J. Markova, H. Mocikova, L. Gaherova, T. Kozak, On behalf of the Czech Hodgkin Lymphoma Study Group
Department of Internal Medicine - Haematology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Prague, Czech Republic
Background: Hodgkin lymphoma (HL) is cured in more than 80% of cases with the first-line treatment, however, the prognosis of repeated relapses was poor. The introduction of new drugs like brentuximab vedotin (BV) and anti PD-1 inhibitors improved the prognosis of repeated relapses of HL after autologous stem cell transplantation (ASCT) significantly.
Case report: 32-year-old female patient with HL nodular sclerosis, clinical stage IVB, international prognostic score 3 was treated with 6 cycles of BEACOPP escalated between 08 – 12/2011. Restaging after chemotherapy confirmed a PET-negative complete metabolic remission with residual PET-negative mediastinal mass (3.5 cm). Radiotherapy was not indicated. The first relapse occured early - 5 months after the first line-treatment (5/2012). Salvage therapy included: 2x DHAP (dexamethasone, cytarabine, cisplatinum), irradiation of residual mediastinal tumour (30 Gy), high dose chemotherapy BEAM (BCNU, etoposide, cytarabine, melphalan) and ASCT. She achieved a PET-negative complete remission 3 months after ASCT (12/2012). The second early relapse of the CD30- positive HL occured in 06/2013. She received 16 doses of BV (7/2013 - 6/2014). A significant tumour reduction was observed after 4 doses and a PET-negative complete remission was confirmed after 8 doses of BV. Polyneuropathy (CTCAE grade III) was the only complication of BV treatment and it disappeared one year after the last infusion of BV. The patient refused allogeneic stem cell transplantation. The patient is in continuous complete remission (PET/CT- negative) lasting 4 years and she is in a very good clinical condition.
Conclusion: The goal of BV treatment in relapsed HL after ASCT is to achieve a longlasting complete remission and it is not only a bridge to allogeneic stem cell transplantation. Currently the best approach after BV- observation or early indication to allogeneic stem cell transplantation is still a matter of debate. Introduction of anti PD-1 inhibitors enables to postpone the decision regarding allogeneic stem cell transplantation to the next relapse.
This work was supported by grant AZV 16-29857A Ministry of Health of the Czech Republic and Research project Q28 Progres and Q40/08 Progres awarded by Charles University in Prague, Third Faculty of Medicine, Prague, Czech Republic
Relapsed Hodgkin lymphoma, Autologous stem cell transplantation, Brentuximab vedotin.