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. 1. Background Despite recent improvement of therapy, the outcome of patients with refractory or relapsed Hodgkin lymphoma (RR-HL) remained compromised [1]. In order to improve the efficacy of induction treatment, the German Hodgkin Study Group (GHSG) developed a more intensive regimen (escalated BEACOPP), which achieved higher response rate (RR) and progression-free survival (PFS), but the overall survival (OS) was not improved due to increase of toxicities [2]. Salvage chemotherapy followed by autologous stem cell transplantation (ASCT) confers a long-term survival rate of 50% for patients with relapsed HL [3]. Unfortunately, this strategy had been less successful for the primary refractory HL, with poor long-term survival (only 30%) but significant morbidities [4]. The optimal therapy for primary refractory HL remains undefined. Brentuximab vedotin (BV), an immunotoxin targeting cell-surface CD30 protein, had demonstrated efficacy in HL and was approved by FDA for treatment of HL relapse after ASCT or failure of two multiagent regimens and not candidates for ASCT. However, its role in the highly resistant primary
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