Bortezomib In Combination with Dexamethasone and Liposome- Adriamycin Chemotherapy Regimen for Relapsed and Refractory Hodgkin Lymphoma: A Case Report

Abstract 4829

Bortezomib is effective in multiple myeloma, but also in other malignancies, particularly in lymphoma. Here we present a-23-year-old-male patient who complained of a progressive chest pain for 2 years. The CT scan of local hospital showed a mass that measured 5×14cm in the anterior mediastinum. He also had multiple lymphadenopathies in other areas. Tissue biopsy verified Classical Hodgkin lymphoma, nodular sclerosis (NDHL) IIIA. Then he had 12 cycles of ABVD, 1 cycle of MINE and CHOPE, 2 cycles of Hyper-CVAD regimen as prior treatments. Initial therapies induced good responses, but his disease progressed before he was transferred to hospital on December 29, 2009. His blood counts showed that WBC 30×10E9/L, with 89% neutrophils, Hb 99g/L, platelet 452 ×10E9/L. Bone marrow aspiration with immunophenotyping, analysis of TCR/IgH and the chromosome were normal. Biopsy reconfirmed the diagnosis of Hodgkin lymphoma. Lymphoma masses in his right neck, and severe edema with his right arm. He was treated with 2 cycle of IGVP regimen (ifosfamide, gemzar, vindesine, prednsone) and 2 cycles of GIP regimen (ifosfamide, gemzar, prednsone). With more progression, he subsequently received methotrexate and Ara-c with minimal response. Two weeks later, CT showed lung infection and pleural effusion, multiple lymphadenopathy. Lymph nodes decreased mildly and edema disappeared temporary after 3 cycles of R-CHOP. He was then treated with Bortezomib, dexamethasone and L-ADM. Four days after the first cycle, lymphoma masses decreased and significantly and his edema resolved. Due to the severe periphery neuropathy, he declined bortezomib, so 2 weeks later, the symptoms back again, and the FMD regimen (fludarabine, mitoxantrone, dexamethasone) was given. He then chose palliative radiation treatment and eventually died of pneumonia. Nearly 30%-40% of Hodgkin lymphoma relapsed after first line therapy even responds well at the initial stage. To these relapsed ones, the second line therapy including salvage chemotherapy and ASCT (autologous stem cell transplantation) act as the major treatment, but only a minority patients benefit from it. Treatment is limited to relapse and refractory ones hence they deserved more focus. The Bortezomib + L-ADM regimen exhibiting its efficacious after two cycles and the condition changed obviously. Our case is showing more antitumor activity of the new combination relative to either single agent alone. The new regimen responded well and with milder bone marrow suppression. Further study is still needed to demonstrate the relationship between the effective duration and treatment cycles. Some results showed that bortezomib inhibited cell proliferation and induced apoptosis in HL cell lines in a dose-dependent manner. At the same time, it is imperative to be aware of the adverse effects, such as peripheral neuropathy, thrombocytopenia and herpes zoster. As the patient mentioned above, the new regimen may work more optimally if more cycles were carried out, and he would have eventually responded if the complication was well controlled.