Sequential Intravascular Large B-Cell Lymphoma Followed by Classic Hodgkin Lymphoma After Autologous Stem Cell Transplantation: A Diagnostic and Therapeutic Challenge
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Intravascular large B-cell lymphoma (IVLBCL) is a rare and aggressive subtype of diffuse large B-cell lymphoma characterized by selective growth of neoplastic B cells within the lumina of small blood vessels. Secondary development of a distinct lymphoid neoplasm following IVLBCL is exceedingly uncommon. We report the case of a 79-year-old woman with a history of intravascular large B-cell lymphoma treated with R-CHOEP followed by autologous stem cell transplantation (auto-SCT) using BEAM conditioning, who subsequently developed biopsy-proven classic Hodgkin lymphoma (cHL) nearly six years after her initial diagnosis. The case highlights the diagnostic complexity of relapsed lymphadenopathy in patients with prior aggressive B-cell lymphoma and underscores therapeutic considerations in elderly patients with extensive prior therapy. This report adds to the limited literature on sequential lymphoid neoplasms and raises important questions regarding clonal evolution, therapy-related immune dysregulation, and optimal management strategies.
