Cheah C Y, Chihara D, Horowitz S, Sevin A, Oki Y, Zhou S, Fowler N H, Romaguera J E, Turturro F, Hagemeister F B, Fayad L E, Wang M, Neelapu S S, Nastoupil L J, Westin J R, Rodriguez M A, Samaniego F, Anderlini P, Nieto Y, Fanale M A
Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA Department of Haematology, Pathwest Laboratory Medicine WA and Sir Charles Gairdner Hospital, Nedlands School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Australia.
Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA.
Ann Oncol. 2016 Jul;27(7):1317-23. doi: 10.1093/annonc/mdw169. Epub 2016 Apr 18.
Brentuximab vedotin (BV) is a key therapeutic agent for patients with relapsed/refractory classical Hodgkin lymphoma (cHL). The outcomes of patients experiencing disease progression after BV are poorly described.
We reviewed our institutional database to identify patients with cHL treated with BV who were either refractory to treatment or experienced disease relapse. We collected clinicopathologic features, treatment details at progression and outcome.
One hundred patients met inclusion criteria, with a median age of 32 years (range 18-84) at progression after BV. The median number of treatments before BV was 3 (range 0-9); 71 had prior autologous stem cell transplant. The overall response rate (ORR) to BV was 57%, and the median duration of BV therapy was 3 months (range 1-25). After disease progression post-BV, the most common treatment strategies were investigational agents (n = 30), gemcitabine (n = 15) and bendamustine (n = 12). The cumulative ORR to therapy was 33% (complete response 15%). After a median follow-up of 25 months (range 1-74), the median progression-free (PFS) and overall survival (OS) were 3.5 and 25.2 months, respectively. In multivariate analysis, no factors analyzed were predictive of PFS; age at progression >45 years and serum albumin <40 g/l at disease progression were associated with increased risk of death. Among patients who achieved response to therapy, allogeneic stem cell transplantation was associated with a non-significant trend toward superior OS (P = 0.11).
Patients with BV-resistant cHL have poor outcomes. These data serve as a reference for newer agents active in BV-resistant disease.
本妥昔单抗（BV）是复发/难治性经典型霍奇金淋巴瘤（cHL）患者的关键治疗药物。关于BV治疗后疾病进展患者的预后描述较少。
我们回顾了机构数据库，以确定接受BV治疗的cHL患者，这些患者要么对治疗无效，要么经历了疾病复发。我们收集了临床病理特征、疾病进展时的治疗细节及预后情况。
100例患者符合纳入标准，BV治疗后疾病进展时的中位年龄为32岁（范围18 - 84岁）。BV治疗前的中位治疗次数为3次（范围0 - 9次）；71例患者曾接受过自体干细胞移植。BV治疗的总缓解率（ORR）为57%，BV治疗的中位持续时间为3个月（范围1 - 25个月）。BV治疗后疾病进展，最常见的治疗策略是研究性药物（n = 30）、吉西他滨（n = 15）和苯达莫司汀（n = 12）。治疗的累积ORR为33%（完全缓解率为15%）。中位随访25个月（范围1 - 74个月）后，无进展生存期（PFS）和总生存期（OS）的中位时间分别为3.5个月和25.2个月。多因素分析中，所分析的因素均不能预测PFS；疾病进展时年龄>45岁和血清白蛋白<40 g/l与死亡风险增加相关。在对治疗有反应的患者中，异基因干细胞移植与OS改善呈非显著性趋势相关（P = 0.11）。
对BV耐药的cHL患者预后较差。这些数据可为对BV耐药疾病有效的新型药物提供参考。
