scholarly journals Complete Remission of Relapsed Hodgkin’s Lymphoma following Brentuximab Vedotin and Gemcitabine Combination Therapy with Severe Hypotension as Possible Treatment-Related Adverse Event: A Case Report

2020 ◽  
Vol 13 (1) ◽  
pp. 341-346 ◽  
Author(s):  
Ibnu Purwanto ◽  
Bambang P. Utomo ◽  
Ahmad Ghozali
Keyword(s):  
Adverse Event ◽  
Complete Remission ◽  
Hodgkin’S Lymphoma ◽  
Brentuximab Vedotin ◽  
Hodgkin's Lymphoma ◽  
High Dose ◽  
High Dose Corticosteroid ◽  
Severe Hypotension ◽  
Dose Corticosteroid

A 40-year-old Asian female with heavily treated relapsed Hodgkin’s lymphoma showed complete remission (CR) after receiving 8 cycles of brentuximab vedotin (BV) in combination with gemcitabine as 4th line treatment. The patient remained in CR at the 18-month post-treatment follow-up. She developed severe hypotension (50/36 mm Hg) with upper and lower limb petechiae and edema after the addition of gemcitabine on the 6th cycle of BV. This adverse event resolved after 3 days of treatment with vasopressor and high-dose corticosteroid. The addition of dexamethasone for the subsequent 2 cycles successfully prevented this adverse event from recurring.

scholarly journals P14.85 Brain metastasis from Hodgkin’s Lymphoma: case report and literature review

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii87-iii88
Author(s):  
F Bruno ◽  
E Pronello ◽  
S Bortolani ◽  
R Palmiero ◽  
A Melcarne ◽  
...  
Keyword(s):  
Case Report ◽  
Complete Remission ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Hodgkin’S Lymphoma ◽  
Brain Lesion ◽  
Whole Brain Radiotherapy ◽  
Hodgkin's Lymphoma ◽  
High Dose ◽  
Thoracic Pain

Abstract BACKGROUND Central nervous system (CNS) metastases from Hodgkin’s Lymphoma (HL) are very rare, occurring in 0.02–0.5% of cases. They are usually associated to systemic relapse of the disease. Treatment options for HL brain metastases include surgery, radiotherapy, and systemic chemotherapy. CASE REPORT A 54 year-old woman presented with thoracic pain and dyspnea. Chest CT showed a thoracic bulky mass larger than 10 cm. Biopsy confirmed HL stage IIA, nodular sclerosing variant. No typical B symptoms, such as fever, night sweats or weight loss, were observed. The patient underwent chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD scheme), followed by 30Gy mediastinic radiotherapy (RT), which led to complete remission in September 2017. After 3 months, she presented with headache and rapidly progressing gait disorder. MRI showed a contrast-enhanced lesion in the right occipital lobe, with central necrosis and massive edema. Total-body CT scan and FDG-PET ruled out either the presence of new solid tumors or systemic relapses of HL. Gross total resection of the brain lesion was carried out, and HL histology was confirmed. CSF analysis from lumbar puncture was normal. Afterwards, the patient underwent 2 cycles of high dose cytarabine, but she rapidly progressed, and received salvage RT (30 Gy). Nevertheless, further systemic progression occurred: the patient developed headache, diplopia and dysphagia and, unfortunately, she died 6 months after the diagnosis of brain metastasis. DISCUSSION Thus far, only 45 cases of CNS HL have been reported from 2000 to 2018. Whole brain radiotherapy, with or without chemotherapy, was the most common treatment. In our patient, we chose surgical resection for the solitary brain metastasis followed by chemotherapy, delaying RT at recurrence. In the literature, median overall survival of patients diagnosed with brain metastases from HL is 18 months (1–273): 17 patients (38%) showed a progression (local / systemic: 12/17 - 71%), while 28 (62%) showed complete remission after a median follow-up of 20 months (6–273). CONCLUSION Intracranial localisation of Hodgkin’s Lymphoma is a rare entity but still has to be taken into account. Advanced brain imaging could be of help in case of uncertain radiological presentation. A multidisciplinary approach is needed as there is no consensus on the best treatment to choose: surgery, radiotherapy and chemotherapy should be considered on individual basis.

