Hypertriglyceridemia Induced Pancreatitis Due to Brentuximab Therapy: First Case Report

Abstract

Brentuximab vedotin is used for relapsed classical Hodgkin’s lymphoma and mature T-cell lymphomas. We present a unique case of severe hypertriglyceridemia after one dose of single-agent brentuximab therapy. A Middle-Eastern male with a history of primary progressive cutaneous gamma/delta T-cell lymphoma was started on single-agent brentuximab vedotin therapy. Two weeks after single dose brentuximab therapy, he complained of severe epigastric pain, nausea, vomiting and was admitted to the intensive care unit with acute pancreatitis. Physical examination revealed an acutely ill patient with abdominal tenderness and laboratory data showed triglyceride levels of 3175 mg/dL, glycated hemoglobin (HbA1C) 9%, lipase 145 U/L and glucose 594 mg/dL. Computed tomography scan of the abdomen and pelvis confirmed acute interstitial pancreatitis. With medical management patient triglyceride levels decreased and the patient improved. This is the first case report in literature depicting, brentuximab induced hypertriglyceridemia leading to acute pancreatitis. It is a serious complication and can be lethal. Therefore, it is critical to maintain a high index of suspicion for hypertriglyceridemia induced pancreatitis after single dose brentuximab therapy.

Case Report: Brentuximab Vedotin Associated Acute Pancreatitis in a Pediatric Hodgkin Lymphoma Patient: Case Report and Literature Review

“…Gandhi et al describe a case series of 8 patients with acute pancreatitis that emerged in a median time of 26 days after the first exposure to brentuximab vedotin and 12 days after its recent administration [15]. Maradana et al reported severe hypertriglyceridemia-induced acute pancreatitis 2 weeks after the first brentuximab treatment in a patient with T-cell skin lymphoma [13]. As mentioned earlier, BV is also useful in the treatment of CD30 + ALCL [12].…”

“…The most common adverse reactions include peripheral neuropathy and neutropenia [11,12]. While acute pancreatitis has been described in a few case series and case reports, all previously described patients were adults [13][14][15]. Brentuximab vedotin is the first agent that should be considered while planning the treatment of R/R HL with any novel agents [12].…”

How I Evaluate a High Anion Gap Metabolic Acidosis

“…The etiology of the hypertriglyceridemia was believed to be multifactorial. We suspect that ketoacidosis superimposed on a background of exposure to estradiol 3 and brentuximab, which is associated with hypertriglyceridemia, 4 triggered severe hypertriglyceridemia. The patient was treated with intravenous fluids, opioids, fenofibrate, and fish oil, and the estradiol was discontinued.…”

Sepsis and Acute Pancreatitis in Tumor-Stage Mycosis Fungoides and Treatment with Brentuximab-Vedotin

“…Awareness of the possibility of pancreatitis as a side effect of BV is essential, especially because it seems to occur not immediately but within days or weeks after the treatment application. The literature describes pancreatitis in patients with HL, ALCL and cutaneous Gamma Delta T-cell Lymphoma (GD-TCL) [3]. The onset of pancreatitis in most cases seems to be delayed with a range of 7-33 days [1,4].…”

“…BV reinduction should be carefully discussed. However, in patients without any other treatment options, it might be possible to reinduce BV without the risk of side effect recurrence [1,3].…”