Association of Hodgkin Lymphoma and Non-Hodgkin Lymphoma In the Same Patient. Clinicopathologic Characteristics and Outcome In a Series of 20 Cases
Authors: Fogazzi Stefano , Tucci Alessandra , Bottelli Chiara , Ungari Marco , Facchetti Fabio , Rossi Giuseppe 
Published: October 2019

Abstract
Abstract 3886
The possibility that a non-Hodgkin lymphoma (NHL) is diagnosed either simultaneously or at a different time in patients with Hodgkin lymphoma (HL) has been reported both as single case reports and in small series. However the significance of such an association is still unclear. We searched the database of HL consecutively diagnosed at our Institution in order to identify such cases and to detect any specific clinicopathological or prognostic characteristics. Twenty cases were retrieved representing to our knowledge the largest series reported so far. Fifteen of them were diagnosed over the last ten years and represented 4,6% of the 326 cases of HL diagnosed during the same time period. There were 12 males and 8 females. Median age was 58. It was lower in patients developing HL as the first lymphoma (35 vs 65). HL was diagnosed first in 7 cases and as the second lymphoma in 9 cases. The mean interval between the two diagnoses was longer when HL occurred first (112 vs 60 months). In four patients the two diagnoses were made simultaneously, on the same histologic specimen in two. Histologic diagnoses of NHL included diffuse large B cell in 6, T cell lymphoma in 4 (peripheral unspecified 2, cutaneous 2), follicular in 3, marginal in 3 and lymphocytic in 4 cases each. T cell, marginal and lymphocytic lymphoma were overrepresented in comparison with their general frequency among NHL. No differences emerged regarding the timing of NHL occurrence, except for lymphocytic lymphoma which never occurred after HL. Nodular sclerosis was the most frequent histologic subtype of HL, representing 58% of cases, whereas only two cases (10%) were nodular lymphocyte predominance HL (NLPHL). Immunohistochemistry on Reed Sternberg cells of HL classical type showed CD30+ in 16 (100%) and CD15+ in 10 (63%) of 16 evaluable cases. CD20+ was present in 3/14 classical HL (21%) and in the 2 cases of NLPHL. Clinical presentation of HL was more aggressive than expected with no patient in stage I, 60% of patients in advanced stage (stage II: 8, stage III: 6; stage IV: 6) and 50% with systemic symptoms. There were no differences between cases presenting as first or second lymphoma. Among NHL 15 cases presented in stage III/IV and 6 with systemic symptoms. In seven cases autoimmune abnormalities/disease coexisted, including Raynaud, thyroiditis, cutaneous lupus, and vasculitis. HL patients were treated with ABVD in 11 cases, or with other chemotherapy programs +/− radiotherapy. NHL received treatments according to histology. In composite lymphoma treatment was directed against the more aggressive lymphoma. In spite of the unfavourable presentation, the complete response rate (CRR) in HL was 74% and the overall response rate (ORR) 79%. It was worse (5/8: 63%) when HL presented after NHL. In NHL the CRR was 63% and the ORR 95%. Relapse occurred in 2 HL, in one composite lymphoma (HL+FL > DLBCL) and in 5 NHL. Seven patients died, with active disease in 6 (2 HL, 4 NHL). One patient died of lung cancer. With a median follow up of 6 years, the 5-year and 10-year survival are 83,5% +/−9% and 68%+/−12%, respectively. We conclude that the occurrence of HL and NHL in the same patient is not rare. T-cell, marginal and lymphocytic lymphoma seem to be more frequently associated with HL. Pathologic and immunohistochemical characteristics are otherwise not distinctive. Patients present with advanced disease and systemic symptoms but their response to treatment and overall prognosis seem not worse than that of patients affected by HL as single tumour. The selective association between some histologic types of NHL and HL as well as the possible association with autoimmunity warrants further investigation.

Disclosures:
No relevant conflicts of interest to declare.