Successful treatment with BrECADD in a patient with Dubin-Johnson syndrome and classic Hodgkin lymphoma: a case report.
Hishan Tharmaseelan, Christian Peter Jaworek, Peter Borchmann et al.
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Case in brief
A 26-year-old man with advanced-stage classic Hodgkin lymphoma also had Dubin–Johnson syndrome (DJS) associated with a homozygous ABCC2 variant, c.2291G>A (p.Gly764Asp). Because MRP2, impaired in DJS, contributes to hepatic elimination of chemotherapy agents, anthracycline-based treatment raised pharmacokinetic concerns. Following a pembrolizumab prephase, he received full-dose BrECADD with therapeutic drug monitoring. Etoposide and doxorubicin pharmacokinetics were normal, and he achieved complete metabolic remission without significant toxicity.
What made this case unusual
The case addresses anthracycline-based chemotherapy in an adult with DJS, where impaired MRP2-mediated drug elimination raised concern; monitoring showed normal etoposide and doxorubicin pharmacokinetics during full-dose BrECADD.
Diagnostic / clinical pearl
In this patient with DJS, therapeutic drug monitoring documented normal etoposide and doxorubicin pharmacokinetics during full-dose BrECADD, supporting the feasibility of this monitored approach in the reported case.