BEAMILIKE'MYELOABLATIVE'REGIMEN'CONSISTED'OF'ETOPOSIDE,'ARAI
CYTARABINE,'AND'MELPHALAN'(EAM'PROTOCOL)'COULD'BE'USE'AS'A'
REASONABLE'CONDITIONING'CHEMOTHERAPY'FOR'AUTOLOGOUS'
TRANSPLANT'IN'A'PATIENT'WITH'RELAPSED'HODGKIN'LYMPHOMA'
POSTER'39'
'
Ridho!M.!Naibaho1,2,!Eko!A.!Pangarsa3!and!Catharina!Suharti3!
!
(1)Fellow!in!Hematology!and!Medical!Oncology,!Semarang,!Indonesia,!(2)Dept.!of!Medicine,!Medical!
Faculty! of! Mulawarman! University! and! Parikesit! Hospital,! Kutai! Kartanegara,! Indonesia,! (3)Div.! of!
Hematology!and!Medical!Oncology,!Dept.!of!Medicine,!Medical!Faculty!of!Diponegoro!University!and!
dr.!Kariadi!Hospital,!Semarang,!Indonesia!
!
INTRODUCTION!
BEAM! (carmustine! (BCNU),! etoposide,! AraJcytarabine,! melphalan)! is! considered! as! the!
standard! conditioning! regimen! for! autologous! stem! cell! transplantation! in! malignant!
lymphoma.! So! far,! we! have! always! been! hindered! to! perform! transplants! by! the!
unavailability! of! BCNU! in! Indonesian! drug! formularies.! We! then! employed! a! BEAMJlike!
myeloablative! regimen! consisting! of! etoposide,! AraJcytarabine! and! melphalan! (EAM)! for!
patients!with!Hodgkin!lymphoma,!of!which,!one!of!the!case!will!be!reported!hereunder.!
CASE!PRESENTATION!
We! report! a! young! patient! with! bone! marrow! Hodgkin’s! relapsed! within! 12! months! after!
frontJline! ABVD! (Ann! Arbor! IIIB,! IPS! score=! 3).! Previous! pathological! report! (March! 2017)!
from!cervical!lymphadenopathy!revealed!a!mixed!cellularity!classical!Hodgkin!lymphoma!and!
presence! of! Reed! Sternberg! cells.! Immunohistochemistry! showed! expression! of! CD15+,!
CD30+,!CD3+,!and!Ki67!>30%.!She!was!staged!as!Ann!Arbor!IVBJE!by!PET/CT!(Deauville!score!
5)!at!relapsed.!As!salvage!therapy,!we!treat!her!with!ICE!protocol!showing!partial!remission!
(Interim!PET/CT!showing!Deauville!score!4)!and!later!switched!to!brentuximab!vedotin!with!
ESHAP!(BRJESHAP!regimen)!for!the!second!salvage.!After!2!BRJESHAP!courses,!examination!
by!PET/CT!demonstrated!negative!metabolic!activity!of!the!bone!marrow!(Deauville!score!2).!
She!agreed!to!proceed!autologous!HSCT.!PBSC!harvest!was!done!on!Oct!2019!by!obtaining!a!
CD34+!of!2.31x106/kgBW!and!the!transplant!was!perfomed!in!Dec!2019.!The!EAM!protocol:!
intravenous! etoposide! (200! mg/m2!q24! hours)! and! AraJcytarabine! (200! mg/m2!q12! hours)!
were!admistered!for!4!consecutive!days!(days!–6!to!–3).!Melphalan!140!mg/m2!was!given!as!
a!single!dose!at!days!–2!followed!by!24!hours!freeJchemo!day.!
RESULTS!
Following! stem! cell! infusion,! ablative! phase! of! transplant! can! be! observed! at! day! +2.! The!
neutrophil!begin!to!decline!to!<500/uL!from!day!+4,!while!platelet!<20,000/uL!at!day!+5.!The!
patient! treated! in! a! positive! pressure! isolation! room! and! all! supportive! measure! were!
adapted! per! local! protocol.! Neutrophil! engraftment! ensue! in! day! +15! and! stable! platelet!
count!>!20,000/uL!did!happening!at!day!+20.!With!followJup!of!8!months,!the!patient!is!in!
good!health!with!complete!and!durable!hematopoietic!resolution!with!brentuximab!vedotin!
as!the!maintenance!agent.!
CONCLUSION!
This! case! report! showed! that! the! EAM! protocol! has! the! potential! to! be! successful! and!
effectively! used! in! countries! with! limited! access! to! BCNU! (carmustine).! Further! nonJ
inferiority!trial!could!be!specifically!design!to!provide!a!more!powerful!evidence!on!the!use!
of!EAM!in!clinical!practice.!
SCIENTIFIC PROGRAMME
SESSION I
HODGKIN’S DISEASE
DEBATE I
IS THERE STILL A ROLE
FOR COMBINED MODALITY
THERAPY FOR EARLY
STAGE CHL?
SESSION II
T-CELL LYMPHOMA
ROUNDTABLE I
FUTURE DIRECTIONS IN
T-CELL LYMPHOMA
SESSION III
FOLLICULAR LYMPHOMA
DEBATE II
CAN WE AVOID
CHEMOTHERAPY IN
THE MANAGEMENT OF
FOLLICULAR LYMPHOMA?
SESSION IV
RARE LYMPHOMAS –
MARGINAL ZONE
LYMPHOMA AND
WALDENSTRÖM M
ACROGLOBULINEMIA
ROUNDTABLE II – WHERE
TO GO IN RARE B-CELL
LYMPHOMAS
SESSION V
MANTLE CELL LYMPHOMA
SESSION VI
DIFFUSE LARGE B-CELL
LYMPHOMA
DEBATE III
DO WE STILL NEED ASCT
IN MCL?
SESSION VII
NOVEL THER APEUTIC
CONCEPTS IN B-CELL
LYMPHOMAS
SELECTED ABSTRACTS
FOR AN ORAL
PRESENTATION
SELECTED ABSTRACTS
FOR A POSTER
PRESENTATION
DISCLOSURES