Fludarabine phosphate as an active and well tolerated salvage therapy in an elderly heavily pretreated Hodgkin's disease patient: A case report

Up to two thirds of all patients affected by advanced Hodgkin's disease wil l be cured by chemotherapy alone or by combined chemoradiation modalities. High-dose chemotherapy with autologous stem cell rescue may be potentially curative for patients progressing under frontline chemotherapy or developin g early relapse of disease. In spite of this, an unacceptably high percenta ge of these highrisk patients will relapse after salvage treatments and die of their disease. Fludarabine phosphate is an adenosine nucleoside analog highly active in chronic lymphocytic leukemia and low-grade non-Hodgkin's l ymphomas. There are only few data in the literature concerning its use in t he management of Hodgkin's disease. We report the case of an elderly, heavi ly pretreated Hodgkin's disease patient in progression under third-line che motherapy who experienced good palliation of her B symptoms and a major cli nical response of her refractory bone lesions with the administration of fl udarabine as monotherapy. The treatment was well tolerated, without grade 4 hematological toxicity or opportunistic infections. The duration of clinic al remission and systemic symptom palliation was 9 and 11 months, respectiv ely. Further evaluation of fludarabine phosphate as salvage therapy in rela psed/refractory elderly Hodgkin's disease patients is needed.