JOURNAL OF HEMATOLOGY & ONCOLOGY Mandac and Kolonic Journal of Hematology & Oncology 2010, 3:20 http://www.jhoonline.org/content/3/1/20 Open Access LETTER TO THE EDITOR © 2010 Mandac and Kolonic; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and repro- duction in any medium, provided the original work is properly cited. Letter to the Editor Lenalidomide induced good clinical response in a patient with multiple relapsed and refractory Hodgkin's lymphoma Inga Mandac and Slobodanka Ostojic Kolonic* Abstract Background: A 24-year-old female patient was diagnosed with classic Hodgkin's lymphoma in clinical stage II, and combination chemotherapy followed by radiotherapy was initiated. During the following 5 years, the disease progressed despite several standard therapeutic approaches, including autologous and allogeneic stem cell transplantation. Methods: Lenalidomide (25 mg daily) treatment was then initiated in a continuous dosing schedule. Positron emission tomography scans were performed before and during lenalidomide treatment. Hematologic and laboratory values, as well as physical condition were also assessed before and during lenalidomide treatment. Results: Four months after continuous lenalidomide treatment, tumor load was significantly reduced, B symptoms had resolved, and the patient's physical condition had improved, allowing her to resume normal daily-living activities. Evaluations after 15 months of lenalidomide treatment indicated limited disease progression. Nevertheless, the patient was feeling well and maintaining a normal active life. Treatment was well tolerated, allowing the patient to remain on continuous dosing, which has now been maintained for 18 months. Conclusion: Daily, long-term lenalidomide treatment provided clinical benefit and was well tolerated in a patient with relapsed, advanced classic Hodgkin's lymphoma. To the editor In February 2003, a 24-year-old female was diagnosed with classic Hodgkin's lymphoma in clinical stage II. Her initial treatment consisted of 6 cycles of ABVD followed by involved-field radiotherapy of the mediastinal mass, and resulted in complete remission until November 2004, when she suffered a relapse. After a peripheral blood stem cell harvest, she underwent high-dose BEAM che- motherapy and an autologous peripheral blood stem cell transplantation (SCT), which was completed in January 2005 and resulted in complete clinical remission. In October 2005 a second relapse occurred, characterized by infiltration of the malignancy into lymph nodes in the L1 region and pelvis. The patient was treated with radio- therapy to the pelvis and 3 cycles of standard dose BEA- COPP resulting in partial remission lasting until September 2006. In October 2006 a donor was identified and an allogeneic SCT was performed resulting in a com- plete response until February 2008 when positron emis- sion tomography (PET) and multislice spiral computed tomography scans identified relapse (Figure 1A). Chemo- therapy with one cycle of LVPP did not produce a clinical response, so in April and May 2008 the patient under- went two cycles of gemcitabine: 1,000 mg/m 2 on day 1 and day 8. A minor clinical response was observed but the patient's physical condition continued to worsen. Abdominal ultrasound revealed enlarged para-aortal, paracaval, mesenterial, and portal lymph nodes. On June 25, 2008 treatment with continuous daily sin- gle-agent lenalidomide (25 mg) was initiated, outside of a clinical trial setting and based on discussions at the 10th International Conference on Malignant Lymphoma, Lugano, Switzerland, 2008. Prior to treatment initiation, the patient's hematologic and laboratory values were within or close to the normal range (Table 1). By October * Correspondence: ostojic@net.hr 1 Department of Internal Medicine, Merkur University Hospital, Zagreb, Croatia Full list of author information is available at the end of the article