828P - Clinical features and outcomes of neurologic paraneoplastic syndromes in Hodgkin lymphoma

Background

Neurologic paraneoplastic syndromes (NPS) due to Hodgkin lymphoma (HL) affect both the central nervous system (CNS) and peripheral nervous system (PNS) with wide-ranging manifestations, such as limbic encephalitis, cerebellar degeneration, and neuropathies. We summarize the clinical findings and outcomes of 23 patients with HL associated with NPS.

Methods

Medical charts of adult patients at Mayo Clinic were retrospectively analyzed based on common endpoints and clinical features. Clinical diagnosis of NPS was made utilizing established criteria by Graus et al (Neurol Neuroimmunol Neuroinflamm, 2021). Survival analysis was performed using Kaplan-Meier estimates.

Results

We analyzed 23 patients with HL with NPS seen at Mayo Clinic from 1995 to 2022. Baseline disease included 17 patients with classical HL and 6 patients with nodular lymphocyte-predominant HL. Median follow-up was 97.1 months (95% CI 66.3-150.3). Baseline demographics included mean age 40 years with 61% males and 87% Caucasian patients. CNS PS was seen in 17 patients. Death had occurred in 5 patients at the time of review, including 4 without PS resolution, although no patients died from PS. NPS was the presenting sign of HL relapse in 39% patients. Following HL treatment, PS relapse was observed in 2 of 5 patients with prior complete PS resolution, temporally linked to HL relapse. Median overall survival (mOS) in patients with no PS improvement was 38.4 months, whereas mOS could not be reached in patients with complete/partial PS resolution (p=0.043). All 6 patients without PS improvement had CNS syndromes, whereas 3 of 5 patients with complete PS resolution had PNS disease. Paraneoplastic antibodies (anti-Tr most common) were detected in 7 of 21 tested patients without mortality or relapse associations. All 5 patients who experienced complete resolution of PS exhibited HL remission.

Conclusions

In our series of 23 patients with HL and NPS, survival was significant higher in patients with complete PS resolution. Despite HL treatment, NPS may be irreversible due to cytoxic neuronal loss; thus, timely recognition of PS is essential in providing effective therapy, requiring oncologic treatment as shown in our series of patients who only achieved complete resolution of NPS with HL remission.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.