Abstract
Capillary leak syndrome (CLS) is a severe complication of allogeneic hematopoietic stem cell transplantation (HSCT) characterized by weight gain, generalized edema, hypotension, and hypoalbuminemia. The primary pathogenesis is injury of the capillary endothelium resulting in a loss of intravascular fluid into the interstitial space. Treatment is limited to vascular endothelial growth factor withdrawal and systemic corticosteroids. We report two cases with CLS where weight gain, ascites, and hypotension developed after neutrophil engraftment following allogeneic HSCT. We obtained serial electrolytes, blood urea nitrogen, creatinine, and albumin from these patients. Ultrasound with Doppler tracing performed on both patients showed no reversal of portal venous flow. Issues addressed were the restoration of regular hydration by hydroxyethyl starch (HES) solutions, together with systemic corticosteroids and forced diuresis. Tetrastarch was administered 10 and 20 days, respectively. Both patients recovered without sequelae. CLS is a frequent complication after allogeneic HSCT. The effects of HES on CLS merit further consideration and prospective study.
Highlights
For patients with Hodgkin Lymphoma ly (HL) who experience relapse post allogenen ic stem cell transplantation, limited treatment options exist, and the ultimate outo come is poor
We describe the clinical course of a patient with HL, who experienced early relapse post alloSCT and failed to achieve disease control after immunomodulatory approaches, but responded twice to Nivolumab treatment
To reduce the risk of GvHD without negatively affecting the GvHL effect, we treated the patient with escalating doses of Nivolumab
Summary
A young male patient, diagnosed at the age of 11 years with nodular sclerosis cHL and stage IIIBS, was initially treated in a pediatric center with the ABVD/COPP regimen. The standard dose for Nivolumab in adult patients is 240 achieved a complete metabolic response (mCR) according to PET/CT criteria (Figure 2B) He continued on escalating doses of Nivolumab and since no treatmentrelated toxicity was noticed, he was able to receive the maximum dose of 3 of GvHD. Six months after r Nivolumab discontinuation, he presented to e our center with the third relapse post alloSCT (Figure 2A) He was re-treated m with Nivolumab, and in order to avoid m severe toxicities and to minimize the risk of severe te-GvHD, we used escalating doses
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