Transformation of Hodgkin's disease to high-grade B-cell lymphoma: remission after Rituximab monotherapy.

Purpose:We demonstrate the usefulness of immunotherapy with theCD20 antibody Rituximab in a case of transformation of Hodgkins disease(HD) to high-grade non-Hodgkins lymphoma (NHL).Case report:A 45-year-old women suffering from lymphocytepredominant HD of paragranuloma type (stage IVb) since 1995 showed mediastinalrelapse despite of 6 cycles of chemotherapy following the COPP/ABVD-protocolin 1998. Again complete remission could be achieved after escalated BEA-COPPII therapy in May 1998. Six months later chest radiograph and CT depictedpulmonary nodules. The non-typical resection of the lung revealed pulmonaryinvolvement of a high-grade T-cell rich large B-cell lymphoma with 100%of the tumoral cells CD20 positive. Since the symptoms occurred shortly afterthe BEA-COPP-escalated protocol chemotherapy resistance had to be assumed.Because of this problems and supported by the refusal of a high-dosechemotherapy with stem-cell transplantation by the patient we decided toperform a mono-immunotherapy with the monoclonal CD20 antibody Rituximab.Today, 14 months later, the patient is still in complete remission includingthe absence of B symptoms.Conclusions:Immunotherapy against CD20 positive cells in casesof sequential HD and NHL seems to be an effective therapy in chemotherapyresistant cases because of the suspected clonally relation of bothdiseases.