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Complete response associated with lenalidomide and celecoxib in a case of primary refractory Hodgkin lymphoma

Authors Garcia-Recio M, Martinez-Serra J, Mestre F, Bento L, Gines J, Ramos R, Daumal J, López P, Sampol A, Gutierrez A

Received 23 May 2018

Accepted for publication 29 June 2018

Published 8 October 2018 Volume 2018:11 Pages 6599—6603


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Federico Perche

Marta Garcia-Recio,1,2 Jordi Martinez-Serra,1 Francesc Mestre,2,3 Leyre Bento,1,2 Jordi Gines,4 Rafael Ramos,2,5 Jaime Daumal,2,6 Paloma López,2,3 Antonia Sampol,1 Antonio Gutierrez1,2

1Hematology Department, 2Lymphoma Unit, 3Radiotherapy Department, 4Pharmacy Department, 5Pathology Department, 6Nuclear Medicine Department, Son Espases University Hospital, IdISBa, Palma, Spain

Abstract: Hodgkin lymphoma (HL) represents ~11% of all lymphoma cases. This disease occurs in young adults, but also affects people over 55 years of age. Despite the fact that >80% of all newly diagnosed patients under 60 will achieve a sustained complete response (CR), 5%–10% of HL patients are refractory to initial treatment and 10%–30% of patients will eventually relapse after an initial CR. The treatment recommendation for primary refractory or relapsed HL patients is salvage therapy followed by high-dose chemotherapy and autologous stem cell transplantation. Following this approach, a significant part will still relapse at any moment. Thus, further research and new drugs or combinations are required. Overexpression of COX-2 has been associated with poor prognosis in relapse/refractory HL patients, so it could be a potential therapeutic target in HL. For this purpose, several drugs may have a role: specific COX-2 inhibitors such as celecoxib or other anti-inflammatory drugs such as lenalidomide may further inhibit lipopolysaccharide-mediated induction of COX-2. Moreover, lenalidomide and COX-2 inhibitors (celecoxib) have been tested in solid tumors with encouraging results. We present a case of a young female diagnosed with a heavily pretreated HL nodular sclerosis subtype who, after failing six treatment lines, only achieved clinical and radiological CR after six cycles of lenalidomide/celecoxib that resulted in an event-free survival of 22 months. We explain the rationale of using this chemotherapy regimen and our patient follow-up.

Keywords: Hodgkin lymphoma, relapse, celecoxib, lenalidomide, COX-2

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