SARS‐CoV‐2‐induced remission of Hodgkin lymphoma

SARS‐CoV‐2‐induced remission of Hodgkin lymphoma

A 61‐year‐old man was referred to the haematology department with progressive lymphadenopathy and weight loss. He was receiving haemodialysis for end‐stage renal failure secondary to IgA nephropathy. He had been off immunosuppressive therapy for three years after a failed renal transplant. Needle‐core biopsy of a supraclavicular node demonstrated Epstein–Barr virus (EBV)‐positive classical Hodgkin lymphoma [EBV viral polymerase chain reaction (PCR) 4800 copies/ml; log10 3·68]. Fluorodeoxyglucose‐positron emission tomography/computed tomography (FDG‐PET/CT) revealed avid stage IIIs disease (left image, PET scan, and supplementary image PET/CT). Shortly after diagnosis he was admitted with breathlessness and wheeze and was diagnosed with PCR‐positive SARS‐CoV‐2 pneumonia. After 11 days of best supportive ward‐based care he was discharged to convalesce at home. No corticosteroid or immunochemotherapy was administered.

Four months later, palpable lymphadenopathy had reduced and an interim PET/CT scan revealed widespread resolution of the lymphadenopathy and reduced metabolic uptake throughout (right image and supplementary image). The EBV viral PCR had also fallen to 413 copies/ml (log10 2·62).

We hypothesise that the SARS‐CoV‐2 infection triggered an anti‐tumour immune response, as has been described with other infections in the context of high‐grade non‐Hodgkin lymphoma.1 The putative mechanisms of action include cross‐reactivity of pathogen‐specific T cells with tumour antigens and natural killer cell activation by inflammatory cytokines produced in response to infection.