Hughes Caren L, Yorio Jeffrey T, Kovitz Craig, Oki Yasuhiro
Division of Pharmacy, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
J Med Case Rep. 2014 Dec 21;8:455. doi: 10.1186/1752-1947-8-455.
Guillain-Barre syndrome, or acute inflammatory demyelinating polyneuropathy, has been described in the presence of malignancies such as lymphoma. Guillain-Barre syndrome/acute inflammatory demyelinating polyneuropathy causes paresthesias and weakness, which can make the treatment of lymphoma with chemotherapy challenging. Given the rarity of this co-presentation it is not known if the effects of Guillain-Barre syndrome should be considered when selecting a treatment regimen for Hodgkin lymphoma. To the best of our knowledge, the impact of these treatment modifications has not been previously reported.
We report the case of a 37-year-old Caucasian man with a diagnosis of stage IIB classical Hodgkin lymphoma with concomitant Guillain-Barre syndrome. Our patient originally presented with an enlarged cervical lymph node and quickly developed distal paresthesia and progressive weakness of all four extremities. He was diagnosed with Hodgkin's lymphoma and initiated on treatment with doxorubicin, bleomycin, vinblastine, and dacarbazine. Doses of bleomycin and vinblastine were held or dose-reduced throughout his initial treatment course due to underlying neuropathy and dyspnea. He continued to have persistent disease after five cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine and went on to receive salvage treatments including more chemotherapy, radiation, autologous stem cell transplant and is currently preparing for an allogeneic stem cell transplant.
Paraneoplastic syndromes such as Guillain-Barre syndrome/acute inflammatory demyelinating polyneuropathy can make the treatment of patients with Hodgkin lymphoma more challenging and can interfere with delivering full-dose chemotherapy. Further case series are needed to evaluate the effect that paraneoplastic syndromes, or adjustments made in therapy due to these syndromes, negatively affect the prognosis of patients with Hodgkin lymphoma.
格林-巴利综合征，即急性炎症性脱髓鞘性多发性神经病，已在淋巴瘤等恶性肿瘤患者中被描述。格林-巴利综合征/急性炎症性脱髓鞘性多发性神经病会导致感觉异常和肌无力，这可能使淋巴瘤的化疗治疗具有挑战性。鉴于这种共同表现的罕见性，在为霍奇金淋巴瘤选择治疗方案时是否应考虑格林-巴利综合征的影响尚不清楚。据我们所知，此前尚未报道过这些治疗调整的影响。
我们报告了一例37岁的白种男性患者，诊断为IIB期经典型霍奇金淋巴瘤，同时患有格林-巴利综合征。我们的患者最初表现为颈部淋巴结肿大，并迅速出现远端感觉异常和四肢进行性无力。他被诊断为霍奇金淋巴瘤，并开始接受多柔比星、博来霉素、长春碱和达卡巴嗪治疗。由于潜在的神经病变和呼吸困难，在他的初始治疗过程中，博来霉素和长春碱的剂量一直维持或降低。在接受了五个周期的多柔比星、博来霉素、长春碱和达卡巴嗪治疗后，他仍有持续性疾病，随后接受了挽救性治疗，包括更多的化疗、放疗、自体干细胞移植，目前正在准备进行异基因干细胞移植。
格林-巴利综合征/急性炎症性脱髓鞘性多发性神经病等副肿瘤综合征会使霍奇金淋巴瘤患者的治疗更具挑战性，并可能干扰全剂量化疗的实施。需要更多的病例系列来评估副肿瘤综合征或因这些综合征而进行的治疗调整对霍奇金淋巴瘤患者预后的负面影响。
