Severe Acute Pulmonary Toxicity Associated with Brentuximab in a Patient with Refractory Hodgkin’s Lymphoma

Abstract

Acute pulmonary toxicity associated with brentuximab appears to be a rare but serious adverse effect that can be potentially fatal. We report the case of a twenty-nine-year-old female with Hodgkin's lymphoma who was treated with brentuximab and later presented with severe acute pulmonary toxicity; she improved after the discontinuation of brentuximab and administration of antibiotics and glucocorticoid therapy. Currently there is very little data in the literature in regard to the clinical manifestations and characteristics of patients taking brentuximab and the potential development of acute severe pulmonary toxicity, as well as the appropriate therapeutic approach, making this particular case of successful treatment and resolution unique.

Infections associated with immunotherapeutic and molecular targeted agents in hematology and oncology. A position paper by the European Conference on Infections in Leukemia (ECIL)

“…Pneumocystis pneumonia (PcP) was rare (0.1−1%) [14]. Noninfectious pulmonary toxicity has been reported [25], but is more likely to be attributable to the coadministration of bleomycin, so that this combination has become contra-indicated [9]. Large phase 3 studies did not show pulmonary toxicity when BV was not combined with bleomycin [21, 23].…”

Brentuximab vedotin: clinical updates and practical guidance

“…Other commonly observed non-hematologic toxicities were nausea, fatigue, diarrhea, pyrexia, rash, or upper respiratory infection. As pulmonary toxicities can occur in conjunction with concurrent or prior bleomycin use [ 72 93 ], the concomitant use of BV with bleomycin is contraindicated. Several reports indicated that BV treatment may induce the reactivation of polyomavirus JC, which can cause fatal progressive multifocal leukoencephalopathy [ 94 95 96 ].…”

Safety profile of brentuximab vedotin in Japanese patients with relapsed/refractory Hodgkin lymphoma or systemic anaplastic large cell lymphoma: a post-marketing surveillance study

“…In both studies, brentuximab vedotin was associated with high response rates and promising progression-free survival (PFS) and overall survival (OS), along with a number of important safety signals including peripheral neuropathy, infections, neutropenia, and infusion reactions [ 3 – 6 ]. Additionally, acute pulmonary toxicity is a rare adverse event (AE) associated with brentuximab vedotin use that is potentially life-threatening [ 7 ].…”