PMC8580659_01
Clinical course of the patient after front-line treatment showing (a) PET-interim partial remission after induction ABVD chemotherapy; (b) PET/CT after completion of 6 cycles reveals complete remission and clinical improvement.
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fig1
The interim evaluation after treatment assessed by an 18-FDG PET scan is shown in Figure 1 and revealed a first complete remission (CR1) upon completion of 6 cycles of ABVD.
Clinical course of the patient at relapse. (a) First early relapse showing bone marrow progression (Ann-Arbor IVB-E); (b) partial remission after 2 cycles of the first ICE salvage treatment, with faint uptake over the bone marrow; and (c) complete remission after 2 cycles of second salvage using the brentuximab vedotin-ESHAP protocol.
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fig2
Ann-Arbor IV-B-E by PET/CT scan (Deauville score 5) and showed bone marrow involvement "only." As salvage therapy, we treated her with ICE protocol showing partial remission (Interim PET/CT resulted in Deauville score 4) and then we switched to anti-CD30 brentuximab vedotin in combination with ESHAP (BR-ESHAP regimen) for the second salvage. After 2 BR-ESHAP courses, examination by PET/CT demonstrated a negative metabolic activity of the bone marrow (Deauville score 2), see Figure 2.
PMC8580659_02
EAM protocol scheme at glance. Preharvested autologous stem cells were infused after 1 full day rest without chemotherapy (day zero). BMT, bone marrow transplantation; PBSC, peripheral blood stem cell.
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fig3
The protocol and drug sequence administration are illustrated in Figure 3.
PMC8580659_03
Day-to-day transplant evaluation from conditioning chemotherapy until engraftment. ANC, absolute neutrophil count; Hb, hemoglobin concentration; Plt, platelet count; PRC, packed red cells; and WBC, white blood cell count.
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fig4
Figure 4. Following EAM chemotherapy and stem cell infusion, the ablative phase of transplant can be observed at day +2.