Relapsed/refractory classical Hodgkin lymphoma treated with pulsed Boom-Boom radiotherapy combined with a PD-1 inhibitor and decitabine: Two case reports

Abstract Hodgkin lymphoma (HL), characterized by cancerous Reed-Sternberg cells within an inflammatory milieu, poses challenges in relapsed or refractory cases. Current standard treatments, including salvage chemotherapy and autologous stem cell transplantation (ASCT), have limitations in achieving long-term remission. Herein, we present two cases of nodular sclerosing relapsed/refractory Hodgkin's lymphoma treated with personalized ultrafractionated stereotactic adaptive radiotherapy (PULSAR) in combination with a PD-1 inhibitor and Decitabine. Patients underwent PULSAR (2Gy/dose x 2f D1-2 q3w) for recurrent lesions along with PD-1 monoclonal antibody (200mg D0 q3w) and Decitabine (10mg D1-5 q3w) for six cycles. Both patients achieved complete remission (CR) post-treatment, enabling subsequent ASCT and PD-1 maintenance therapy. Follow-up revealed prolonged survival without recurrence. PULSAR, by delivering radiation pulses at longer intervals, allows for tumor adaptation and immune response, potentially enhancing treatment efficacy and minimizing toxicity. Combined with immunotherapy and Decitabine, PULSAR shows promise in managing relapsed/refractory HL, warranting further investigation through clinical trials. This approach signifies a paradigm shift towards precision tumor therapy and immunomodulation in HL management.