Up to 40% of patients with advanced
Hodgkin lymphoma (HL) become refractory or relapsed after current standard
chemotherapy, among which primary refractory HL confers a particularly poor outcome. With intensive salvage
chemotherapy and autologous
stem cell transplantation, the long-term remission rate for these patients was only 30%, but more selective treatments with higher therapeutic index are needed. We report the experience of using a new anti-CD30
immunotoxin,
brentuximab vedotin, in
salvage treatment of a 30-year-old woman with primary refractory
Hodgkin lymphoma. The patient presented with
SVC syndrome due to the bulky mediastinal
tumor and was confirmed to have classical
Hodgkin lymphoma, nodular
sclerosis type, stage IIIA. The
tumor responded to
induction chemotherapy transiently, but local progression was noted during subsequent cycles of treatment. Salvage
radiotherapy to the mediastinal
tumor, obtained no remission but was followed by rapid in-field progression and then lung
metastasis. She declined
stem cell transplantation and received salvage
brentuximab vedotin (BV)
therapy, which induced dramatic shrinkage of
tumor without significant side effects. Serial followup of PET/CT imaging confirmed a rapid and continuous complete remission for 12 months. Although durability of the remission needs further observation, this case illustrates the excellent efficacy of
brentuximab vedotin in primary refractory
Hodgkin lymphoma.