HL-024: Case Report: Re-Challenging with Pembrolizumab for a Case of Hodgkin Lymphoma with no Transplant with Multiple Relapses

Abstract

In classical Hodgkin lymphoma (cHl), characterized by the overexpression of PDL1 and PDL2, there is a benefit from novel therapeutic strategy for the relapsed refractory disease, and has been approved by the FDA. A 44-year-old female patient presented in 2007 with diffuse enlarged lymph nodes. Biopsy showed a classical nodular sclerosis HL; stage IV according to the Ann Arbor classification system. She received 6 cycles of chemotherapy ABVD regimen (doxorubicin 25 mg/m2, bleomycin 10 IU/m2, vinblastine 6 mg/m2 IV, dacarbazine 375 mg/m2), leading to complete remission. Upon follow-up, end of 2008, PET-CT showed a relapse. Three cycles of chemotherapy ICE protocol were administered (cisplatin 20 mg/m2 day 1-3, etoposide 75 mg/m2 day 1-3, ifosfamide 1200 mg/m2 day 1-3, mesna 1600 mg/m2 day 1-3). PET-CT showed a complete remission, but the patient refused to have an autologous transplant due to financial difficulties. Early 2017, PET-CT showed a recurrence of disease. Treatment with the anti-CD30 antibody brentuximab vedotin 1.8 mg/kg with bendamustine 100 mg/m2 q3 weeks given for 3 cycles resulted in partial response. We continued the treatment for 3 more cycles with a complete remission. An autologous HSCT was not performed, and she continued the follow up for 1 year. December 2017 a Pet CT scan showed a new relapse, initiation of pembrolizumab 200 mg q3 weeks for 1 year with a partial response on Pet-Ct. November 2018 for financial issues, pembrolizumab was stopped (treatment not approved). A new PET-CT in April 2019 showed a progression of supra and infra diaphragmatic LNs and bone marrow disease. Re-challenging strategy, the patient was re-treated with pembrolizumab 200 mg Q3W, with evidence of disease progression in October 2019, suggesting a pseudo progression. A new PET-CT in January 2020 showed a persistent stable disease. Treatment was continued and new PET-CT in April 2020 showed a stable partial response. In summary, re-treatment with pembrolizumab is still active for non-transplanted recurrent HL with multiple previous relapses treated with pembrolizumab.