Klin Onkol 2019; 32(1): 66-69. DOI: 10.14735/amko201966.
Background: Allogeneic hematopoietic stem cell transplantation is one of the therapeutic options for patients with relapsed or refractory classic Hodgkin’s lymphoma (cHL). In the case of disease relapse after transplant, other treatment options are still limited (for example donor lymphocyte infusion, and chemotherapy with brentuximab, bendamustine, or other agents) with uncertain outcomes in terms of patient tolerance and long-term disease remission. One way to achieve remission is administration of the PD-1 inhibitor nivolumab, a PD-1 checkpoint inhibitor. Nivolumab is also indicated for the treatment of cHL relapses after autologous hematopoietic stem cell transplantation. Since September 2018, nivolumab has been approved by the State Institute for Drug Control in the Czech Republic for treatment of cHL autologous hematopoietic stem cell transplantation relapse; however, treatment with nivolumab is accompanied by an increased risk of developing fatal, acute graft-versus-host disease. Case: The article describes the development of resistant acute graft-versus-host disease in a patient who had received allogeneic-unrelated transplantation and nivolumab treatment for Hodgkin’s lymphoma relapse. Conclusion: Our case study, as well as the literature review, demonstrates the excellent efficacy of PD-1 inhibitors, but also cautions against the administration of these agents in patients following allogeneic hematopoietic stem cell transplantation. Administration of nivolumab to these patients should be done on a strictly individual basis in the context of known risks, and consideration should be given to other treatment options.
