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LEARNING OBJECTIVES

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.

PATIENT PRESENTATION

Chief Complaint

“I have been having night sweats, fever, and weight loss despite health eating. I have also been a lot more tired lately. My neck has been swollen and I have a growth on my neck that has gotten bigger over the past month.”

HPI

Mike McCaffrey is a 27-year-old man who presents to an outpatient medical oncology clinic with a 1-month history of night sweats, fever, fatigue, and a 9-kg weight loss. He noticed weight loss because he has been watching his weight while training for an upcoming 2-week climbing trip. His wife also noticed neck swelling and a neck mass that has gotten progressively larger over the past month. He initially associated the mass with a strep throat infection and went to see his primary care provider 5 weeks ago. He was started on a 10-day course of antibiotics, but the mass did not resolve. One week ago, his primary care provider scheduled an ultrasound of the neck due to persistent and worsening symptoms. At this visit, enlarged right and left supraclavicular lymph nodes were palpated on physical exam. The ultrasound of the neck showed a cervical lymph node that measured approximately 11 cm in diameter. As a result, an excisional lymph node biopsy was performed that day, which demonstrated classic HL, nodular sclerosing (NS) subtype.

PMH

Epstein-Barr virus as a teenager

FH

The patient’s mother, father, and two siblings (brother and sister) are all in good health. Paternal grandfather died of lung cancer.

SH

Works as structural engineer. Is a rock climber and is training for a 2-week climbing trip. Drinks socially, about three to four beers per week. He has never smoked. He does not use illicit drugs. The patient is married and wishes to start a family in the next 2 years.

Meds

Ibuprofen 400 mg PO Q 4–6 H PRN pain/fever

All

NKDA

ROS

(+) For fevers, night sweats, fatigue, and weight loss ...

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