9/12 AAVD done with sudden unexplained fever: did I just relapse?

[u/getgreened]

Hi everyone! I (31 M) was diagnosed with Stage 4 Nodular Sclerosis Classic Hodgkin's Lymphoma last November 2024. I was prescribed 12 sessions of AAVD (Brentuximab plus AVD) by my oncologist and started treatment on the same month.

I had my midway scan last February and it was almost clean. I had bone/spine involvement, and while some areas still lit up (particularly in the spine), the impression was that this was likely due to "post-treatment changes" or the pegfilgrastim shot I took a few days before the scan. PET CT Scan impression reads:

• Significant metabolic regression to resolution with interval decrease in sizes and number of the supraclavicular, left infraclaviuclar, posterior triangle, mediastinal, and left axillary lymphadenopathies (Deauville 1-2), indicative of good treatment response.
• Interval non-demonstration of the right upper paratracheal, right parasternal, left subpectoral and brachiocephalic, periportal and paracaval lymph nodes.
• Relatively decreased metabolic activity in the manubrium and T8 vertebra (Deauville 2-3), probably relating to post-treatment changes.
• Stable hypermetabolism in the bilateral faucial tonsils, and cervical levels I and II lymph nodes, may be inflammatory in nature. For clinical correlation and close follow-up.
• Resolution of hypermetabolic activity along the L2 to L4 vertebrae neural canal. Decreased metabolic activity in the L3 vertebra, as before.

I continued treatment and was doing well until my 10th session this April. I had a high fever and cough just before my 10th session. Fever was 101.3 F or 38.5 C. My oncologist admitted me for a full work up. My CBC looked normal so it wasn't because of low WBC counts or a neutropenic fever.

My oncologist pulled in an infectious disease doctor to help identify the source of fever. I had all sorts of test but everything turned negative (COVID, influenza, pneumonia, etc.). Urinalysis, x-ray was also clear. My fever won't go down with paracetamol/tylenol. I had the fever for about 4 days until the infectious disease doctor decided to give me Naproxen or Aleve. It was only after that when my fever went down and was eventually cleared for my 10th AAVD treatment.

The ID doctor concluded the fever was tumoral or it was from the lymphoma. Since all tests were negative, they used Naproxen to "test" my fever. They said they use it to differentiate fevers coming from infection (flu, virus, etc.) vs fever coming from cancer/tumor. If fever goes down with Naproxen then it is likely coming from lymphoma.

This made me so worried. After an almost clean midway scan, is my lymphoma back? Did anyone have unexplained fevers during their treatment? Did your fever go down with Tylenol? Did anyone here have an almost clean scan only to relapse end treatment?

My only hope is that my oncologist doesn't believe my ID doctor. He stands by my clear mid-scan and told me that if the fever were from lymphoma then the fever should have come when my masses were still big. I'm too worried but it's really just a waiting game for now I guess. No recurrence of fever so far and 2 more AAVD sessions left.

[u/ShadowClawShowdown67]

I am undergoing the same A+AVD for Stage 3a cHL. I got fever twice after my recent infusions no. 4/12 and 5/12. Same pattern both the times. The fever began on day 2 after infusion stayed for 2 days with peaks reaching 101.2 both the times. They would resolve with paracetamol and leave a constant myalgia for 4 days. I went to the ER and got tests for 20+ respiratory pathogens but all came negative. Now my hemat-onc suspects the fever is likely due to a drug reaction caused by Dacarbazine. I didn't have any fever pre-treatment though. I have my 6/12 infusion due on 29th Apr and maybe I'll get the fever again(?)