Hodgkin’s Lymphoma Patient Responds Well to Off-label Therapy with Nivolumab

Hodgkin’s Lymphoma Patient Responds Well to Off-label Therapy with Nivolumab
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Promising results from what is believed to be the first patient treated with nivolumab after allogeneic stem cell transplantation (alloSCT) has recently been reported in a case study titled “Nivolumab in a patient with refractory Hodgkin’s lymphoma after allogeneic stem cell transplantation,” published in Bone Marrow Transplantation journal.

Hodgkin’s lymphoma (HL) is a neoplastic disease, of lymphoid origin, that can initially be successfully treated in more than 75% of patients with chemotherapy, usually in combination with radiation. Relapsed or refractory (r/r) patients tend to respond well to high-dose therapy and stem cell transplantation, with the antibody-drug conjugate brentuximab bedotin (BV) showing promising results. In highly refractory cases, allogeneic stem cell transplantation (alloSCT) is considered a therapeutic option for eligible patients.

In this particular study, an 18-year-old man was diagnosed with classical Hodgkin’s lymphoma (HL) with mediastinal and hilar lymph nodes, exhibiting a middle lobe of the lung that corresponded to a stage IV B (fever) disease. The patient’s condition, refractory to multiple therapies such as alloSCT or BV, deteriorated after  treatment with CEVD (lomustine, etoposide, vindesine, dexamethasone) chemotherapy. In need for a new liver and showing bone lesions, the patient was seen as deteriorating progressively with increased nausea, loss of appetite, severe B symptoms, and significant loss of weight.

Considering the high response rates of nivolumab in r/r HL, the medical team decided to start an off-label therapy with nivolumab, an anti-PD1 antibody. Previous studies had reported that checkpoint inhibition by nivolumab proved a significant overall response rate of 87%, including 17% of complete remissions in 23 patients with r/r HL.

The patient consented to receiving a single dose of nivolumab at 3 mg/kg in June 2015. The treatment was well tolerated with a mild fever during the first two hours, which was recorded as the only side effect. After the first week of nivolumab administration, the patient’s B symptoms went away and his clinical condition improved dramatically over the following weeks. Importantly, there was no evidence of GVHD (graft-versus-host-disease) induction.

These clinical results suggest PD1 inhibition could become an effective means of unleashing a graft-versus-tumor effect in the immunosuppressive microenvironment of HL. However, more research is necessary, as this study was solely based on a single experience of nivolumab’s off-label use.

Inês holds a PhD in Biomedical Sciences from the University of Lisbon, Portugal, where she specialized in blood vessel biology, blood stem cells, and cancer. Before that, she studied Cell and Molecular Biology at Universidade Nova de Lisboa and worked as a research fellow at Faculdade de Ciências e Tecnologias and Instituto Gulbenkian de Ciência. Inês currently works as a Managing Science Editor, striving to deliver the latest scientific advances to patient communities in a clear and accurate manner.
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Inês holds a PhD in Biomedical Sciences from the University of Lisbon, Portugal, where she specialized in blood vessel biology, blood stem cells, and cancer. Before that, she studied Cell and Molecular Biology at Universidade Nova de Lisboa and worked as a research fellow at Faculdade de Ciências e Tecnologias and Instituto Gulbenkian de Ciência. Inês currently works as a Managing Science Editor, striving to deliver the latest scientific advances to patient communities in a clear and accurate manner.
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