How I Treat How I treat advanced classical Hodgkin lymphoma

A 45-year-old man presented with progressively increasing breathlessness, a dry cough, drenching night sweats, and significant weight loss. Physical examination identified enlarged lymph nodes in both sides of the neck and both supraclavicular fossae. A chest radiograph showed widening of the mediastinum, which a computed tomographic (CT) scan confirmed as being the result of lymph nodes of maximum diameter 12 cm, accompanied by small pleural effusions, enlarged aortocaval nodes, and a focal defect in the spleen. Hemoglobin was 114 g/L, total white cell count was 9.23 10/L, lymphocyte count was 1.0 3 10/L, erythrocyte sedimentation rate was 48 mm/h, albumin was 31 g/L, andb2-microglobulinwas 3.1mg/L. A biopsy from one of the cervical nodes demonstrated grade 2 nodular sclerosing Hodgkin lymphoma. An FDG-PET scan (Figure 1A) demonstrated increased uptake in bilateral cervical, supraclavicular, mediastinal, subcarinal, paraesophageal, paraaortic and aortocaval nodes, as well as a focus of uptake in the left iliac bone, which had not been noted on the CT scan.