Successful administration of rituximab-bendamustine regimen in the relapse of Hodgkin lymphoma after autologous hemopoietic stem cell transplantation.
OBJECTIVE
Treatment options for relapsing Hodgkin lymphoma (HL) are controversial after autologous hemopoietic stem cell transplantation (HSCT). Nevertheless, allogeneic HSCT may be curative if it is performed in complete remission.


METHODS
In 2007, a 22-year-old female patient was diagnosed with nodular sclerosis subtype of classical HL. Her clinical stage was IIAX with unfavorable prognosis. Eight courses of doxorubicin, bleomycin, vinblastine and dacarbazine chemotherapy and involved field irradiation were applied, but after 3 months of complete remission, disseminated relapse was recognised by (18)FDG-PET/CT. After two cycles of salvage dexamethasone, cisplatinum, and cytosine arabinoside therapy, further progression was noticed, so the treatment was modified to ifosfamide, gemcitabine, vinorelbine, and prednisone (IGEV) regimen. After two cycles of IGEV regimen, she achieved a complete metabolic remission, which was confirmed by a (18)FDG-PET/CT scan again. She was referred for autologous-HSCT, and a successful stem cell collection was performed in August 2008. However, a rapid progression was detected again, so total body irradiation was applied before the conditioning therapy with R-mini-BEAM regimen. The (18)FDG-PET/CT scan performed 100 days after the autologous-HSCT was still positive. In December 2009, multiple nodal and extranodal progression was detected, so ifosfamide, carboplatine, etoposide, mesna protection rescue treatment was started, but it was ineffective. Based on sporadic data of the literature, rituximab-bendamustine therapy was started in March 2010. After four cycles, she achieved complete metabolic remission, which was verified by (18)FDG-PET/CT. The patient has been referred for an allogeneic HSCT with reduced intensity conditioning.


CONCLUSIONS
Based on our experience, bendamustine-rituximab salvage therapy can be a suitable option for the treatment of post-transplant progression or relapse of HL.
Institute for Internal Medicine, Medical and Health Science Center, University of Debrecen, Hungary. magyarif@freemail.hu
Ferenc
F
Magyari
Zsofia
Z
Simon
Sandor
S
Barna
Miklos
M
Udvardy
László
L
Váróczy
Árpád
Á
Illés
D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000069461:Bendamustine Hydrochloride; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000628:therapy*; D006801:Humans; D009588:Nitrogen Mustard Compounds / Q000008:administration & dosage; D012008:Recurrence; D000069283:Rituximab; D016879:Salvage Therapy; D014182:Transplantation, Autologous
D058846:Antibodies, Monoclonal, Murine-Derived; D009588:Nitrogen Mustard Compounds; D000069283:Rituximab; D000069461:Bendamustine Hydrochloride