High-dose chemotherapy and peripheral hematopoietic stem cell transplantation in relapsed/refractory Hodgkin’s lymphoma

2018 ◽  
Vol 104 (6) ◽  
pp. 471-475 ◽  
Author(s):  
Mouhammed Kelta ◽  
Jamal Zekri ◽  
Ehab Abdelghany ◽  
Jalil Ur Rehman ◽  
Zahid Amin Khan ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hodgkin’S Lymphoma ◽  
High Dose Chemotherapy ◽  
Salvage Chemotherapy ◽  
Hodgkin's Lymphoma ◽  
Phase Iii ◽  
High Dose

Purpose: High-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT) is used to treat patients with relapsed Hodgkin’s lymphoma. In this retrospective study we report our experience with patients who underwent HDCT and ASCT. Methods: All patients ≥15 years old with relapsed/refractory Hodgkin’s lymphoma who underwent HDCT and ASCT between June 2001 and December 2013 were included. Results: Fifty-four patients were identified. Median age at transplant was 22 years (range 15-49 years); 26 were men and 28 were women. Forty-eight patients (89%) underwent HDCT and ASCT after achieving a radiological response to salvage chemotherapy. The rate of radiological complete response to salvage chemotherapy was 13% and reached 50% within 3 months of ASCT in assessable patients. After a median follow-up of 25 months, 31 patients (57%) were still alive with no evidence of relapse or progression. Median event-free survival (EFS) was 24 months (95% CI 8.7-39.3) and 3-year EFS was 56%. Median overall survival (OS) was not reached and 3-year OS was 82.5%. Bulky mediastinal disease at relapse, hemoglobin level, and number of salvage regimens did not significantly impact EFS in univariate and multivariate analyses. After transplantation there was a trend towards longer EFS (30 vs. 24 months; p = 0.36) in patients with a longer time from the end of first-line treatment until relapse (≥12 vs. <12 months). The 100-day transplant-related mortality was 5.5%. Conclusions: HDCT and ASCT for relapsed/refractory Hodgkin’s lymphoma is safe. Our findings are consistent with published phase III results. Longer follow-up is warranted.

High Dose Chemoradiotherapy and ASCT Can Overcome the Prognostic Importance of Bcl-2, Bim, and p53 in Relapsed/Refractory Hodgkin’s Lymphoma.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2073-2073
Author(s):  
Daniel Persky ◽  
Julie Teruya-Feldstein ◽  
Tarun Kewalramani ◽  
Pauline D. Bonner ◽  
Alexia Iasonos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Complete Remission ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Comprehensive Treatment ◽  
High Dose ◽  
Second Line ◽  
Prognostic Features ◽  
Remission Duration ◽  
Extranodal Disease

Abstract Introduction: Approximately twenty percent of patients with Hodgkin’s lymphoma (HL) relapse or have primary refractory disease. About 50% of these patients achieve long-term remissions after high-dose chemoradiotherapy and autologous stem cell transplantation (HDT/ASCT). At MSKCC, ICE (ifosfamide, carboplatin, etoposide) was incorporated as second-line chemotherapy prior to HDT/ASCT in a comprehensive treatment program. In addition to chemosensitive disease, a clinical prognostic model that emerged from this study identified 3 risk factors - B symptoms at relapse, extranodal disease, and complete remission duration of less than 1 year (Blood. 2001 Feb 1;97(3):616–23). This model was used to intensify treatment according to the number of risk factors, with stratification overcoming the significance of poor prognostic features (Blood. 2003 Nov 16;102(11), abstract #403). Methods: To further identify important prognostic factors, we evaluated pre-ICE biopsy specimens of patients enrolled on one of 3 IRB-approved clinical trials of HDT/ASCT. Prior studies showed that overexpression of bcl-2 and p53 have negative impact on outcome with primary therapy. We sought to determine if our comprehensive second-line program could overcome these poor prognostic features. We performed immunohistochemistry staining for bcl-2, bim (a bcl-2 family marker), and p53; samples were considered positive if any Reed-Sternberg (RS) cells stained for bcl-2 or bim, and if more than 50% stained for p53, at any staining intensity. Results: Seventy one patients had sufficient tissue available. Thirty five patients (49%) had disease progression and 28 (39%) died. Median PFS was 4.8 years, median OS was not reached, and median follow-up was 5.7 years. Bcl-2 was overexpressed in 19(27%), bim in 22 (32%), and p53 in 20 (29%) patients. Expression of bcl-2, bim, or p53 had no significant association with PFS or OS. Five-year PFS rates for positive vs. negative cases were 52.6% vs 50% for bcl-2, 54.5% vs 50% for bim, and 50% vs 51% for p53 (all p=NS). The 3 factor clinical model (B symptoms at relapse, extranodal disease and complete remission duration of less than 1 year) remained highly significant (0/1 vs 2/3 factors) for PFS and OS (p=0.002 and p=0.0003, respectively). Conclusion: Despite the evidence that p53 and bcl-2 overexpression may predict a worse prognosis with initial treatment, it appears that the approach of incorporating ICE and HDT/ASCT may overcome the significance of these biological markers at relapse. Further studies will focus on other pathways that are thought to play a role in relapsed/refractory HL outcomes. Bim is a novel pro-apoptotic marker from the bcl-2 family that is expressed on RS cells and suggests a role in the pathogenesis of HL. Future studies will focus on its role in both initial and relapsed/refractory setting.

