60-Year-Old Woman Achieves Positive Remission in Anaplastic Large Cell Lymphoma with Systemic Chemotherapy

Medical Case Study: This article is intended solely for educational and informational purposes. To protect patient privacy, certain personal details have been anonymized or modified while preserving clinical relevance.

Overview of the Clinical Journey

A 60-year-old female presented with unexplained generalized lymphadenopathy—swollen lymph nodes in the neck, supraclavicular region, axillae, and inguinal areas—without prior infections, fever, night sweats, or unintentional weight loss. Initial imaging revealed significant cortical thickening and disrupted medullary architecture within affected nodes. A definitive diagnosis of anaplastic large cell lymphoma (ALCL) was confirmed through lymph node biopsy, immunohistochemistry, and molecular testing. The patient underwent a tailored systemic chemotherapy regimen over four cycles, resulting in near-complete remission and stabilization of all clinical markers.

Patient Profile & Diagnostic Framework

Age & Gender: 60-year-old womanDiagnosis: Anaplastic Large Cell Lymphoma (ALK-positive subtype suspected)Hospital: Binzhou Central HospitalDate of Initial Consultation: December 2021Treatment Approach: Combination chemotherapy using Prednisolone Acetate Injection, Cyclophosphamide for Injection, Pirarubicin Hydrochloride for Injection, and Vincristine Sulfate for InjectionTreatment Duration: Four full cycles of chemotherapyOutcome: Complete regression of enlarged lymph nodes, controlled disease progression, and normalization of hematological and biochemical parameters

Initial Clinical Assessment

The patient first noticed widespread lymph node enlargement approximately one week before seeking medical attention. Physical examination revealed firm, non-tender, poorly mobile lymph nodes—some fused into conglomerates—in multiple anatomical regions including cervical, supraclavicular, axillary, and inguinal zones. Notably, there were no signs of recent upper respiratory infection, cough, chest discomfort, joint pain, or constitutional symptoms such as fever or nocturnal diaphoresis.

She had not initiated any self-medication at home. After preliminary evaluation at a local clinic, ultrasound imaging confirmed multifocal lymphadenopathy with marked cortical hyperplasia and partial loss of medullary structure, though no definitive diagnosis or treatment plan was established.

Upon referral to our center, we conducted a comprehensive workup including complete blood count, erythrocyte sedimentation rate (ESR), coagulation profile, liver and kidney function tests, and cross-sectional imaging via CT scans of the chest and abdomen. Based on physical findings and radiological evidence, lymphoma was strongly suspected. According to the Ann Arbor staging system, involvement on both sides of the diaphragm classified her condition as Stage III disease, warranting urgent histopathological confirmation.

Diagnostic Confirmation and Therapeutic Strategy

An excisional biopsy of a cervical lymph node was performed. Histopathology indicated reactive lymphoid hyperplasia with atypical features. Subsequent immunohistochemical staining revealed strong CD30 positivity—a hallmark marker—and aberrant expression patterns consistent with T-cell lineage, leading to a confirmed diagnosis of anaplastic large cell lymphoma. Molecular analysis further supported clonal T-cell receptor gene rearrangement, reinforcing the malignant nature of the process.

Following multidisciplinary review and assessment for comorbidities, the patient was deemed eligible for combination chemotherapy. She was admitted for her first cycle of treatment using a standard CHOP-like regimen: Prednisolone, Cyclophosphamide, Pirarubicin (an anthracycline analog), and Vincristine—all administered intravenously under close monitoring.

Chemotherapy Cycles and Response Monitoring

After the initial cycle, a noticeable reduction in lymph node size was observed clinically. Radiological follow-up after Cycle 2 showed continued shrinkage. During this phase, the patient developed mild peripheral neuropathy—likely attributable to vincristine neurotoxicity—which was managed conservatively with dose adjustment and supportive care.

Cycles 3 and 4 proceeded without major complications. Post-treatment CT imaging demonstrated near-complete response (CR), with resolution of previously enlarged nodal masses and restoration of normal tissue architecture in key regions. Laboratory results, including LDH levels and inflammatory markers, returned to baseline, indicating effective tumor burden reduction.

Long-Term Management and Recovery Guidance

With successful completion of therapy and sustained remission, the focus shifted toward recovery and long-term surveillance. Key recommendations include:

Physical Activity: Avoid high-intensity exercise such as running, steep hiking, or competitive swimming during early recovery. Prioritize rest and gradually reintroduce light activities like walking or gentle stretching.
Lifestyle Modifications: Abstain from tobacco and alcohol use. These substances can impair immune recovery and increase relapse risk.
Nutritional Support: Emphasize soft, easily digestible foods rich in high-quality protein—such as lean meats, eggs, dairy, legumes, and well-cooked vegetables. Avoid spicy, acidic, or coarse-textured foods that may irritate mucosal surfaces post-chemotherapy.
Self-Monitoring: Learn basic self-examination techniques to monitor superficial lymph nodes. Report any new swellings, persistent fatigue, or unexplained fevers promptly.
Follow-Up Schedule: Regular outpatient visits every 3–6 months for blood tests (CBC, CMP), ultrasound, and periodic CT scans to detect recurrence early.

Clinical Insights and Prognostic Outlook

Anaplastic large cell lymphoma often presents diagnostic challenges due to overlapping morphological features with Hodgkin's lymphoma and other T-cell malignancies. Accurate differentiation requires robust immunophenotyping—particularly CD30 expression, which is nearly universal in ALCL cases. Additional markers such as ALK (anaplastic lymphoma kinase) help determine prognosis, with ALK-positive patients generally exhibiting better outcomes.

In this case, the patient responded exceptionally well to frontline chemotherapy. Current data suggest that ALCL has a favorable prognosis when diagnosed early and treated appropriately, with overall five-year survival rates exceeding 70%. Individualized treatment planning—considering age, performance status, organ function, and genetic subtypes—is critical to optimizing therapeutic success and minimizing toxicity.

Early detection, precise diagnosis, and timely intervention remain pivotal in improving long-term outcomes for patients with aggressive lymphomas. This case underscores the importance of thorough clinical investigation and coordinated oncology care in achieving durable remissions.