Case Description n.1
A 15-year-old boy presented classical-HL, advanced stage (IVB) and started treatment according to the EuroNet-PHL-C2 protocol, TL-3. After two OEPA cycles, the PET/CT scan for the early response assessment (ERA) showed partial metabolic response (pMR) with Deauville Score (DS) 5. He went on with 4 DECOPDAC-21 cycles. Late response assessment (LRA) PET/CT scan showed slight residual uptake in the mediastinum, requiring mediastinal residual node radiotherapy (28.8 Gy). The three-month follow-up CT scan showed pulmonary nodules (19mm diameter); the PET/CT revealed high metabolic uptake in the lungs and in multiple supra-diaphragmatic adenopathies. After repeated biopsies, insufficient to confirm the suspect of relapsed disease, the pulmonary biopsy confirmed the diagnosis of R/R cHL. According to the EuroNet-PHL recommendations1, this patient was candidate to HDCT/ASCT. Considering published data in adults3, we decided to take a chance on salvage induction chemotherapy regimen adopting the BV plus DHAP regimen (figure 1) followed by HDCT/ASCT. The boy collected successfully hematopoietic stem cells after one cycle. After 2 cycles, the interim PET/CT revealed complete metabolic response (cMR), DS2. After 4 BV-DHAP the PET/TC showed no pathological uptake. The patient then proceeded to HDCT/ASCT. Hematological toxicity grade 3-4 was reported without any particular adverse event (AE) during the BV-DHAP administration. Considering the high- risk disease, BV consolidation program (12 doses) was added. The boy is in complete remission and good clinical conditions at 36-month follow-up.