Division of Hematology Oncology, University of South Florida, Tampa, FL USA.
Department of Internal Medicine, University of South Florida, Tampa, FL USA.
J Immunother Cancer. 2017 Jun 20;5:49. doi: 10.1186/s40425-017-0252-3. eCollection 2017.
We report the first case to our knowledge of a patient with relapsed/refractory classical hodgkin lymphoma and liver failure with encephalopathy along with human immunodeficiency virus/acquired immunodeficiency syndrome infection, successfully treated with nivolumab without major side effects and encouraging prolonged disease control.
In December 2015, at the time of the patient's progression from his Hodgkin lymphoma after fourth line treatment, he developed persistent fevers, abdominal distension, jaundice and worsening of his liver function tests. Magnetic resonance imaging of abdomen/pelvis demonstrated hepatomegaly with innumerable new liver lesions, splenomegaly with multiple splenic nodules and several new mediastinal, intraperitoneal and retroperitoneal lymphadenopathy. In accordance with the patient's wishes before admission, and after agreement with the family, nivolumab (3 mg/kg every 2 weeks) was given. Of note, antiretroviral therapy was on hold due to liver function tests, his viral load was undectable and cluster of differentiation 4 counts were 103/uL at the time of nivolumab administration. One week after the first dose of nivolumab both his hepatic encephalopathy and constitutional symptoms started to improve, and after 2 doses, (January 2016) his LFTs were almost back to normal. After 5 months of nivolumab treatment (10 doses), restaging (computerized tomography scans of neck, chest, abdomen, pelvis) done on May 2016 showed resolution of hepatosplenomegaly with two residual small hepatic lesions, heterogeneous spleen with no splenic lesions, and stable non-enlarged retroperitoneal lymph nodes without intraabdominal lymphadenopathy; consistent with partial response.
We report a case of a patient with human immunodeficiency virus/acquired immunodeficiency syndrome -related relapsed/refractory classical Hodgkin lymphoma and acute liver failure with encephalopathy successfully treated with nivolumab after failing all standard therapeutic options. Unlike classic cytotoxic chemotherapy, which relies on preserved organ function to ameliorate potential severe side effects (i.e. myelosuppression), elimination of monoclonal antibodies is fairly independent of baseline renal and hepatic function since they are usually metabolized by circulating phagocytes and/or by their target antigen-expressing cell.
我们报告了首例已知病例，患者患有复发/难治性经典霍奇金淋巴瘤和伴有人类免疫缺陷病毒/获得性免疫缺陷综合征感染的肝衰竭和脑病，成功接受了 nivolumab 治疗，没有出现重大副作用，并取得了令人鼓舞的疾病控制效果。
2015 年 12 月，患者在经历了第四线治疗后霍奇金淋巴瘤进展，出现持续性发热、腹胀、黄疸和肝功能检查恶化。腹部/骨盆磁共振成像显示肝肿大，有无数新的肝脏病变，脾肿大，有多个脾结节，以及一些新的纵隔、腹腔和腹膜后淋巴结病变。根据患者入院前的意愿，并在与家属协商后，给予 nivolumab（每 2 周 3mg/kg）。值得注意的是，由于肝功能检查，抗逆转录病毒治疗暂停，病毒载量不可检测，CD4 计数在给予 nivolumab 时为 103/uL。在接受第一剂 nivolumab 一周后，患者的肝性脑病和全身症状开始改善，在接受两剂治疗后（2016 年 1 月），他的肝功能检查几乎恢复正常。接受 nivolumab 治疗 5 个月（10 剂）后，于 2016 年 5 月进行了再次分期（颈部、胸部、腹部、骨盆计算机断层扫描），结果显示肝脾肿大缓解，有两个残留的小肝脏病变，脾不均匀肿大，无脾病变，以及稳定的非增大腹膜后淋巴结，无腹腔内淋巴结病变；符合部分缓解。
我们报告了一例人类免疫缺陷病毒/获得性免疫缺陷综合征相关复发/难治性经典霍奇金淋巴瘤和伴有肝衰竭和脑病的患者，在所有标准治疗方案失败后，成功接受了 nivolumab 治疗。与依赖于保存器官功能来减轻潜在严重副作用（即骨髓抑制）的经典细胞毒性化疗不同，由于单克隆抗体通常被循环吞噬细胞和/或其靶抗原表达细胞代谢，因此消除单克隆抗体与基线肾功能和肝功能相当独立。
