomycin and vinblastine were held or dose-reduced throughout his initial treatment course due to underlying neuropathy and dyspnea. He continued to have persistent disease after five cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine and went on to receive salvage treatments including more chemotherapy, radiation, autologous stem cell transplant and is currently preparing for an allogeneic stem cell transplant.

Conclusions

Paraneoplastic syndromes such as Guillain-Barre syndrome/acute inflammatory demyelinating polyneuropathy can make the treatment of patients with Hodgkin lymphoma more challenging and can interfere with delivering full-dose chemotherapy. Further case series are needed to evaluate the effect that paraneoplastic syndromes, or adjustments made in therapy due to these syndromes, negatively affect the prognosis of patients with Hodgkin lymphoma.

【 授权许可】

   
2014 Hughes et al.; licensee BioMed Central.

【 参考文献 】

• [1]Darnell RB, Posner JB: Paraneoplastic syndromes involving the nervous system. N Engl J Med 2003, 349:1543-1554.
• [2]Hagler KT, Lynch JW Jr: Paraneoplastic manifestations of lymphoma. Clin Lymphoma 2004, 5:29-36.
• [3]Yuki N, Hartung HP: Guillain-Barre syndrome. N Engl J Med 2012, 366:2294-2304.
• [4]Amundson DE, Goodman JC: Hodgkin’s disease in association with Guillain-Barre-Strohl syndrome: case report. Mil Med 1983, 148:512-513.
• [5]Cuttner J, Meyer R: Guillain-Barre syndrome in a patient with Hodgkin’s disease. Mt Sinai J Med 1978, 45:415-417.
• [6]Julien J, Vital C, Aupy G, Lagueny A, Darriet D, Brechenmacher C: Guillain-Barre syndrome and Hodgkin’s disease–ultrastructural study of a peripheral nerve. J Neurol Sci 1980, 45:23-27.
• [7]Lisak RP, Mitchell M, Zweiman B, Orrechio E, Asbury AK: Guillain-Barre syndrome and Hodgkin’s disease: three cases with immunological studies. Ann Neurol 1977, 1:72-78.
• [8]Maslovsky I, Volchek L, Blumental R, Ducach A, Lugassy G: Persistent paraneoplastic neurologic syndrome after successful therapy of Hodgkin’s disease. Eur J Haematol 2001, 66:63-65.
• [9]Polo-Romero FJ, Sanchez-Beteta P, Perona-Buendia P, Perez-Garcia AM: Guillain-Barre syndrome as first presentation of non-Hodgkin lymphoma. Neurologia 2012, 27:511-513.
• [10]Seffo F, Daw HA: Non-Hodgkin lymphoma and Guillain-Barre syndrome: a rare association. Clin Adv Hematol Oncol 2010, 8:201-203.
• [11]Ehrenfeld M, Abu-Shakra M, Buskila D, Shoenfeld Y: The dual association between lymphoma and autoimmunity. Blood Cells Mol Dis 2001, 27:750-756.
• [12]Kelly JJ, Karcher DS: Lymphoma and peripheral neuropathy: a clinical review. Muscle Nerve 2005, 31:301-313.
• [13]Connors JM: Clinical manifestations and natural history of Hodgkin’s lymphoma. Cancer J 2009, 15:124-128.
• [14]Chabner BA, Longo DL (Eds): Cancer Chemotherapy: Principles and Practices. 4th edition. Philadelphia, PA: Lippincott Williams and Wilkins; 2006.
• [15]Toft CE: Guillian-Barre syndrome–a case study. Accid Emerg Nurs 2002, 10:92-102.