Double Dilemma: Managing a Sequential Lymphoma (Case Report)

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Introduction: Sequential lymphoma, characterized by the occurrence of two distinct lymphoma subtypes in tandem within the same patient, presents a unique challenge in diagnosis and management. While transformation from Nodular Lymphocyte-Predominant Hodgkin Lymphoma (NLPHL) to aggressive B-cell lymphomas is well-documented, sequential development of Diffuse Large B-Cell Lymphoma (DLBCL) following Classical Hodgkin Lymphoma (cHL) is exceedingly uncommon, presenting primarily the challenge of cumulative toxicities faced due to different regimens. Case Report: We present a case of a 25-year-old man initially diagnosed with classical Hodgkin lymphoma (CHL) who subsequently developed diffuse large B-cell lymphoma (DLBCL), following his initial metabolic response to ABVD chemotherapy. Following treatment, he presented disease progression, presenting with a hepatic lesion with diagnosis of CD20 DLBCL, confirming the diagnosis of sequential lymphoma Management and Outcomes: Due to patients receiving higher cumulative doses of anthracycline therapy, it prompted the decision to consider R-ICE regimen over the traditional R-CHOP regimen primarily due to the risk of increased cardiotoxicity. Better tolerance to the regimen was reported by the patient on the completion of 6 cycles , achieving a complete metabolic response on end-of-treatment PET scan. Discussion: This case highlights a critical dilemma in managing sequential lymphomas: balancing efficacy against long-term toxicity. The choice of R-ICE over R-CHOP underscores the importance of individualized therapy to mitigate anthracycline-induced cardiotoxicity in young patients. This report adds to the sparse data on this condition and emphasizes the need for consensus guidelines to optimize outcomes in these complex cases.

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