Case Report
The Use of Etoposide, Ara-Cytarabine, and Melphalan (EAM)
Conditioning Chemotherapy in Autologous Stem Cell
Transplantation (ASCT) for a Patient with Relapsed
Hodgkin’s Lymphoma
Eko A. Pangarsa ,
1
Ridho M. Naibaho ,
2,3
Vina Yunarvika ,
1
Budi Setiawan ,
1
Damai Santosa ,
1
and Catharina Suharti
1
1
Subdivion of Hematology and Medical Oncology, Medical Faculty of Diponegoro University, Dr. Kariadi General Hospital,
Semarang, Indonesia
2
Trainee in Hematology and Medical Oncology, Medical Faculty of Diponegoro University, Dr. Kariadi General Hospital,
Semarang, Indonesia
3
DepartmentofInternalMedicine,ParikesitHospital,MulawarmanSchoolofMedicine,Samarinda,EastKalimantan,Indonesia
Correspondence should be addressed to Eko A. Pangarsa; ekopangarsa90@gmail.com
Received 1 August 2021; Accepted 15 October 2021; Published 3 November 2021
Academic Editor: Kostas Konstantopoulos
Copyright © 2021 Eko A. Pangarsa et al. is is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Up to 20–40% of patients with Hodgkin’s lymphoma will eventually relapse after treatment, among which early relapse
confers a poor outcome. With salvage chemotherapy followed by autologous stem cell transplantation (ASCT), the long-
term remission rate is 30%. We report our experience of using a modified-BEAM conditioning regimen without BCNU
consisting of etoposide, cytarabine, and melphalan (EAM) in a patient with relapsed Hodgkin’s lymphoma. Before
transplantation, the patient achieved second complete remission (CR2) using brentuximab vedotin and ESHAP (BR-
ESHAP) chemotherapy. e ASCT went well without significant complications. is case demonstrated the considerable
efficacy of EAM protocol as a conditioning regimen in terms of sufficient ablative capabilities, and the patient showed a
successful hematopoietic engraftment. Although durability of the disease-free survival needs further observation, it had
nearly 18 months of complete remission and the patient was in good performance status at the time of writing
this manuscript.
1.Background
BEAM (carmustine (BCNU), etoposide, Ara-cytarabine,
and melphalan) is considered as the standard condi-
tioning regimen for autologous stem cell transplantation
(ASCT) in malignant lymphoma [1, 2]. Unexpectedly,
since 2010, the oncological community faced the issue of
shortage of some essential chemotherapy drugs, among
which was BCNU, one of the central components of the
BEAM protocol. Physicians were, thus, forced to change
their standard for those regimens in which a component
was no longer available: two common solutions were to
replace the missing drug with a substitutive agent or even
to skip the unavailable drug, trusting that the modified
regimen would yield a noninferior result in terms of
efficacy and better toxicity profile [3].
BCNU shortage was also reported in Indonesia. So far, we
have always been hindered to perform hematopoietic stem cell
transplants by the unavailability of this particular drug in the
national formularies [4]. We then employed a BEAM-like
myeloablative protocol without the letter “B” consisting of
etoposide, Ara-cytarabine, and melphalan (EAM) for a pre-
parative ASCT regimen [5], of which one of the cases will be
reported here in a patient with Hodgkin’s lymphoma.
Hindawi
Case Reports in Hematology
Volume 2021, Article ID 9632427, 6 pages
https://doi.org/10.1155/2021/9632427