Role of [18F]Fluorodeoxyglucose Positron Emission Tomography Scan in the Follow-Up of Lymphoma

2009 ◽  
Vol 27 (11) ◽  
pp. 1781-1787 ◽  
Author(s):  
Pier Luigi Zinzani ◽  
Vittorio Stefoni ◽  
Monica Tani ◽  
Stefano Fanti ◽  
Gerardo Musuraca ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Complete Remission ◽  
Fdg Pet ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Emission Tomography ◽  
Fluorodeoxyglucose Positron Emission Tomography ◽  
Positron Emission ◽  
Fluorodeoxyglucose Positron Emission

Purpose In lymphoma, [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) is routinely used for initial staging, early evaluation of treatment response, and identification of disease relapse. However, there are no prospective studies investigating the value of serial FDG-PET over time in patients in complete remission. Patients and Methods All patients with lymphoma who achieved the first complete remission were prospectively enrolled onto the study and scheduled for serial FDG-PET scans at 6, 12, 18, and 24 months; further scans were then carried out on an annual basis. Overall, the population included 421 patients (160 patients with Hodgkin's lymphoma [HL], 183 patients with aggressive non-Hodgkin's lymphoma [NHL], and 78 patients with indolent follicular NHL). All patients had a regular follow-up evaluation, including complete clinical and laboratory evaluation, and final assessment of any suspect FDG-PET findings using other imaging procedures (computed tomography [CT] scan) and/or biopsy and/or clinical evolution. FDG-PET findings were reported as positive for relapse, inconclusive (when equivocal), or negative for relapse. Results PET enabled documentation of lymphoma relapse in 41 cases at 6 months, in 30 cases at 12 months, in 26 cases at 18 months, in 10 cases at 24 months, and in 11 cases at more than 36 months. All 36 patients with inconclusive positive PET underwent biopsy; only 12 (33%) of 36 patients had a concomitant suggestion of positivity on CT. A lymphoma relapse was diagnosed in 24 (66%) of 36 patients. Conclusion Our results confirm FDG-PET as a valid tool for follow-up of patients with HL and NHL. In patients with inconclusive positive results, histologic confirmation plays an important role in identifying true relapse.

Brentuximab Vedotin in Pretreated Hodgkin Lymphoma Patients: A Systematic Review and Meta-Analysis

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3866-3866
Author(s):  
Dada Reyad ◽  
Fawwaz Khalid Yassin ◽  
Mohamed Bayoumy
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Hodgkin Lymphoma ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Hodgkin’S Lymphoma ◽  
High Dose Chemotherapy ◽  
Brentuximab Vedotin ◽  
Hodgkin's Lymphoma ◽  
High Dose

