Cancer linfoma hodgkin clasico


The tomographic evaluation revealed a large mass in the mediastinum and numerous pulmonary nodules. Two months later, he was admitted for cough and fever; the X-ray evaluation revealed new pulmonary mass in right lung lobe, and a new biop­sy confirmed the disease relapse.

Limfomul Hodgkin

Cancer linfoma hodgkin clasico was re­ini­tia­ted with one course of DHAP followed by five courses of brentuximab. We initiated another chemotherapy protocol with six cour­ses of GVD, but with no response at the tomographic re­eva­lua­tion. Allogeneic transplantation was considered, but there was no suitable donor available.

We decided to introduce immunotherapy with nivolumab, an anti-PD-1 antibody, which induced a significant improvement in interim PET-CT after seven courses.

Cancerul Hodgkin - simptome și tratament

In this case report, nivolumab was an effective treatment in refractory relapsed Hodgkin lymphoma. Evaluarea tomografică a evidenţiat o masă mare în mediastin şi numeroşi noduli pulmonari. O biopsie pulmonară a stabilit diagnosticul de limfom clasic de Hodgkin — scleroză nodulară, stadiul IVB.

Două cancer linfoma hodgkin clasico mai târziu, a fost internat pentru tuse şi febră; evaluarea cu raze X a arătat o nouă tumoră pulmonară în lobul drept şi o nouă biopsie a confirmat recăderea bolii.

  • Cancer de prostata immunocal
  • Scleroza nodulara, celularitate mixtă, depletie limfocitare si predominenta limfocitara sunt cele patru tipuri de limfom Hodgkin classic LHC.

Chimioterapia a fost reluată cu un ciclu de DHAP, urmat de cinci cicluri de brentuximab. Am iniţiat un alt protocol de chimioterapie cu şase serii de GVD, dar fără răspuns la reevaluarea tomografică. S-a luat în considerare transplantul alogen, dar nu a fost disponibil un donator adecvat. Am decis să introducem imunoterapia cu nivolumab, un anticorp anti-PD-1, care a indus o îmbunătăţire semnificativă a PET-CT intermediare după şapte administrări.

Un caz complex de limfom Hodgkin clasic recidivat refractar – scleroză nodulară

În acest raport de caz, nivolumab a fost un tratament eficient în limfomul Hodgkin recidivant refractar. It is a curable disease that affects predominantly young patients years oldwith a generally good prognosis if a complete response to chemotherapy is obtained after the first-line treatment.

The incidence varies with regions: Relapsed refractory cases remain a challenging problem for hematologists. The addition of anti-CD30 antibody to the pretransplant therapy or posttransplant consolidation and maintenance has improved outcomes, but there are young patients who relapsed even after ASCT and brentuximab therapy 2.

Fewer solutions are available for them: allogeneic transplantation, clinical trials and also some novel drugs cancer linfoma hodgkin clasico. Novel therapies, with very good results and safety profile risks, are based on immunotherapies targeting programmed cell death-1 PD-1 receptor, nivolumab and pembrolizumab.

Cancer linfoma hodgkin clasico is a PD-1 antibody that inhibits the PD-1 pathway, enhancing T-cell response, including antitumor responses; it acts by blocking the attachment of PD-L1 and PD-L2 ligands to the PD-1 receptor, which leads to the reduction of tumor growth.

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Reed-Sternberg cells are characterized by the genetic changes at the 9p Nivolumab seems to be a safe choice for patients heavily pretreated as a bridge to allogeneic transplantation after ASCT and brentuximab relapses, as well as salvage therapy in case of allogeneic transplant failure 3,4.

Case presentation In Maya healthy young male of 32 years old presented for dry cough and dyspnea associated with fever over the past two months.

A challenging case of relapsed refractory classical Hodgkin’s lymphoma – nodular sclerosis

The bronchoscopy evaluation revealed tracheal mucosa with irregular, microgranular and congested appearance. The bronchoalveolar lavage described modified bronchial mucosa with macrophages, lymphocytes, neutrophils, eosinophils, and atypical cells.

The bacteriological screening was negative.

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Bone marrow biopsy showed no malignant infiltration. Ebstein Barr serology was negative.

Un caz complex de limfom Hodgkin clasic recidivat refractar – scleroză nodulară

Two months later, in Novemberhe presented for respiratory symptoms. The patient was directed to the pneumologist for further investigation.

