mycophenolic-acid and Hodgkin-Disease

Immune checkpoint inhibitor (ICI) treatment has become important for treating various cancer types, including Hodgkin's lymphoma. However, ICI can overstimulate the immune system, leading to a broad range of immunological side effects, known as immune-related adverse events (irAEs). Here, we report a case of optic neuropathy caused by pembrolizumab.. A patient with Hodgkin's lymphoma received pembrolizumab every three weeks. Twelve days after the sixth cycle of pembrolizumab, the patient was admitted to the emergency department with blurred vision, visual field impairment and altered color perception affecting the right eye. The diagnosis of immune-related optic neuropathy was established. Pembrolizumab was stopped permanently and high-dose steroid treatment was immediately started. This emergency treatment led to a satisfactory binocular vision and an improvement of visual acuity testing results. After another 7 months, the left eye was affected with the same symptoms. At this time, only an extended immunosuppressive therapy consisting of high-dose steroid treatment, plasmapheresis, immunoglobulin treatment, retrobulbar injection of steroids and mycophenolate mofetil, successfully reduced the symptoms.. This case highlights the need for prompt recognition and treatment of rare irAEs, such as optic neuropathy. Urgent treatment with initial high-dose steroid treatment is required to avoid persistent loss of visual acuity. Options for further treatment are mainly based on small case series and case reports. In our case, a retrobulbar injection of steroids in combination with mycophenolate mofetil showed significant success in treating steroid-refractory optic neuropathy.

Topics: Antibodies, Monoclonal, Humanized; Hodgkin Disease; Humans; Mycophenolic Acid; Optic Nerve Diseases

To examine disease activity versus treatment as lymphoma risk factors in systemic lupus erythematosus (SLE).. We performed case-cohort analyses within a multisite SLE cohort. Cancers were ascertained by regional registry linkages. Adjusted HRs for lymphoma were generated in regression models, for time-dependent exposures to immunomodulators (cyclophosphamide, azathioprine, methotrexate, mycophenolate, antimalarial drugs, glucocorticoids) demographics, calendar year, Sjogren's syndrome, SLE duration and disease activity. We used adjusted mean SLE Disease Activity Index scores (SLEDAI-2K) over time, and drugs were treated both categorically (ever/never) and as estimated cumulative doses.. We studied 75 patients with lymphoma (72 non-Hodgkin, three Hodgkin) and 4961 cancer-free controls. Most lymphomas were of B-cell origin. As is seen in the general population, lymphoma risk in SLE was higher in male than female patients and increased with age. Lymphomas occurred a mean of 12.4 years (median 10.9) after SLE diagnosis. Unadjusted and adjusted analyses failed to show a clear association of disease activity with lymphoma risk. There was a suggestion of greater exposure to cyclophosphamide and to higher cumulative steroids in lymphoma cases than the cancer-free controls.. In this large SLE sample, there was a suggestion of higher lymphoma risk with exposure to cyclophosphamide and high cumulative steroids. Disease activity itself was not clearly associated with lymphoma risk. Further work will focus on genetic profiles that might interact with medication exposure to influence lymphoma risk in SLE.

Topics: Adult; Antimalarials; Azathioprine; Case-Control Studies; Cyclophosphamide; Female; Glucocorticoids; Hodgkin Disease; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Lymphoma, Non-Hodgkin; Male; Methotrexate; Middle Aged; Mycophenolic Acid; Risk Factors; Young Adult

Topics: Adult; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Azathioprine; Diagnosis, Differential; Drug Therapy, Combination; Epstein-Barr Virus Infections; Female; Gingival Diseases; Hepatitis, Autoimmune; Herpesvirus 4, Human; Hodgkin Disease; Humans; Iatrogenic Disease; Immunocompromised Host; Immunosuppressive Agents; Lymphoproliferative Disorders; Mandibular Diseases; Mycophenolic Acid; Oral Ulcer; Prednisone; Remission Induction; Rituximab; Virus Activation

Topics: Administration, Oral; Adult; Aged; Antibiotics, Antineoplastic; Caproates; Carcinoma; Esophageal Neoplasms; Female; Hodgkin Disease; Humans; Injections, Intraperitoneal; Injections, Intravenous; Leukemia, Lymphoid; Leukemia, Myeloid; Lymphoma, Large B-Cell, Diffuse; Male; Middle Aged; Multiple Myeloma; Mycophenolic Acid; Stomach Neoplasms

Topics: Administration, Oral; Antibiotics, Antineoplastic; Caproates; Fluorescence; Half-Life; Hodgkin Disease; Humans; Injections; Injections, Intravenous; Mycophenolic Acid; Pleura; Spectrophotometry