Rossi Cédric, Casasnovas René-Olivier
CHU le Bocage, hématologie clinique, 14, rue Paul-Gaffarel, 21000 Dijon, France; Inserm umr1037, Cancer Research Center of Toulouse, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France.
CHU le Bocage, hématologie clinique, 14, rue Paul-Gaffarel, 21000 Dijon, France; Inserm UMR866, faculté de médecine, 7, boulevard Jeanne-d'Arc, BP 27877, 21078 Dijon cedex, France.
Bull Cancer. 2017 Feb;104(2):182-194. doi: 10.1016/j.bulcan.2016.11.005. Epub 2017 Jan 12.
Classical Hodgkin lymphoma (HL) is a curable disease in 80% of advanced and 90% of localized stages. An improvement of the HL curability is still possible with the emergence of first-line therapy with a better balance between efficacy and toxicity and early identification patients with high risk of failure requiring specific treatment. 18FDG PET-CT gained a major role in the baseline staging and response assessment to HL treatment. The prognostic value of early PET-CT allowed to develop PET-CT guided therapies able to optimize the balance between efficacy and toxicity including the modulation of the chemotherapy intensity or the omission of radiotherapy for some localized diseases. New drugs emerged in the treatment of relapse or refractory HL (brentuximab vedotine [BV], immunological checkpoint inhibitor anti-PD1). Although their place in the strategies of salvage therapy is still debated several trials have reported relevant efficacy in some unmet medical need: refractory patients or relapses after auto/allograft. This review addresses the questions of PET-CT-based therapeutic strategies in first-line and the impact of new drugs targeting the micro-environment (anti-PD1) or the Hodgkin Reed Sternberg cells (BV).
经典型霍奇金淋巴瘤(HL)在80%的晚期和90%的局限期患者中是可治愈的疾病。随着一线治疗的出现,在疗效和毒性之间取得了更好的平衡,并且能够早期识别有高失败风险需要特殊治疗的患者,HL的治愈率仍有可能提高。18FDG PET-CT在HL治疗的基线分期和疗效评估中发挥了重要作用。早期PET-CT的预后价值使得能够开展PET-CT引导的治疗,从而优化疗效和毒性之间的平衡,包括调整化疗强度或对某些局限性疾病省略放疗。在复发或难治性HL的治疗中出现了新药(brentuximab vedotine [BV],免疫检查点抑制剂抗PD1)。尽管它们在挽救治疗策略中的地位仍存在争议,但一些试验已报道在某些未满足的医疗需求方面具有相关疗效:难治性患者或自体/异体移植后的复发。本综述探讨了一线基于PET-CT的治疗策略问题以及靶向微环境(抗PD1)或霍奇金-里德-斯腾伯格细胞(BV)的新药的影响。