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.