Iraqi Journal of Hematology · Published 2025-01-01 · DOI 10.4103/ijh.ijh_118_24
Using single-agent high-dose melphalan for multiple myeloma and refractory or relapsed (R/R) lymphomas transplant was reported to be clinically beneficial. In view of earlier literature, we opted for this new, modified conditioning regimen (carmustine and melphalan instead of BEAM; B – Carmustine, E – Etoposide, A– Cytarabine, and M– Melphalan) in our patient for autologous hematopoietic stem cell transplantation (aHSCT) to treat relapsed/refractory gastric diffuse large B-cell lymphomas (DLBCLs) in resource-limiting counties like India. In this report, we have articulated all our clinical experiences and insights related to our patient pre- and post-aHSCT in terms of treatment outcomes and survival. Here, we report a case of a 63-year-old male diagnosed with gastric DLBCL and no history of smoking, alcohol, or use of illicit drugs. Routine positron emission tomography–computed tomography (PET-CT) revealed abnormally increased fluorodeoxyglucose (FDG) uptake in parts of the stomach (maximum standardized uptake value: 51.2). Immunohistochemistry revealed high-grade non-Hodgkin’s lymphoma of B-cell phenotype (DLBCL of stomach). The patient was started on 6 cycles of R-CHOP (R – Rituximab, C – Cyclophosphamide, H – Doxorubicin, O – Vincristine, P – Prednisone) regimen. End-of-treatment FDG PET-CT revealed persistent disease. Hence, the patient received radiation therapy (involved-field radiotherapy-45 Gy/25#). Later, the patient was planned for salvage chemotherapy followed by aHSCT. It’s been > 18 months’ post-aHSCT, the patient is event-free and is on a 6-monthly follow-up.
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