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He received one course of DHAP chemotherapy, but due to the long-lasting hematological complications severe pancytopenia with prolonged need of transfusion and opportunistic infectionshe was switched to brentuximab 1. Cancer linfoma hodgkin clasico was very well tolerated, without complications.

PET-CT reevaluation after ASCT in September revealed relapsed and progressive disease, with new active lesions localized in the right middle lobe and increased metabolic activity in splenic parenchyma. We continued the administration of brentuximab cancer linfoma hodgkin clasico after ASCT, but with dose reduction due to neuropathy.

Due to disease progression after ASCT and brentuximab therapy, the chemotherapy options were discussed and we decided in favor of salvage chemotherapy. So, the patient received six courses of GVD gemcitabine, vinorelbin, liposomal doxorubicin between January and Aprilbut cancer linfoma cancer linfoma hodgkin clasico clasico no response at the PET-CT cancer linfoma hodgkin clasico — disease progression with increasing size of existing lesions located in the superior upper lobe and right middle lobe.

Allogeneic stem cell transplantation allo-SCT was planned, but it was not performed due to the lack of a matching donor and also the lack of chemosensitivity at that cancer linfoma hodgkin clasico.

Limfom Hodgkin

Despite the medical history with multiple regimes of chemotherapy, relapsed in less than three months after ASCT, progressive disease under brentuximab and accumulated toxicity, our patient was young, with no other comorbidities or diseases, with very good performance status and an enormous wish to reach curability. That was the moment when we opted for a novel therapy with an anti-PD-1 antibody, nivolumab.

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Until now, he received 14 courses of nivolumab, very well tolerated and with no hematological or other toxicities. After this evaluation, we should decide what is next for our patient. The option for allogeneic stem cell transplantation is still a viable choice at this time, but there is still no suitable donor.

infecții cu vierme de cârlig și tratament preparate pentru îndepărtarea viermilor din corpul uman

Another option could be the haploidentical transplant from his father, because we consider that in this particular case the advantage of transplantation is superior to any other possible treatment, with a superior overall survival and progressive papilloma seno mascellare survival. It is a well-known fact that patients who relapsed after the first course of chemotherapy have a low chance to cure after the second-line therapy, especially when the relapse occurred in less than six months after the first treatment.

In these cases, the international guidelines recommend salvage chemotherapy followed by autologous stem cancer linfoma hodgkin clasico transplantation 2. In most cases, second-line therapy includes regimens such as ICE ifosfamide, carboplatin, etoposideGVD gemcitabine, vinorelbine, liposomal doxorubicinDHAP dexamethasone, cytarabine, cisplatin or brentuximab vedotin 2.

The relapsed cases after ASCT remain very challenging, with longevity directly related to the time of relapse after transplantation. In these cases, the first option is brentuximab vedotin, an anti-CD30 antibody.

It also appears to improve the outcome and is being investigated in chemotherapy combination in frontline settings 9, However, there still remains a minority of patients who relapse after ASCT, with very poor outcomes and a median survival rate OS of years 1,2.

Un caz complex de limfom Hodgkin clasic recidivat refractar – scleroză nodulară

The third and fourth regimen can be used including single or combined chemotherapy, immunomodulatory agents, histone deacetylase inhibitors and radiation therapy, but with very few response rates and short duration of remissions 1,2.

If not previously used, brentuximab has shown major efficacy as a bridge to allogeneic transplantation 12 or after allogeneic transplantation relapses The novel therapy is centered on the use of nivolumab or pembrolizumab in patients with disease recurrence after HDCT followed by ASCT and brentuximab terapy Nivolumab seems cancer linfoma hodgkin clasico be a safe choice for patients heavily pretreated as a bridge to allogeneic transplantation after ASCT and brentuximab relapses, cancer linfoma hodgkin clasico well as salvage therapy in case of allogeneic transplant failure 17,18, The durability of response to nivolumab is still unknown, and clearly more information is required to quantify the risk of immune toxicity 1,2,4.

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The initiation of nivolumab in our patient treatment enhances his clinical and imagistic response and allows us to check an suitable donor for allogeneic transplantation. Conflict of interests: The authors declare no conflict of interests.

Limfom Hodgkin - Cancer linfoma hodgkin clasico

Nivolumab for relapsed or refractory Hodgkin lymphoma: real-life experience. Ann Oncol. How I treat cancer linfoma hodgkin clasico and refractory Hodgkin lymphoma.