Successful reversal of severe liver function impairment with Brentuximab vedotin in multiply relapsed/refractory classical Hodgkin lymphoma.

Purpose: To present our experience on the use of Brentuximab Vedotin (BV) in patients with relapsed/refractory classical Hodgkin Lymphoma (cHL) and severe liver function impairment with marked jaundice.

Methods: Two patients with relapsed/refractory cHL were evaluated. BV was administered in the presence of liver dysfunction and severe jaundice due to liver infiltration by cHL, as confirmed by PET-CT. Complete blood counts, biochemical profile, physical and imaging findings were reviewed to assess BV efficacy and tolerance.

Results: Case 1 had stage IVB, mixed cellularity cHL. Following ABVD chemotherapy, the patient experienced a relapse and responded to IGEV (ifosfamide, gemcitabine, vinorelbine, steroids) chemotherapy followed by autologous stem cell transplantation (ASCT). Thereafter, he experienced a second relapse with constitutional symptoms, severe jaundice and pancytopenia. Liver involvement was confirmed by PET-CT. Case 2 was admitted with a very late relapse of cHL. After a single cycle of gemcitabine-vinorelbine chemotherapy, which was not tolerated, the patient developed fever, anemia and jaundice, with laboratory findings indicating bone marrow and liver infiltration. The latter was confirmed by PET-CT. Both patients received BV monotherapy according to its formal indication at the reduced dose of 1.2 mg/kg due to severe liver impairment and experienced a rapid clinical and laboratory improvement. BV was well tolerated and offered a clinical benefit for approximately 4 months.

Conclusions: BV was safely administered to patients with relapsed/refractory cHL and severe liver function impairment with marked jaundice due to liver involvement, offering significant clinical improvement and reversal of liver abnormalities. BV may serve as a bridge to further salvage combination chemotherapy or a transplant procedure.