Hematopoietic stem cell mobilization following PD-1 blockade: Cytokine release syndrome after transplantation managed with ascorbic acid

Eur J Haematol. 2019 Aug;103(2):134-136. doi: 10.1111/ejh.13248. Epub 2019 Jun 7.

Abstract

Checkpoint inhibitor therapy is effective in the treatment of relapsed classical Hodgkin's Lymphoma. Here, we report a patient with relapsed Hodgkin's Lymphoma who received nivolumab prior to autologous stem cell mobilization. She went on to develop cytokine storm shortly following transplantation, with marked T-cell proliferation coincident with myeloid engraftment. Non-cardiogenic pulmonary edema and alveolar hemorrhage developed despite corticosteroid therapy. There was rapid and complete resolution of these complications with parenteral ascorbic acid infusion. Our case illustrates the risk of cytokine release syndrome following infusion of stem cells mobilized after checkpoint inhibitor therapy and the role of ascorbic acid in its management.

Keywords: Hodgkin's lymphoma; bone marrow transplantation; transplantation.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antineoplastic Agents, Immunological / administration & dosage
  • Antineoplastic Agents, Immunological / adverse effects
  • Antineoplastic Agents, Immunological / therapeutic use*
  • Ascorbic Acid / administration & dosage
  • Cytokine Release Syndrome / diagnosis
  • Cytokine Release Syndrome / drug therapy
  • Cytokine Release Syndrome / etiology
  • Disease Management
  • Female
  • Hematopoietic Stem Cell Mobilization* / methods
  • Hematopoietic Stem Cell Transplantation / adverse effects
  • Hematopoietic Stem Cell Transplantation / methods
  • Hodgkin Disease / complications*
  • Hodgkin Disease / diagnosis
  • Hodgkin Disease / therapy*
  • Humans
  • Immunohistochemistry
  • Immunophenotyping
  • Neoplasm Staging
  • Programmed Cell Death 1 Receptor / antagonists & inhibitors*
  • Tomography, X-Ray Computed
  • Transplantation Conditioning

Substances

  • Antineoplastic Agents, Immunological
  • Programmed Cell Death 1 Receptor
  • Ascorbic Acid