Abstract | March 11, 2024
The First Successful Employment of Brentuximab Vedotin in a Peritoneal Dialysis Patient
Learning Objectives
- Upon completion of this lecture, learners should be better prepared to diagnose primary cutaneous anaplastic large cell lymphoma. Primary cutaneous anaplastic large cell lymphoma is a subtype of cutaneous T-cell lymphoma and ranks as the second most prevalent form of cutaneous T-cell lymphoma, following mycosis fungoides. Its name was derived from the histologic features, characterized by a dermal infiltration of medium to large anaplastic cells. This cutaneous lymphoma also exhibits a notable trait of being strongly positive for CD30 antigen. Its prognosis generally associated with a favorable outcome, but it can be less favorable in cases of multiple skin lesions. Treatment modalities include radiation therapy with a good response rate and chemotherapy.
- Upon completion of this lecture, learners should be better prepared to identify the indication or side effects of Brentuximab Vedotin. Brentuximab Vedotin is a chemotherapeutic agent employed in the treatment of untreated Stage III or IV classical Hodgkin lymphoma, or Hodgkin lymphoma with a high risk of relapse, primary cutaneous/systemic anaplastic large cell lymphoma or other CD30 expressing T-cell lymphomas. Common side effects associated with its use include peripheral neuropathy, infusion reaction, fatigue, nausea, and a rare occurrence of reported progressive multifocal leukoencephalopathy.
- Upon completion of this lecture, learners should be better prepared to discuss and explore further application of Brentuximab Vedotin to end-stage renal disease patient group. Information regarding the utilization of Brentuximab Vedotin in dialysis patients remains exceptionally limited. To our knowledge, a sole case report by Nanni L et al., 2019, reported a successful administration of Brentuximab in a patient receiving hemodialysis. This abstract serves as the primary documentation of its application in a peritoneal dialysis patient with successful outcomes marked by the resolution of pathologic lesions. This preliminary evidence suggests the potential application of Brentuximab in dialysis patients. Further case reports and research studies will broaden the scope of its safe application to include the end-stage renal disease population.
Introduction: Brentuximab Vedotin is a chemotherapeutic agent selectively targeting CD30 antigen. Its indication includes the treatment of Hodgkin lymphoma, systemic/primary cutaneous large-cell lymphoma, and CD30-expressing T-cell lymphomas. As of now, there is no available data on its administration in patients undergoing peritoneal dialysis. This abstract describes the first case regarding the successful employment of Brentuximab Vedotin in a patient with peritoneal dialysis.
Case presentation: A 75-year-old male with a documented medical history of end-stage renal disease on peritoneal dialysis presented at the dermatology clinic due to a rapidly enlarging skin lesion on his right flank. It was described as a 4×3.5cm erythematous oval lesion. Another lesion on the lower back exhibited a similar description. The patient denied any prior episodes of such skin lesions, fever, chills, sweat, or weight changes. Vital signs were within normal. Physical examinations were unremarkable.
The patient underwent a skin biopsy of the right flank lesion due to concerning signs of malignancy. It revealed dermal infiltration of large atypical T-cells with a positive CD30 antigen. His PET/CT scan yielded negative results for additional lesions, except for two aforementioned lesions. Peripheral blood flow cytometry showed no evidence of abnormal T-cells in the blood.
Final Diagnosis: Consequently, he was diagnosed with primary cutaneous anaplastic large-cell lymphoma. Given the localized nature of the patient’s skin cancer, radiation therapy was scheduled.
Management: Unfortunately, the patient developed multiple skin lesions in between, making radiation therapy not a feasible option. After an extensive discussion, he decided to receive Brentuximab Vedotin, a treatment that had never been administered to patients undergoing peritoneal dialysis. Peritoneal dialysis was held on the day he received chemotherapy. He was started with a reduced dosage, taking into consideration his kidney dysfunction, which was complicated by severe weakness. The dosage was further reduced to 0.9mg/kg every 3 weeks. Notably, he experienced an improvement in weakness throughout the cycle and did not report any new side effects.
Following the completion of 9 cycles of Brentuximab, the patient exhibited resolution of the skin lesions. A follow-up PET/CT scan was negative with no evidence of abnormal uptakes, indicating neoplasm.
References and Resources
- Ortiz-Hidalgo C, Pina-Oviedo S. Primary Cutaneous Anaplastic Large Cell Lymphoma—A Review of Clinical, Morphological, Immunohistochemical, and Molecular Features. Cancers. 2023; 15(16):4098. https://doi.org/10.3390/cancers15164098.
- Nanni L, Pellegrini C, Stefoni V, Argnani L, Cavo M, Zinzani PL. Successful Employment of Brentuximab Vedotin in a Patient Undergoing Hemodialysis: The First Real-life Experience. Clin Lymphoma Myeloma Leuk. 2019;19(11):e595-e596. doi:10.1016/j.clml.2019.07.443.
