Preprint Case Report Version 1 Preserved in Portico This version is not peer-reviewed

Intracranial Manifestation in Classical Hodgkin’s Lymphoma, Case Series and Review of the Literature

Version 1 : Received: 16 April 2024 / Approved: 16 April 2024 / Online: 16 April 2024 (14:00:25 CEST)

How to cite: Singh, K. B.; Muthyala, K.; Pierotti, D.; Martin, B.; Morrison, E.; Pearson, M.; Alkharabsheh, O. Intracranial Manifestation in Classical Hodgkin’s Lymphoma, Case Series and Review of the Literature. Preprints 2024, 2024041067. https://doi.org/10.20944/preprints202404.1067.v1 Singh, K. B.; Muthyala, K.; Pierotti, D.; Martin, B.; Morrison, E.; Pearson, M.; Alkharabsheh, O. Intracranial Manifestation in Classical Hodgkin’s Lymphoma, Case Series and Review of the Literature. Preprints 2024, 2024041067. https://doi.org/10.20944/preprints202404.1067.v1

Abstract

Background: Classical Hodgkin's lymphoma (cHL) is a lymph node disease, however, extranodal involvement is present in about 10% of affected individuals. Various forms of direct central nervous system (CNS) involvement have been reported, including intracranial, epidural, leptomeningeal, and intramedullary spinal cord cHL (Table 1). We hereby describe the clinical presentation, work up, and outcomes of two distinctive cases of cHL with intracranial extra-axial spread in patients receiving novel combination and traditional chemotherapy. Methods: This case series (n=2) was conducted following the CARE guidelines. Institutional review board (IRB) approved protocol #24-015 for HIPPA waiver of subjects in our retrospective study. Results: Patients with cHL exhibiting CNS symptoms or relapse refractory cases benefit from neuroimaging and excluding infectious etiologies. Suspicious lesions include iso- to hypointensity on T1 weighted and iso- to hyperintensity on T2 MR scans. Diagnosis is confirmed with biopsy. Treatment with A-AVD has shown more benefit than traditional ABVD chemotherapy. There has been shown progression free survival with nivolumab-AVD (N-AVD) over brentuximab-AVD (B-AVD). Conclusion: cHL with CNS involvement is rare and requires comprehensive workup to exclude infectious and other malignancies. Diagnosis relies on neuroimaging and subsequent brain biopsy. Treatment with novel N-AVD has shown greater PFS in patients with advanced cHL.

Keywords

Central nervous system (CNS) 1, intracranial lesion 2, Hodgkin lymphoma 3, relapse 4, refractory 5, neuroimaging 6, ring enhancing 7, immunotherapy 8, chemotherapy 9

Subject

Medicine and Pharmacology, Oncology and Oncogenics

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