title: Nivolumab in the Treatment of Refractory Pediatric Hodgkin Lymphoma.
abstract: The programmed death-1 (PD-1) pathway of immune evasion is exploited by many malignancies to limit host T-cell-mediated immune responses. Nivolumab is a PD-1-blocking monoclonal antibody that disrupts this pathway and is FDA approved for the treatment of metastatic melanoma, renal cell carcinoma, and squamous non-small cell lung cancer. In this case report, we describe the first published pediatric experience of nivolumab in refractory classic Hodgkin lymphoma. In this patient with primary refractory disease and high disease burden, cytokine release syndrome requiring inotropic support developed following the first infusion of nivolumab. The patient subsequently demonstrated a dramatic clinical response with resolution of fevers, transfusion independence, improvement in functional status, and very good partial response on PET/CT following a single dose. Nivolumab was continued with corticosteroid and antihistamine premedication without further adverse events and clinical benefit was sustained at 11 months after therapy initiation, despite evidence of slow radiographic disease progression.
authors.affiliation: *Faculty of Medicine †Department of Radiology Divisions of ‡Anatomic Pathology ∥Hematology/Oncology/Bone Marrow Transplantation, British Columbia Children's Hospital §Centre for Lymphoid Cancer, British Columbia Cancer Agency ¶Michael Cuccione Childhood Cancer Research Program, Child & Family Research Institute, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Alexandra E
authors.initials: AE
authors.lastname: Foran
authors.forename: Helen R
authors.initials: HR
authors.lastname: Nadel
authors.forename: Anna F
authors.initials: AF
authors.lastname: Lee
authors.forename: Kerry J
authors.initials: KJ
authors.lastname: Savage
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Deyell
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002648:Child; D006689:Hodgkin Disease / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D008297:Male; D000077594:Nivolumab; D000072078:Positron Emission Tomography Computed Tomography; D016879:Salvage Therapy / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D002316:Cardiotonic Agents; D000077594:Nivolumab