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A case report and literature review of primary resistant Hodgkin lymphoma: a response to anti-PD-1 after failure of autologous stem cell transplantation and brentuximab vedotin

View Article: PubMed Central - PubMed

ABSTRACT

Hodgkin lymphoma (HL) is a highly curable hematologic malignancy, and ~70% of cases can be cured with combination chemotherapy with or without radiation. However, patients with primary resistant disease have a cure rate of <30%. For such patients, high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is considered to be the standard treatment. If patients fail to respond to ASCT or relapse soon thereafter, they usually receive another ASCT, allogeneic stem cell transplantation or treatment with novel agents. This case report presents the case of a 54-year-old patient with primary resistant HL who received single-agent treatment, brentuximab vedotin, after ASCT relapse. Despite treatment with brentuximab vedotin, the disease continued to progress. In patients with such highly resistant disease, the treatment options are limited. Depending on the physical condition and the willingness of the patient, pembrolizumab, a programmed cell death protein-1 inhibitor, can be given as salvage therapy. But, out of our expectation, the patient achieved a very good partial response after four cycles of pembrolizumab. No serious adverse events were observed with pembrolizumab treatment. This case provides support for a new and effective strategy for treating primary resistant Hodgkin lymphoma.

No MeSH data available.


Related in: MedlinePlus

Response to therapy as shown on the PET/CT.Notes: (A) The patient was diagnosed with classical Hodgkin lymphoma (HL) involving the neck, mediastinal and left hilus pulmonis lymph nodes in stage II B (fever) disease in May 2012. (B) After four cycles of ABVD, the neck and right hilus pulmonis lymph nodes faded. The mediastinal lymph nodes diminished but still appeared metabolically active in October 2012. Furthermore, the disease involved a new lesion. (C) After ASCT in May 2013, a partial response was achieved, and the mediastinal lymph nodes remained as residual lesions. (D) After the patient received ASCT and radiotherapy, the patient suffered again from fever and cough. The PET/CT demonstrated multifocal progressive disease involving primary and additional involved lymph nodes with increased metabolism of different levels compared with the previous PET/CT scan. The arrows indicate mediastinal and hilus pulmonis lymph nodes involved with Hodgkin lymphoma cells.Abbreviations: ABVD, doxorubicin, bleomycin, vincristine, and dacarbazine; ASCT, autologous stem cell transplantation; CT, computed tomography; PET, positron emission tomography.
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f2-ott-9-5781: Response to therapy as shown on the PET/CT.Notes: (A) The patient was diagnosed with classical Hodgkin lymphoma (HL) involving the neck, mediastinal and left hilus pulmonis lymph nodes in stage II B (fever) disease in May 2012. (B) After four cycles of ABVD, the neck and right hilus pulmonis lymph nodes faded. The mediastinal lymph nodes diminished but still appeared metabolically active in October 2012. Furthermore, the disease involved a new lesion. (C) After ASCT in May 2013, a partial response was achieved, and the mediastinal lymph nodes remained as residual lesions. (D) After the patient received ASCT and radiotherapy, the patient suffered again from fever and cough. The PET/CT demonstrated multifocal progressive disease involving primary and additional involved lymph nodes with increased metabolism of different levels compared with the previous PET/CT scan. The arrows indicate mediastinal and hilus pulmonis lymph nodes involved with Hodgkin lymphoma cells.Abbreviations: ABVD, doxorubicin, bleomycin, vincristine, and dacarbazine; ASCT, autologous stem cell transplantation; CT, computed tomography; PET, positron emission tomography.

Mentions: A 54-year-old female was diagnosed with classical HL (Figure 1) involving her neck, mediastinal, and left hilus pulmonis lymph nodes corresponding to stage IIB (fever) in May 2012. According to the German Hodgkin Study Group classification system, the patient was considered to have advanced HL as the erythrocyte sedimentation rate was >30 mm/h with B symptoms and more than two regional lymph nodes were invaded, without extranodal involvement as assessed by positron emission tomography (PET)/computed tomography (CT) (Figure 2). On the basis of the National Comprehensive Cancer Network clinical guidelines for the treatment of HL, the patient received four cycles of ABVD (doxorubicin, bleomycin, vincristine, and dacarbazine). Following ABVD treatment, the patient experienced relief of clinical symptoms (fever and cough). In addition, the neck and right hilus pulmonis lymph nodes had decreased in size. Although the mediastinal lymph nodes had also diminished, PET/CT revealed that their metabolic activity had not decreased obviously or detectably (Figure 2). Moreover, PET/CT also identified that the seventh right rib was a new zone of increased metabolism compared with the initial scan.