Abstract Introduction : The outcome of Hodgkin lymphoma (HL) has improved over the past 20 years. However, the probability of relapse after response to initial treatment is currently approximately 10 to 15 percent for localized HL (i.e. stage I and II) and 20 to 40 percent for advanced stages (i.e. IIIB and IV), dependent on prognostic factors [1]. In young patients eligible for dose intensive chemotherapy, salvage chemotherapy with autologous stem cell transplantation (ASCT) is a frequently used therapy option and can be considered as standard [2, 3]. Patients who relapse following ASCT and those not eligible for myeloablative therapy are being treated with conventional chemotherapy or new novel agents such brentuximab vedotin (BV). Since approval of BV several study groups published the results of their experience in treating refractory/relapsed HL patients with BV. Patients and methods: The purpose of this study was to evaluate the impact of BV on outcome of patients with refractory and relapsed HL. In this systematic review we analyzed the published data on refractory / relapsed Hodgkin lymphoma patients who received BV as single agent. A systematic literature search was performed and included studies published from 1st January 2000 to 1st July 2015 in PubMed, electronic databases EMBASE (Dialog), Cochrane Library, DIMDI-Recherche and MEDPILOT. We used the key words brentuximab, brentuximab vedotein, adcetris, CD30 antibody and SGN-35. Recent conference abstracts from the American Society for Clinical Oncology (ASCO) (2012-2015) and American Society of Hematology (ASH) (2012-2014) were also included. Serial reports of 5 patients and more were included. If several publications from same author and group were published, the publications were re-scanned whether the reported patients' cohorts are the same. We included patients treated with BV pre- and post-transplantation as well as those not eligible for transplantation. Publications reporting about experience with BV in several diseases, e.g. T cell lymphoma and HL, underwent special analysis in order to extract only the HL data. Studies using BV in combination with radiation were disqualified for our analysis. Results: 51 out of 5369 screened records met the eligibility criteria. After exclusion of duplicates and serial reports with <5 patients total of 22 records (17 full articles and 5 abstracts) were included. Data of 903 patients treated with BV as salvage treatment was collected. The median age of the cohort was 31 year (range: 26-45). The patients received in median 4 lines (range: 1-9) of chemotherapy prior to BV. Median follow up was 16.1 months (range: 4.5-45.1). Most patients were heavily pretreated, 529/903 and 232/903 underwent high dose chemotherapy and autologous stem transplantation or received allogeneic stem transplantation prior of BV respectively. The response rate was 62.7% (range: 30-100%). The complete remission, partial remission, stable disease and progressive disease rates were 31.8%, 35.1%, 19.5% and 11.7% respectively. The one year progression free survival and estimated one year overall survival were 47.7% and 70% respectively. Conclusion: Significant number of the cohort received autologous and/or allogeneic stem cell transplantation prior BV. Response rate of 62.7% and complete remission rate of 31.8% are supporting results of the pivotal study [4] and establish the solid basis for using BV in heavily pretreated HL patients. Litreature: 1. Josting, A., et al., New prognostic score based on treatment outcome of patients with relapsed Hodgkin's lymphoma registered in the database of the German Hodgkin's lymphoma study group. J Clin Oncol, 2002. 20 (1): p. 221-30. 2. Sirohi, B., et al., Long-term outcome of autologous stem-cell transplantation in relapsed or refractory Hodgkin's lymphoma. Ann Oncol, 2008. 19 (7): p. 1312-9. 3. Rancea, M., et al., High-dose chemotherapy followed by autologous stem cell transplantation for patients with relapsed/refractory Hodgkin lymphoma. Cochrane Database Syst Rev, 2013. 6: p. CD009411. 4. Younes, A., et al., Results of a pivotal phase II study of brentuximab vedotin for patients with relapsed or refractory Hodgkin's lymphoma. J Clin Oncol, 2012. 30 (18): p. 2183-9. Disclosures No relevant conflicts of interest to declare.

Pseudotumor cerebri following tapered corticosteroid treatment in an 8-month-old infant

2008 ◽  
Vol 1 (1) ◽  
pp. 88-90 ◽  
Author(s):  
Wilson Z. Ray ◽  
Amy Lee ◽  
Spiros L. Blackburn ◽  
Gregg T. Lueder ◽  
Jeffrey R. Leonard
Keyword(s):  
Lumbar Puncture ◽  
High Volume ◽  
Corticosteroid Treatment ◽  
Pseudotumor Cerebri ◽  
Capillary Hemangioma ◽  
High Dose ◽  
Ophthalmological Examination ◽  
High Dose Corticosteroid ◽  
Dose Corticosteroid

✓The authors report on an 8-month-old infant with an orbital capillary hemangioma. The patient had been treated with high-dose corticosteroid therapy and had had a recent decrease in dose. The patient presented to the emergency department with increased irritability and bulging fontanelles. On lumbar puncture the opening pressure was > 55 cm H2O. Ophthalmological examination revealed interval development of papilledema. The child was treated with high-volume lumbar puncture, subsequent drainage of 10 ml of cerebrospinal fluid, resumption of the previous steroid dose, and acetazolomide therapy. The patient's symptoms resolved and follow-up ophthalmological examination revealed interval resolution of papilledema. The authors present the youngest reported case of pseudotumor development after corticosteroid tapering.

scholarly journals Can Rituximab Improve the Outcome of Patients with Nodular Lymphocyte-Predominant Hodgkin's Lymphoma?

