Nivolumab
- PDF / 170,343 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 0 Downloads / 152 Views
1 S
Tumour pseudo-progression: case report A 34-year-old woman developed tumour pseudo-progression during treatment with nivolumab for refractory plasmablastic lymphoma (PBL). The woman, who was diagnosed with stage III PBL, was initiated on DA-EPOCH regimen (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin) with radiographic and clinical evidence of partial response. However, after the completion of cycle 5, progression of tumour was observed, and owing to plasmacytoid nature of the disease, she was initiated on KRd regimen (carfilzomib, lenalidomide and low-dose dexamethasone) for a total of 4 cycles with no response. Subsequently, she received one cycle of ICE regimen (ifosfamide, carboplatin and etoposide) with no benefit. Her disease was thus deemed refractory to chemotherapy and plasma celldirected therapy. Given the recent literature indicating PD-L1 expression in PBL and the limited therapeutic options available, she was initiated on nivolumab 3 mg/kg every 2 weeks [route not stated]. She tolerated the therapy well with no immune-mediated toxicity. Repeat PET/CT after 6 doses of nivolumab (i.e. 3 months of nivolumab initiation) revealed worsening disease activity. The woman was continued on nivolumab therapy, given the possibility of tumour pseudo-progression as she was clinically well with evidence of reduced pain requiring lower doses of narcotics [specific drug not stated]. The tumour pseudo-progression was attributed to nivolumab. Repeat PET/CT following 11 cycles of nivolumab showed significant improvement in PBL. She was maintained on therapy and PET/CT following 16 doses of nivolumab showed continued improvement in PBL. Given the excellent but partial response to immunotherapy, good performance status and lack of other comorbidities, the woman underwent an allogeneic transplant. Nivolumab was discontinued 6 weeks prior to transplant, given the increased risk of graft versus host disease (GvHD) in this setting. She was discharged from the hospital at 65 days post-transplant. To date, there was no evidence of GvHD. Damlaj M, et al. Therapeutic Potential of Checkpoint Inhibitors in Refractory Plasmablastic Lymphoma. Clinical Lymphoma, Myeloma & Leukemia 19: e559-e563, No. 10, 803503858 Oct 2019. Available from: URL: http://doi.org/10.1016/j.clml.2019.06.008
0114-9954/20/1823-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 26 Sep 2020 No. 1823
Data Loading...
