How do you manage patients with primary refractory Hodgkin lymphoma?

Without advising directly on this particular case, which is difficult to do without more information, a few principles in lymphoma management may be helpful:

1. Whenever there is discordance in the clinical picture, or whenever initial management would be drastically changed, it is always prudent to perform a biopsy to confirm what you suspect. It is typically less important which site you biopsy, though in general you want to target a lesion that has both an anatomical and PET correlate.

2. PET-CT imaging is imperfect. Beware of making clinical decisions solely on the results of imaging. While PET-CT is a sensitive modality, the specificity is less dependable.

3. If lymphoma is progressing through systemic therapy (e.g., new sites of disea...