A case report and literature review of primary resistant Hodgkin lymphoma: a response to anti-PD-1 after failure of autologous stem cell transplantation and brentuximab vedotin
Response to therapy as shown on the PET/CT.Notes: (A) The patient was diagnosed with classical Hodgkin lymphoma (HL) involving the neck, mediastinal and left hilus pulmonis lymph nodes in stage II B (fever) disease in May 2012. (B) After four cycles of ABVD, the neck and right hilus pulmonis lymph nodes faded. The mediastinal lymph nodes diminished but still appeared metabolically active in October 2012. Furthermore, the disease involved a new lesion. (C) After ASCT in May 2013, a partial response was achieved, and the mediastinal lymph nodes remained as residual lesions. (D) After the patient received ASCT and radiotherapy, the patient suffered again from fever and cough. The PET/CT demonstrated multifocal progressive disease involving primary and additional involved lymph nodes with increased metabolism of different levels compared with the previous PET/CT scan. The arrows indicate mediastinal and hilus pulmonis lymph nodes involved with Hodgkin lymphoma cells.Abbreviations: ABVD, doxorubicin, bleomycin, vincristine, and dacarbazine; ASCT, autologous stem cell transplantation; CT, computed tomography; PET, positron emission tomography.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5036553&req=5

f2-ott-9-5781: Response to therapy as shown on the PET/CT.Notes: (A) The patient was diagnosed with classical Hodgkin lymphoma (HL) involving the neck, mediastinal and left hilus pulmonis lymph nodes in stage II B (fever) disease in May 2012. (B) After four cycles of ABVD, the neck and right hilus pulmonis lymph nodes faded. The mediastinal lymph nodes diminished but still appeared metabolically active in October 2012. Furthermore, the disease involved a new lesion. (C) After ASCT in May 2013, a partial response was achieved, and the mediastinal lymph nodes remained as residual lesions. (D) After the patient received ASCT and radiotherapy, the patient suffered again from fever and cough. The PET/CT demonstrated multifocal progressive disease involving primary and additional involved lymph nodes with increased metabolism of different levels compared with the previous PET/CT scan. The arrows indicate mediastinal and hilus pulmonis lymph nodes involved with Hodgkin lymphoma cells.Abbreviations: ABVD, doxorubicin, bleomycin, vincristine, and dacarbazine; ASCT, autologous stem cell transplantation; CT, computed tomography; PET, positron emission tomography.
Mentions: A 54-year-old female was diagnosed with classical HL (Figure 1) involving her neck, mediastinal, and left hilus pulmonis lymph nodes corresponding to stage IIB (fever) in May 2012. According to the German Hodgkin Study Group classification system, the patient was considered to have advanced HL as the erythrocyte sedimentation rate was >30 mm/h with B symptoms and more than two regional lymph nodes were invaded, without extranodal involvement as assessed by positron emission tomography (PET)/computed tomography (CT) (Figure 2). On the basis of the National Comprehensive Cancer Network clinical guidelines for the treatment of HL, the patient received four cycles of ABVD (doxorubicin, bleomycin, vincristine, and dacarbazine). Following ABVD treatment, the patient experienced relief of clinical symptoms (fever and cough). In addition, the neck and right hilus pulmonis lymph nodes had decreased in size. Although the mediastinal lymph nodes had also diminished, PET/CT revealed that their metabolic activity had not decreased obviously or detectably (Figure 2). Moreover, PET/CT also identified that the seventh right rib was a new zone of increased metabolism compared with the initial scan.

View Article: PubMed Central - PubMed

ABSTRACT

Hodgkin lymphoma (HL) is a highly curable hematologic malignancy, and ~70% of cases can be cured with combination chemotherapy with or without radiation. However, patients with primary resistant disease have a cure rate of <30%. For such patients, high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is considered to be the standard treatment. If patients fail to respond to ASCT or relapse soon thereafter, they usually receive another ASCT, allogeneic stem cell transplantation or treatment with novel agents. This case report presents the case of a 54-year-old patient with primary resistant HL who received single-agent treatment, brentuximab vedotin, after ASCT relapse. Despite treatment with brentuximab vedotin, the disease continued to progress. In patients with such highly resistant disease, the treatment options are limited. Depending on the physical condition and the willingness of the patient, pembrolizumab, a programmed cell death protein-1 inhibitor, can be given as salvage therapy. But, out of our expectation, the patient achieved a very good partial response after four cycles of pembrolizumab. No serious adverse events were observed with pembrolizumab treatment. This case provides support for a new and effective strategy for treating primary resistant Hodgkin lymphoma.

No MeSH data available.


Related in: MedlinePlus