Successful treatment with BrECADD in a patient with Dubin-Johnson syndrome and classic Hodgkin lymphoma: a case report

Dubin-Johnson syndrome (DJS) results from ABCC2/MRP2 mutations causing impaired biliary transport. MRP2 also mediates hepatic elimination of chemotherapeutic agents, yet no data exist on anthracycline-based chemotherapy in adult DJS patients. We report a 26-year-old male with advanced-stage classic Hodgkin lymphoma and DJS harboring a novel homozygous ABCC2 variant (c.2291G>A, p.Gly764Asp). After a pembrolizumab prephase, full-dose BrECADD was administered, and samples were taken for therapeutic drug monitoring (TDM), which demonstrated normal etoposide and doxorubicin pharmacokinetics. Complete metabolic remission was achieved without significant toxicity. This case demonstrates that TDM-guided, full-dose anthracycline-based chemotherapy is feasible in DJS.