患有经典霍奇金淋巴瘤(cHL)等具有挑战性的血液恶性肿瘤的患者在受到并发冠状病毒病-2019(COVID-19)感染的影响时会变得更加复杂,并且经常面临独特而复杂的管理和结果。在这个案例报告中,我们描述了1例难治性或复发性经典霍奇金淋巴瘤患者,在化疗前3次复发COVID-19感染.一名52岁的女性因第二次COVID-19和发烧而出现在我们医院,厌食症,盗汗,和腹部淋巴结肿大,为此,她被诊断出患有混合细胞性经典霍奇金淋巴瘤。三周后,考虑到她肺部疾病的表现,这是由于她过去的气道超敏反应和肺功能异常检查史以及COVID-19检测呈阳性,她开始接受伦图昔单抗vedotin的一线化疗,阿霉素,长春碱,和达卡巴嗪化疗方案,通常称为Bv-AVD,没有博来霉素。经过六个周期的化疗,在治疗结束时,正电子发射断层扫描/计算机断层扫描(PET/CT)显示腹部淋巴结的进展以及胸部和右锁骨上区域新的淋巴结病的发展。因此,被认为是难治性霍奇金淋巴瘤,患者被转介接受抢救治疗。她开始接受苯妥昔单抗/苯达莫司汀(BvB)的抢救化疗。BvB两个周期后的随访评估继续显示右侧膈下区域有较新的病变,内部乳腺,锁骨上淋巴结.因此,患者改用pembrolizumab免疫治疗,PD-1抑制剂。经过四个周期的pembrolizumab单药治疗,PET/CT显示出完全分子反应(CMR)的显着改善。然后,她在收集干细胞后接受大剂量治疗/自体干细胞移植(HDT/ASCT).PET/CT:ASCT后三个月,她继续在多维尔得分为1的CMR中。之后,患者继续接受pembrolizumab维持治疗六个月。目前,病人健康,做得很好。患有血液系统恶性肿瘤的COVID-19患者可能会经历病毒消除受损和长时间的病毒感染,这也可能使症状和结果恶化,并使他们有权获得全面和长期的护理。
Patients with challenging hematological malignancies like classic Hodgkin lymphoma (cHL) can be further complicated when affected by a concurrent coronavirus disease-2019 (COVID-19) infection and often face unique and complex management and outcomes. In this
case report, we describe a refractory or relapsed classic Hodgkin lymphoma patient with a recurrent infection of COVID-19 three times preceding chemotherapy. A 52-year-old female presented to our hospital with a second incidence of COVID-19 and a complaint of fever, anorexia, night sweats, and abdominal lymphadenopathy, for which she was diagnosed with mixed cellularity classic Hodgkin lymphoma. Three weeks later, in consideration of her manifestation of lung disease, which was due to her past medical history of airway hypersensitivity and abnormal pulmonary function test along with testing positive for COVID-19, she was started with the first-line chemotherapy of the brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine chemotherapy regimen, commonly referred to as Bv-AVD, without bleomycin. After six cycles of chemotherapy, at the end of treatment, positron emission tomography/computed tomography (PET/CT) revealed the progression of nodes in the abdomen and the development of new lymphadenopathy in the chest and right supraclavicular region. Hence, it was considered refractory Hodgkin\'s lymphoma, and the patient was referred for salvage therapy. She was started on salvage chemotherapy with brentuximab/bendamustine (BvB). Follow-up evaluations after two cycles of BvB continued to show newer lesions in the right sub-diaphragmatic area, internal mammary, and supraclavicular lymph nodes. Therefore, the patient was switched to pembrolizumab immunotherapy, a PD-1 inhibitor. After four cycles of pembrolizumab monotherapy, PET/CT showed significant improvement with a complete molecular response (CMR). Then, she was admitted for high-dose therapy/autologous stem cell transplantation (HDT/ASCT) after collecting stem cells. PET/CT: three months post-ASCT, she continued to be in a CMR with a Deauville score of 1. The patient was continued on pembrolizumab maintenance for six months afterward. Currently, the patient is healthy and doing well. COVID-19 patients with hematological malignancies may experience compromised viral elimination and a prolonged period of viral infection, which may also worsen the symptoms and outcomes and entitle them to comprehensive and extended care.