Clinical Case of an Abscopal Effect in a Patient with Hodgkin's Lymphoma Treated with Checkpoint Inhibition and Radiotherapy

Abstract

Introduction. Hodgkin lymphoma (HL) is a malignant lymphoproliferative disorder characterized by Reed-Sternberg cells. Modern clinical research and advanced treatments have achieved high cure rates and overall survival. However, despite novel therapies including checkpoint inhibitors, monoclonal antibodies, and CAR-T cells, some cases remain refractory with unfavorable outcomes. Immunoradiotherapy represents a promising therapeutic approach for HL patients, though global literature on combining radiotherapy with checkpoint inhibitors remains limited to isolated reports.

Case Description. We present a clinical case of a female HL patient with >12-year disease history and multiple prior therapies including autologous hematopoietic stem cell transplantation (auto-HSCT), immunotherapy, and targeted therapy, all followed by disease progression. Given the patient's refusal of allogeneic HSCT, immunoradiotherapy was initiated to induce an abscopal effect. Treatment began with one cycle of pembrolizumab followed by radiotherapy (2 Gy/fraction to 30 Gy total) targeting the right lung hilar lymph node conglomerate, right lower paratracheal nodes, and left axillary nodes. Immunotherapy was continued post-radiation.

Conclusion. Clinical and radiographic assessment demonstrated treatment response including regression of non-irradiated left cervical/supraclavicular lymph nodes. This case confirms that immunoradiotherapy can successfully induce an abscopal effect in refractory HL.