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Case of a Stage IIIB Hodgkin’s Lymphoma Patient Treated with Brentuximab - Modern Concepts for Immunotherapy

Tsvetan Popov, Daniel Zhelev, Zhenya Marinova, Roksana Tsvetanova, Ilina Micheva

Abstract

Introduction: Hodgkin’s Lymphoma (HL) is a malignant lymphoma with distinct histology, biologic behavior, and clinical characteristics. The neoplastic Reed-Sternberg cell is mostly of B-cell origin, derived from lymph node germinal centers but incapable of producing antibodies. Although it is potentially curable, some patients remain primary resistant to standard chemotherapy and appear to be a serious therapeutic challenge. The emerging new agents, however, give new perspectives in the treatment of HL.

Materials and Methods: A case report of a 57-year-old man with nodular sclerosis HL is discussed. He was diagnosed in 2012. Seven cycles of chemotherapy by BEACOPP were prescribed as first line treatment with subsequent assessment of the tumor response. Because of the resistant disease, he received four cycles of ICE, four cycles of DHAP, four cycles of IGEV as salvage therapy, followed by mobilization of peripheral stem cells, high-dose chemotherapy BEAM and autologous stem cell transplantation (ASCT). His PET/CT still remained positive after ASCT.

Brentuximab vedotin (BV) is an antibody-drug conjugate, consisting of chimeric IgG1 antibody cAC10, specifically targeting human CD30, expressed on Reed-Sternberg cells, and microtubule disrupting agent, monomethyl auristatin E. It is indicated as consolidation therapy following ASCT in patients at high risk of relapse.

The human IgG4 anti-PD-1 monoclonal antibody Nivolumab, a checkpoint inhibitor approved in May 2016, is used for resistant HL, relapsed or progressed after ASCT and post-transplantation BV.

A survey of the literature was conducted regarding the currently available information about the above-mentioned novel agents and their mechanism of action.

Results: After ASCT, the patient was prescribed Brentuximab vedotin as a consolidation therapy and the result of the evaluation by PET/CT after four cycles shows for the first time a complete remission.

Conclusion: The concept for cell biology and antibody-based immunotherapy is a modern heuristic approach for discovering innovative therapeutics against resistant HL.


Keywords

Hodgkin’s lymphoma, immunotherapy, oncohaematology


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