There was no argument for left ventricular hypertrophy as RV2?+?SV5? ?35?mm. of a 33-year-old male with classical Hodgkin lymphoma who was successfully treated for lymphoma but experienced severe and eventually fatal multisystem organ failure following nivolumab administration and allogeneic stem cell transplantation. Case presentation The patient was diagnosed with stage IIIa nodular sclerosing Hodgkin lymphoma. Originally treated by chemotherapy and autologous stem cell transplantation, he subsequently received two allogeneic stem cell transplants from matched and haplo-identical siblings upon successive disease recurrences. Nivolumab treatment was administered prior to the second allograft, after which total remission of lymphoma was achieved (12 months 10), as evidenced by Rabbit polyclonal to FosB.The Fos gene family consists of 4 members: FOS, FOSB, FOSL1, and FOSL2.These genes encode leucine zipper proteins that can dimerize with proteins of the JUN family, thereby forming the transcription factor complex AP-1. clinical and radiographic examination. However within the next 3?months, the patient went on to develop a constellation of symptoms affecting multiple organs, including acute pneumonia with no evidence of bacterial infection, widespread cutaneous eruptions on trunk and lower limbs, mucosal ulcerations, myositis, diarrhea and colitis. Further complications included hepatic cytolysis, acute renal failure, pancreatitis, as well as complete heart block. Some of these injuries being suggestive of graft-versus-host disease, the patient was administered immunosuppressive therapy (mycophenolate, steroids and polyvalent immunoglobulins), but died shortly afterwards. Tissue biopsies revealed considerable lymphocytic infiltration (mostly CD3?+?T cells) in skin, liver, and Palmitic acid most peculiarly in muscles, including the myocardium. Massive lymphoid-histiocytic infiltration of muscle mass fibers was accompanied by acute necrotizing myositis and endomysial inflammation. Conclusions Palmitic acid Multi-organ failure represents a rare but potentially fatal end result of immune checkpoint blockade in patients receiving allogeneic stem cell grafts. Nivolumab may induce atypical immune-mediated tissue inflammation and damage, such as the considerable muscular polymyositis explained here in a patient with Hodgkin lymphoma. Nivolumab might also worsen GVHD symptoms in the context of allogeneic stem cell transplantation. Irrespective of the actual pathological mechanisms, clinicians should be alerted to these fatal drug-related toxicities. Electronic supplementary material The online version of this article (10.1186/s40164-019-0132-2) contains supplementary material, which is available to authorized users. strong class=”kwd-title” Keywords: Hodgkin lymphoma, Nivolumab, PD1, GVHD, Myositis, Allogeneic stem cell transplantation, Immune-related adverse events Introduction Standard front line treatments such as chemotherapy with or without radiotherapy can cure patients with classical Hodgkin Lymphoma (cHL), however 15C20% of patients relapse or become refractory to these treatments. High dose chemotherapy Palmitic acid followed by autologous stem cell transplant (SCT) is usually proposed for chemosensitive relapse, with an approximate 50% response rate. For patients who relapse after autologous stem cell transplant, numerous options are possible: chemotherapy, radiotherapy, allogeneic SCT, or immune checkpoint blockers, as recently examined by Alinari et al. . Allogeneic SCT with reduced-intensity conditioning regimen (RIC) is usually a validated approach to treat patients with chemoresistant relapse, relapse post autologous transplant, with cells from matched or mismatched unrelated donor, or haploidentical related donor. With these non-myeloablative allogeneic SCT, the 3-12 months overall survival is 63C76%, and the progression-free survival is usually 58C59% [2, 3]; the graft-versus-host disease (GVHD)-free relapse-free survival being longer with haplo-identical donor compared to mismatched unrelated donor or cord blood . The rationale for allografting entails the graft-versus-tumor effect, and long-term anti-tumor responses rely on an immunological effect mediated by donor immune cells. The immune-mediated graft-versus-tumor effect is usually often associated with development of GVHD, GVHD being a major cause of non-relapse Palmitic acid morbidity and mortality after allo-SCT. Besides allo-SCT, targeting of the PD-1/PD-L1 axis represents an alternative strategy to manipulate the immune system in cHL . Anti PD-1 is known to restore anti-tumor immune responses, and the clinical efficacy of this immune checkpoint blocker has been demonstrated in a number of cancers. PD-1-centered therapy is specially interesting in cHL as the predominant cells present inside the tumor are mainly T-cells, along with macrophages, eosinophils, plasma cells, B cells, and neutrophils; whereas malignant Reed-Sternberg cells constitute significantly less than 5% from the tumor mass. PD-1/PD-L1 discussion could donate to immune system subversion in cHL, since an elevated quantity of PD-1?+?tumor-infiltrating lymphocytes is certainly a poor prognostic element of general survival , while up-regulation of PD-L1 is observed on malignant tumor and cells infiltrating macrophages . High expression of PD-L1 in cHL is certainly due to alterations from the PD-L1 locus (9p24 frequently.1 amplification) that are connected with shorter progression free of charge survival . Nivolumab received accelerated authorization from the U recently.S. Meals and Medication Administration (FDA) for individuals with cHL that relapsed or advanced after autologous SCT and.