Case Description n.2
A 13-year-old boy was diagnosed with cHL stage IIBE, bulky disease, extranodal involvement of pleura and enrolled in the EuroNet-PHL-C2 study, TL-3. The ERA-PET, after 2 OEPA, showed pMR with DS-5. Four DECOPDAC-21 cycles were performed and the LRA-PET showed the complete disappearance of the pathological uptake. One month later, the patient presented Covid-19 and, shortly after, enlargement of left axillary lymphnodes. The excisional biopsy showed no evidence of the disease. However, because of the persistence of the axillary lymphadenopathy, high fever and deteriorated clinical conditions, a new biopsy confirmed relapsed cHL, stage IVB (bone marrow involvement). Based on our previous experience, considering the high risk of the disease, the patient started with BV-DHAP as salvage therapy. The clinical conditions recovered. The interim PET/CT evaluation showed pMR, DS-3; the BM trephine confirmed absence of HL, and stem cell apheresis was successfully performed. The patient proceeded with two further cycles of BV-DHAP. At this moment the disease assessment showed persistent pMR. With the aim to obtain complete metabolic response before HDCT/ASCT, and taking into account the good clinical conditions of the patient, 2 cycles of BV-Bendamustine4 regimen were delivered. Haematological toxicity grade 3-4 without any particular adverse event was reported. The pre-ASCT PET/TC scan evaluation showed a cMR and the boy proceeded to HDCT/ASCT. Considering the features of high-risk disease, the patient started consolidation treatment with 12 doses of BV. At the time of this writing, after 12-month follow-up, the boy is in good clinical conditions free of disease.