a 17-year - old girl presented with painless swelling of the right neck and supraclavicular lymph nodes accompanied with fever and fatigue in february 2007 .
the pathology report after lymph node biopsy indicated that the normal lymph node structure had disappeared and scattered distributions of reed - sternberg ( rs ) cells and hodgkin disease ( hd ) cells occurred .
immunohistochemical staining showed that these cells were positive for cd30 ( figure 1a ) , paired box protein 5 ( pax5 ) ( figure 1b ) , and epstein - barr virus ( ebv ) , and negative for cd15 and anaplastic lymphoma kinase ( alk ) .
treatment with 4 cycles of abvd was conducted as induction chemotherapy followed by bilateral neck and supraclavicular radiation therapy ( 36 gy ) .
the patient achieved complete remission ( cr ) but , after about 1 year , relapsed with inguinal and mediastinal lymph node involvement , as detected by positron emission tomography ( pet)/computed tomography ( ct ) scan .
afterwards , 8 cycles of salvage chemotherapy with cyclophosphamide , vindesine , epirubicin , and prednisone ( chop ) were performed , and the patient achieved cr again .
a pet / ct scan in april 2010 indicated relapse , with mediastinal , left axillary , retroperitoneal , pelvic cavity , and inguinal lymph node involvement and multiple nodules at the thoracolumbar vertebrae , right iliac crest , and right ischium .
the patient was diagnosed with hl of nodular sclerosis subtype after a left inguinal lymph node biopsy .
she then underwent 2 cycles of salvage chemotherapy with rituximab , cyclophosphamide , vindesine , epirubicin , prednisone , and etoposide ( r - chope ) and underwent asct in december 2010 .
a pet / ct scan in june 2011 subsequently demonstrated relapse once more , with nodules in the liver , spleen , and lung ( figure 2a ) .
consequently , 2 cycles of salvage chemotherapy with gemcitabine , dexamethasone and nedaplatin ( gdp ) were given , but the disease persisted at the end of therapy .
on october 20th , 2011 , results of ct scan showed that the number and size of nodules in the lung significantly increased ( figure 2b ) .
the patient exhibited persistent fever and systemic failure , and showed an eastern cancer oncology group ( ecog ) score of 3 . in october 2011 ,
the patient began brentuximab monotherapy , with a dose of 1.8 mg / kg , once every 3 weeks .
following the first course of brentuximab , the patient 's body temperature dropped gradually after 4 days of treatment and returned to normal 1 week later . because of bone marrow involvement , white blood cell , hemoglobin , and platelet counts decreased markedly before treatment .
however , the patient continued with brentuximab therapy without interruption under the support of granulocyte colony - stimulating factor ( g - csf ) , thrombopoietin ( tpo ) , and interleukin-11 ( il-11 ) . following the first course of brentuximab
, ct scan showed that the lung nodules were significantly reduced in size and number ( figure 2c ) .
after the second treatment , the patient began to recover from pancytopenia and regain physical strength , and her condition improved significantly . after the third course of treatment , the patient was capable of self - care , indicating an ecog score of 2 .
pet / ct scan suggested partial remission ( pr ) . after the fourth course of treatment , anemia began to improve , with hemoglobin increasing from 60 to 100 g / l .
after physical activity palpitations disappeared , the patient 's heart rate fell from 110130 to 7080 beats / min .
shrinkage was noted in multiple nodular shadows in double lung fields ( figure 2d ) .
after the sixth course of treatment , hemoglobin count had nearly returned to normal , and lesions in the lungs , liver , spleen , bones , mediastinum , and abdomen significantly decreased .
a pet / ct scan showed that the lung nodules had disappeared , and the maximum standard uptake values ( suvmax ) of thoracolumbar vertebral nodules and liver and spleen nodules had decreased to normal ( figure 3 ) .
the patient encountered reversible adverse reactions during treatment , including peripheral neuropathy , elevated aminotransferases , hair loss , and dry cough , and these adverse effects were controlled with symptomatic treatments . at the time this paper was submitted
tissue specimens were collected after lymph node biopsy , sectioned , and stained to detect cd30 and pax5 .
a , reed - sternberg ( rs ) cells show cd30-positive membrane ( white arrow ) .
a , nodules before treatment with gemcitabine , dexamethasone , and nedaplatin ( gdp ) in june 2011 .
c , in november 2011 , after the first course of brentuximab , significant shrinkage of lung nodules was noted .
d , in february 2012 , after the fourth course of brentuximab , the nodules had nearly disappeared .
we introduced brentuximab therapy to a patient with hl refractory to chemotherapy , radiotherapy , and asct .
the patient 's most recent relapse involved several organs , including the liver , lungs , bones , bone marrow , and mediastinal and retroperitoneal lymph nodes . to the best of our knowledge ,
this is the first patient with hl in the mainland of china who underwent brentuximab treatment .
brentuximab , a new targeted therapy for lymphoma , is an antibody - drug conjugate which consists of the anti - cd30 monoclonal antibody cac10 conjugated with the cytotoxic agent monomethyl auristatin e ( mmae ) . as a monoclonal antibody
moreover , chemotherapeutic drugs can also be coupled to the monoclonal antibody to directly target tumor cells , resulting in more specific and effective anti - tumor action .
this new drug has shown dramatic efficacy on a number of relapsed and refractory hl patients .
our data showed that brentuximab 's efficacy on this refractory and relapsed case appeared quickly .
further , after 6 courses of brentuximab , all lesions disappeared and cr was achieved .
adverse effects including peripheral neuropathy , elevated aminotransferases , hair loss , and dry cough appeared but could be controlled with symptomatic treatments .
 at present , approximately 20% of hodgkin lymphomas ( hl ) are relapsed and refractory , and therapeutic methods including chemotherapy , radiotherapy , and even stem cell transplantation are unsatisfactory . 
 brentuximab vedotin , composed of cd30 antibody and a chemotherapeutic agent , is a new targeted drug that eradicates tumor cells by binding to the cd30 antigen on their surface . in clinical trials , 
 the response rate and complete remission rate of this drug were 73% and 40% , respectively , for relapsed and refractory hl . 
 here we report a case of cd30-positive relapsed and refractory hl that was treated with brentuximab . before the treatment with brentuximab , the patient underwent chemotherapy , radiotherapy , and autologous stem cell transplantation . 
 however , the disease continued to progress , affecting multiple organs and prompting symptoms such as persistent fever . 
 after the treatment with brentuximab , the patient 's condition improved . 
 body temperature returned to normal after 4 days . 
 lung nodules were reduced in size and number after a single course of treatment , and pet / ct showed partial remission and complete remission after 3 and 6 courses of treatment , respectively . 
 the entire treatment process progressed smoothly , though the patient experienced some symptoms due to chemotherapy , including peripheral neuritis of the limbs , irritating dry cough , and mild increase in aminotransferase . 
 no serious adverse effects were observed . 
 the current general condition of the patient is good ; the continuous complete remission has amounted to 6 months . 