title: Successful treatment with low-dose nivolumab in refractory Hodgkin lymphoma after allogeneic stem cell transplantation.
abstract: Previous studies have reported that an antibody that blocks programmed cell death 1 (PD-1) has therapeutic activity in patients with refractory/relapsed Hodgkin lymphoma (HL). However, the safety and efficacy of these agents in the post-allogeneic stem cell transplantation (allo-SCT) setting are not well known. Here, we describe a patient who was diagnosed as classical HL and treated with five regimens of chemotherapies with autologous SCT. Complete remission (CR) was not achieved following this initial treatment, so we performed allo-SCT from an HLA-matched sibling donor. Since his disease progressed at day 403 after allo-SCT, we decided to use nivolumab in the treatment of his refractory disease. To prevent the worsening of his chronic graft-versus-host disease (GVHD), we reduced the initial dose and frequency of nivolumab compared with the previous report. After four courses of 0.5 mg/kg of nivolumab every three weeks, FDG-PET imaging showed partial response (PR) to the treatment, a remarkable result. However, since the escalated dose of 2 mg/kg resulted in worsening of dyspnea and skin sclerosis, we initiated systemic administration of prednisolone and reduced nivolumab to 1 mg/kg. At the time of this report, his HL is in stable PR with three weekly administration of nivolumab and steroid controlled mild chronic GVHD.
authors.affiliation: Department of Hematology and Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1143, Japan. moni5@mac.com.
authors.forename: Makoto
authors.identifier: http://orcid.org/0000-0003-3864-0823
authors.initials: M
authors.lastname: Onizuka
authors.affiliation: Department of Hematology and Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1143, Japan.|Department of Hematology, Ebina General Hospital, Ebina, Kanagawa, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Kojima
authors.affiliation: Department of Hematology and Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1143, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Matsui
authors.affiliation: Department of Hematology and Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1143, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Machida
authors.affiliation: Department of Hematology and Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1143, Japan.
authors.forename: Masako
authors.initials: M
authors.lastname: Toyosaki
authors.affiliation: Department of Hematology and Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1143, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Aoyama
authors.affiliation: Department of Hematology and Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1143, Japan.
authors.forename: Hidetsugu
authors.initials: H
authors.lastname: Kawai
authors.affiliation: Department of Hematology and Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1143, Japan.|Department of Hematology, Ebina General Hospital, Ebina, Kanagawa, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Amaki
authors.affiliation: Department of Hematology and Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1143, Japan.
authors.forename: Ryujiro
authors.initials: R
authors.lastname: Hara
authors.affiliation: Department of Hematology and Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1143, Japan.
authors.forename: Akifumi
authors.initials: A
authors.lastname: Ichiki
authors.affiliation: Department of Hematology and Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1143, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ogawa
authors.affiliation: Department of Hematology and Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1143, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawada
authors.affiliation: Department of Pathology, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Nakamura
authors.affiliation: Department of Hematology and Oncology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1143, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Ando
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001706:Biopsy; D018450:Disease Progression; D019008:Drug Resistance, Neoplasm; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008297:Male; D058990:Molecular Targeted Therapy; D000077594:Nivolumab; D049268:Positron-Emission Tomography; D011182:Postoperative Care; D061026:Programmed Cell Death 1 Receptor / Q000037:antagonists & inhibitors; D019233:Retreatment; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D061026:Programmed Cell Death 1 Receptor; D000077594:Nivolumab
keywords: GVHD; Hodgkin lymphoma; Nivolumab; PDL-1