Institute for Internal Medicine, Medical and Health Science Center, University of Debrecen, Hungary.
Hematol Oncol. 2012 Jun;30(2):98-100. doi: 10.1002/hon.1004. Epub 2011 Oct 28.
Treatment options for relapsing Hodgkin lymphoma (HL) are controversial after autologous hemopoietic stem cell transplantation (HSCT). Nevertheless, allogeneic HSCT may be curative if it is performed in complete remission.
In 2007, a 22-year-old female patient was diagnosed with nodular sclerosis subtype of classical HL. Her clinical stage was IIAX with unfavorable prognosis. Eight courses of doxorubicin, bleomycin, vinblastine and dacarbazine chemotherapy and involved field irradiation were applied, but after 3 months of complete remission, disseminated relapse was recognised by (18)FDG-PET/CT. After two cycles of salvage dexamethasone, cisplatinum, and cytosine arabinoside therapy, further progression was noticed, so the treatment was modified to ifosfamide, gemcitabine, vinorelbine, and prednisone (IGEV) regimen. After two cycles of IGEV regimen, she achieved a complete metabolic remission, which was confirmed by a (18)FDG-PET/CT scan again. She was referred for autologous-HSCT, and a successful stem cell collection was performed in August 2008. However, a rapid progression was detected again, so total body irradiation was applied before the conditioning therapy with R-mini-BEAM regimen. The (18)FDG-PET/CT scan performed 100 days after the autologous-HSCT was still positive. In December 2009, multiple nodal and extranodal progression was detected, so ifosfamide, carboplatine, etoposide, mesna protection rescue treatment was started, but it was ineffective. Based on sporadic data of the literature, rituximab-bendamustine therapy was started in March 2010. After four cycles, she achieved complete metabolic remission, which was verified by (18)FDG-PET/CT. The patient has been referred for an allogeneic HSCT with reduced intensity conditioning.
Based on our experience, bendamustine-rituximab salvage therapy can be a suitable option for the treatment of post-transplant progression or relapse of HL.
自体造血干细胞移植（HSCT）后，复发霍奇金淋巴瘤（HL）的治疗选择存在争议。然而，如果在完全缓解期进行异基因 HSCT，可能具有治愈作用。
2007 年，一名 22 岁女性患者被诊断为经典 HL 的结节性硬化亚型。她的临床分期为 IIAX，预后不良。接受了 8 个疗程的多柔比星、博来霉素、长春碱和达卡巴嗪化疗和受累野照射，但在完全缓解 3 个月后，（18）FDG-PET/CT 发现弥漫性复发。在挽救性地塞米松、顺铂和阿糖胞苷治疗两个周期后，发现进一步进展，因此治疗方案改为异环磷酰胺、吉西他滨、长春瑞滨和泼尼松（IGEV）方案。在 IGEV 方案两个周期后，她达到完全代谢缓解，再次通过（18）FDG-PET/CT 扫描确认。她被转介进行自体-HSCT，并于 2008 年 8 月成功采集干细胞。然而，再次快速进展，因此在 R-mini-BEAM 方案预处理前进行全身照射。自体-HSCT 后 100 天进行的（18）FDG-PET/CT 扫描仍为阳性。2009 年 12 月，检测到多个淋巴结和结外进展，因此开始使用异环磷酰胺、卡铂、依托泊苷、美司钠保护抢救治疗，但无效。基于文献中的零星数据，于 2010 年 3 月开始利妥昔单抗-苯达莫司汀治疗。四个周期后，她达到完全代谢缓解，再次通过（18）FDG-PET/CT 证实。该患者已被转介接受强度降低的异基因 HSCT。
根据我们的经验，苯达莫司汀-利妥昔单抗挽救治疗可作为治疗 HL 移植后进展或复发的合适选择。
