Nivolumab therapy for refractory and relapsed Hodgkin’s lymphoma — case report

Abstract

A case of a 34-year-old male patient was described with increased sweating, itching of the skin without accompanying skin lesions, and a dry cough. Numerous enlarged nodes in the chest and hypodense centres in the spleen were visualised in the CT imaging. Based on lymph node biopsy, Hodgkin’s lymphoma (HL) nodular sclerosis type was diagnosed. After ABVD (doxorubicin 25 mg/m2, bleomycin 10 mg/m2, vinblastine 6 mg/m2, dacarbazine 375 mg/m2), chemotherapy, and radiotherapy complete remission was achieved. Two months after treatment completion the disease relapsed. Six courses of chemotherapy DHAP (cisplatin 100 mg/m2 on day 1, cytarabine 2000 mg/m2 every 12 hours on day 2, dexamethasone 40 mg on day 1–4) were followed by high-dose chemotherapy BEAM (carmustine 300 mg/m2, etoposide 400–800 mg/m2, cytarabine 800–1600 mg/m2, and melphalan 140 mg/m2) supported with autologous transplantation of haemopoietic stem cells (ASCT). Through numerous relapses of the disease, the patient received many lines of chemotherapy and immunotherapy, including IGEV (ifosfamide 2000 mg/m2 on day 1–4, gemcitabine 800 mg/m2 on day 1–4, vinorelbine 20 mg/m2 on day 1), brentuximab vedotin 1.8 mg/m2 (BV), CNOP (cyclophosphamide 750 mg/m2, mitoxantrone 10 mg/m2, vincristine 1.4 mg/m2, dexamethasone 20 mg), chlorambucil 12 mg daily for 14 days with a seven-day break + prednisone chronically in a dose of 40 mg daily, and TBS (thalidomide 100 mg per day chronically, bendamustine 90 mg/m2 on day 1–2, methylprednisolone 1000 mg/day on day 1–3). We decided to introduce an immunotherapy with nivolumab, the anti-PD1 antibody, achieving a significant clinical response. This case report presents nivolumab as an effective treatment in refractory and relapsed HL.