After completing this case study, the reader should be able to:
Recognize the signs and symptoms commonly associated with Hodgkin lymphoma (HL).
Discuss the pharmacotherapeutic treatment of choice and the alternatives available for treating HL.
Identify acute and chronic toxicities associated with the medications used to treat HL and the measures used to prevent, treat, and monitor these toxicities.
Determine monitoring parameters for response and toxicity in patients with HL.
Formulate appropriate educational information to provide to a patient receiving chemotherapy treatment for HL.
“I have been having night sweats, fever, and have been a lot more tired lately. I also have a growth on my chest that has gotten bigger over the past few weeks.”
Mike McCaffrey is a 27-year-old man who presents with a 1-month history of night sweats, fever, fatigue, and a 9-kg weight loss. He was previously working in finance but desired a career change and has been training for his interview and physical fitness test to join the local fire station. He served as a volunteer firefighter in college and missed that line of work. He denies any shortness of breath, and first attributed his fatigue to increased exercise. His wife also noticed a mass on his chest that has gotten progressively larger over the past 2 weeks. He initially associated the mass with an “elbow to the chest” he received during a recreation league basketball game. An ultrasound of the mediastinum showed a lymph node that measured approximately 11 cm. On physical exam, enlarged supraclavicular lymph nodes were noted on both the right and left. As a result, an excisional lymph node biopsy was performed that demonstrated classical HL, nodular sclerosing (NS) subtype.
The patient’s parents and one sibling (brother, also a firefighter) are all in good health. Paternal grandfather died of colon cancer.
Worked in finance, now training to join the local fire squadron. Drinks socially, about 2 beers per week. He has never smoked. He does not use illicit drugs. The patient is married and wishes to start a family.
Ibuprofen 400 mg PO Q 4–6 H PRN pain/fever
(+) For fevers, night sweats, fatigue and weight loss of approximately 9 kg over the past month.
(–) For vision changes, headaches, shortness of breath, chest pain, nausea, vomiting, diarrhea, constipation, or urinary symptoms. Denies feeling depressed or having loss of pleasure with activities. His performance status is 1 on the ECOG scale.