2015 ◽  
Vol 134 (3) ◽  
pp. 187-192 ◽  
Author(s):  
Heidi Mocikova ◽  
Robert Pytlik ◽  
Pavla Stepankova ◽  
Jozef Michalka ◽  
Jana Markova ◽  
...  
Keyword(s):  
Complete Remission ◽  
Partial Remission ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Line Treatment ◽  
Second Line ◽  
Treatment Results ◽  
Cd20 Expression

Background: Nodular lymphocyte-predominant Hodgkin's lymphoma (NLPHL) is a rare subtype of Hodgkin's lymphoma showing strong CD20 expression. The role of rituximab in treating NLPHL still needs clarification. Methods: We retrospectively reviewed the outcome of 23 patients with NLPHL treated with rituximab alone or in combination with chemotherapy and/or radiotherapy as part of their first- or second-line treatment. Results: The median follow-up of the whole group was 67 months, and all patients remained alive. Twenty-two patients achieved complete remission after rituximab-based therapy, and one of them relapsed 32 months after treatment. One patient treated with rituximab alone achieved partial remission and progressed 22 months after treatment. Conclusion: The prognosis of NLPHL is excellent. Rituximab combined with chemotherapy and/or radiotherapy appears to prevent disease progression/relapse.

scholarly journals Outcomes of Direct Vision Internal Urethrotomy for Bulbar Urethral Strictures: Technique Modification with High Dose Triamcinolone Injection

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Rishi Modh ◽  
Peter Y. Cai ◽  
Alyssa Sheffield ◽  
Lawrence L. Yeung
Keyword(s):  
Corticosteroid Injection ◽  
Direct Vision ◽  
High Dose ◽  
Internal Urethrotomy ◽  
High Dose Corticosteroid ◽  
Urethral Strictures ◽  
Significant Difference ◽  
Triamcinolone Injection ◽  
Dose Corticosteroid

Objective. To evaluate the recurrence rate of bulbar urethral strictures managed with cold knife direct vision internal urethrotomy and high dose corticosteroid injection.Methods. 28 patients with bulbar urethral strictures underwent direct vision internal urethrotomy with high dose triamcinolone injection into the periurethral tissue and were followed up for recurrence.Results. Our cohort had a mean age of 60 years and average stricture length of 1.85 cm, and 71% underwent multiple previous urethral stricture procedures with an average of 5.7 procedures each. Our technique modification of high dose corticosteroid injection had a recurrence rate of 29% at a mean follow-up of 20 months with a low rate of urinary tract infections. In patients who failed treatment, mean time to stricture recurrence was 7 months. Patients who were successfully treated had significantly better International Prostate Symptom Scores at 6, 9, and 12 months. There was no significant difference in maximum flow velocity on Uroflowmetry at last follow-up but there was significant difference in length of follow-up (p=0.02).Conclusions. High dose corticosteroid injection at the time of direct vision internal urethrotomy is a safe and effective procedure to delay anatomical and symptomatic recurrence of bulbar urethral strictures, particularly in those who are poor candidates for urethroplasty.

scholarly journals A novel treatment of childhood lymphoblastic non-Hodgkin's lymphoma: early and intermittent use of teniposide plus cytarabine

Blood ◽  
1985 ◽  
Vol 66 (5) ◽  
pp. 1110-1114
Author(s):  
GV Dahl ◽  
G Rivera ◽  
CH Pui ◽  
J Jr Mirro ◽  
J Ochs ◽  
...  
Keyword(s):  
Complete Remission ◽  
Hodgkin’S Lymphoma ◽  
Lymphoblastic Leukemia ◽  
Alkylating Agents ◽  
Central Nervous System Involvement ◽  
Hodgkin's Lymphoma ◽  
High Dose ◽  
Early Therapy ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

We treated 24 children and adolescents with stage III or IV lymphoblastic non-Hodgkin's lymphoma, using a protocol designed for patients with poor-prognosis acute lymphoblastic leukemia (ALL). Early therapy consisted of teniposide plus cytarabine administered before and immediately after prednisone, vincristine, and asparaginase. The two- drug combination was also given intermittently with continuous 6- mercaptopurine and methotrexate during the first year of continuation chemotherapy. Periodic intrathecal methotrexate and delayed cranial irradiation were used to prevent central nervous system involvement. Anthracycline compounds, alkylating agents, high-dose methotrexate, and involved-field irradiation were not used in any phase of treatment. Twenty-two (96%) of the 23 evaluable patients achieved complete remission. With a median follow-up of 2 1/2 years, only four patients have relapsed; the remainder have been disease-free for eight months to more than five years. The projected four-year continuous complete remission rate is 73% for all patients and 79% for the 19 with mediastinal involvement at diagnosis. These results demonstrate that use of teniposide plus cytarabine with an otherwise conventional plan of ALL therapy is an effective approach to the treatment of childhood lymphoblastic lymphoma.

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