Hodgkin's disease coexisting with myelodysplastic syndrome prior to therapy: a case report and a review of the association of Hodgkin's disease with stem cell disorders.

The myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) are well-documented complications secondary to chemotherapy and radiation therapy for Hodgkin's disease (HD). The coexistence of primary MDS with HD prior to therapy is an extremely rare event which has been reported only once in the English literature. This is the second case of such combination. Both patients with MDS developed AML only 7 months after diagnosis and both died shortly after the initiation of treatment. Since these cases raise the possibility of a stem cell association with HD, we reviewed the literature for other stem cell disorders with similar association with HD prior to aggressive therapy. Four cases of stem cell disorders other than MDS were reported. These included two cases of aplastic anemia, one case of myeloid metaplasia with myelofibrosis, and one of polycythemia vera. Two of the four patients died, one of AML and the other of thrombocytopenia-related cerebral hemorrhage. The association between HD and stem cell disorders, although rare, may need to be investigated further.