Early Radiation-Induced Sarcoma in an Adolescent Treated for Relapsed Hodgkin Lymphoma with Nivolumab

Lukas Šalaševičius; Goda Elizabeta Vaitkevičienė; Ramunė Pasaulienė; Rosita Kiudelienė; Ernesta Ivanauskaitė-Didžiokienė; Donatas Vajauskas; Nemira Jurkienė; Jelena Rascon

doi:10.3390/medicina56040155

Early Radiation-Induced Sarcoma in an Adolescent Treated for Relapsed Hodgkin Lymphoma with Nivolumab

Medicina (Kaunas). 2020 Mar 31;56(4):155. doi: 10.3390/medicina56040155.

Authors

Lukas Šalaševičius¹, Goda Elizabeta Vaitkevičienė^{1

2}, Ramunė Pasaulienė², Rosita Kiudelienė³, Ernesta Ivanauskaitė-Didžiokienė⁴, Donatas Vajauskas^{5

6}, Nemira Jurkienė⁷, Jelena Rascon^{1

2}

Affiliations

¹ Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania.
² Center for Pediatric Oncology and Hematology, Vilnius University, 08406 Vilnius, Lithuania.
³ Center of Pediatric Oncology and Hematology at Pediatric Department and Hospital of Kauno Klinikos, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania.
⁴ National Center of Pathology, 08406 Vilnius, Lithuania.
⁵ Institute of Biomedical Sciences, Department of Radiology, Nuclear Medicine and Medical Physics, Vilnius University, 03101 Vilnius, Lithuanian.
⁶ Radiology and Nuclear Medicine Center, Department of Nuclear Medicine, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania.
⁷ Radiology Clinic, Nuclear Medicine Department of Kauno Klinikos, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania.

Abstract

Radiation-induced sarcoma (RIS) has been reported as a late secondary malignancy following radiotherapy for various types of cancer with a median latency of 10 years. We describe an early RIS that developed in an adolescent within three years of treatment (including PD-L1 check-point inhibitor Nivolumab) of a relapsed classic Hodgkin lymphoma (HL) and was diagnosed post-mortem. The patient died of the progressive RIS that was misleadingly assumed to be a resistant HL based on the positive PET/CT scan. Repetitive tumor biopsies are warranted in cases of aggressive and multi-drug resistant HL to validate imaging findings, ensure correct diagnosis and avoid overtreatment.

Keywords: Hodgkin lymphoma; Nivolumab; children; obesity; post-radiation sarcoma.

Publication types

Case Reports

MeSH terms

Adolescent
Antineoplastic Agents, Immunological / therapeutic use
Female
Hodgkin Disease / drug therapy
Hodgkin Disease / radiotherapy*
Humans
Neoplasms, Radiation-Induced / etiology*
Nivolumab / therapeutic use*
Positron-Emission Tomography / methods
Sarcoma / etiology*

Substances

Antineoplastic Agents, Immunological
Nivolumab