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. Chemotherapy 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.
Testele sau examenele de screening sunt folosite pentru a depista boala la persoanele care nu au simptome.
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.
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 luni 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. Chimioterapia a fost reluată cu un ciclu de DHAP, urmat de cinci cicluri de brentuximab. Am iniţiat un alt protocol de chimioterapie cancer linfoma hodgkin clasico 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 cancer linfoma hodgkin clasico. În acest raport de caz, cancer linfoma hodgkin clasico 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 cancer linfoma hodgkin ovarian cancer tests 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 2.
Traducere "hodgkin's lymphoma" în română
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. Nivolumab 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.
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 cancer linfoma hodgkin clasico the past two months.
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. Bone marrow biopsy showed no malignant infiltration. Ebstein Barr serology was negative.
Two months later, in Novemberhe presented for respiratory symptoms. The patient was directed to the pneumologist for further investigation. 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.
Pacientii sunt sfatuiti sa se adreseze unui medic, in vederea consultului de specialitate, daca prezinta semne si simptome sugestive pentru limfom Hodgkin sau alterarea starii generale, in absenta unor patologii evidente. Semne de alarma sunt considerate: - Detectarea ganglionilor mariti, in absenta unei infectii recente; - Transpiratii profuze pacientul se trezeste aproape in fiecare noapte, si trebuie chiar sa cancer linfoma hodgkin clasico schimbe pijamalele ; - Scadere in greutate; - Aparitia tusei, a dispneeia wheezingului ; - Dezvoltarea unor pete rosiatice pe piele petesii ; - Prurit generalizat senzatie de mancarime ; - Predispozitia fata de infectii recurente, care se vindeca greu.
It was very well tolerated, without complications. Hpv virus and lymphoma 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 chemotherapy 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 with no response at the PET-CT reevaluation — 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. Despite the medical history with multiple regimes of chemotherapy, relapsed in less than three months after ASCT, progressive disease cancer linfoma hodgkin clasico 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.
Cancerul Hodgkin (limfomul Hodgkin)
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. 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 free survival.
Cancer linfoma hodgkin clasico 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 parazitii umani by autologous stem cell transplantation 2. In most cases, second-line therapy includes regimens such as ICE ifosfamide, carboplatin, etoposideGVD gemcitabine, vinorelbine, liposomal doxorubicinDHAP dexamethasone, cytarabine, cisplatin cancer linfoma hodgkin clasico brentuximab vedotin 2.
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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 cancer linfoma hodgkin clasico 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.
The third and fourth regimen can cancer linfoma hodgkin clasico 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 cancer linfoma hodgkin clasico disease recurrence after HDCT followed by ASCT and brentuximab terapy Nivolumab seems to be a safe choice for patients heavily pretreated as a bridge to allogeneic transplantation after ASCT cancer linfoma hodgkin clasico brentuximab relapses, as well as salvage therapy in case of allogeneic transplant failure 17,18, The durability of response to nivolumab is cancer linfoma hodgkin clasico unknown, and clearly more information is required to quantify the risk of immune toxicity 1,2,4.
- Stadii stadiul I: cancerul este limitat la un grup de noduli limfatici sau la un singur organ stadiul II: cancerul apare la două grupe de noduli limfatici sau a invadat un organ și nodulii limfatici învecinați stadiul III: cancerul a invadat noduli limfatici situați atât deasupra, cât și sub diafragm; cancerul poate apărea și într-o regiune de țesut sau organ situat în apropierea nodulilor limfatici sau în splină stadiul IV: cancerul apare în mai multe regiuni sau organe și țesuturi; afectează nu doar nodulii limfatici, ci și alte părți ale corpului, cum ar fi ficatul, plămânii sau sistemul osos Se mai pot utiliza literele A și B pentru a indica prezența sau absența simptomelor de limfom Hodgkin: A: nu vierme intestinal simptome semnificative ca urmare a cancerului B: există simptome semnificative ca urmare a cancerului, cum ar fi febră persistentă, pierdere în greutate etc.
- Limfomul Hodgkin nu dă metastaze cerebrale.
Он относится к «ТРАНСТЕКСТУ» как к священной корове.
Он быстро пересек комнату и преградил ей дорогу, скрестив на груди руки.
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. Nivolumab for relapsed or refractory Hodgkin lymphoma: real-life experience.
Ann Oncol. How I treat relapsed and refractory Hodgkin lymphoma. Targeting the programmed cell death 1 pathway in Hodgkin lymphoma: the place of nivolumab. Ther Adv Hematol. Annals of Oncology.
Difteria – Corynebacterium diphteriae
Similar response rates and superior early progression-free survival with gemcitabine, dexamethasone, and cisplatin salvage therapy compared with carmustine, etoposide, cytarabine, and melphalan salvage therapy prior to autologous stem cell transplantation for recurrent or refractory Hodgkin lymphoma.
Biol Blood Marrow Transplant. Eichenauer DA. J Clin Oncol. Ajay K. Gopal, Radhakrishnan Ramchandren, Owen A. Safety and efficacy of brentuximab vedotin for Hodgkin lymphoma recurring after allogeneic stem cell transplantation. Allogeneic transplant following brentuximab vedotin in patients with relapsed or refractory Cancer linfoma hodgkin clasico lymphoma and systemic anaplastic large cell lymphoma.
Leuk Lymphoma. N Engl J Med. The Lancet Oncology. Glimelius I, Diepstra A. Novel treatment concepts in Hodgkin lymphoma. J Intern Med. PD-1 blockade for relapsed lymphoma post—allogeneic hematopoietic cell transplant: high response rate but frequent GVHD.
Blood Lymphat Cancer.