Eyre Toby A, Phillips Elizabeth H, Linton Kim M, Arumainathan Arvind, Kassam Shireen, Gibb Adam, Allibone Suzanne, Radford John, Peggs Karl, Burton Cathy, Stewart Gillian, LeDieu Rifca, Booth Catherine, Osborne Wendy L, Miall Fiona, Eyre David W, Ardeshna Kirit M, Collins Graham P
Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK.
Br J Haematol. 2017 Nov;179(3):471-479. doi: 10.1111/bjh.14898. Epub 2017 Aug 31.
Relapsed or refractory classical Hodgkin lymphoma (cHL) is associated with a poor outcome when standard chemotherapy fails. Brentuximab vedotin (BV) is an anti-CD30 monoclonal antibody-drug conjugate licensed for use at relapse after autologous stem cell transplant (ASCT) or following two prior therapies in those unsuitable for ASCT. There are limited data assessing the ability of BV to enable curative SCT. We performed a UK-wide retrospective study of 99 SCT-naïve relapsed/refractory cHL. All had received 2 prior lines and were deemed fit for transplant but had an insufficient remission to proceed. The median age was 32 years. Most had nodular sclerosis subtype, Eastern Cooperative Oncology Group performance status 0-1 and advanced stage disease. The median progression-free survival (PFS) was 5·6 months and median overall survival (OS) was 37·2 months. The overall response rate was 56% (29% complete response; 27% partial response). 61% reached SCT: 34% immediately post-BV and 27% following an inadequate BV response but were salvaged and underwent deferred SCT. Patients consolidated with SCT had a superior PFS and OS to those not receiving SCT (P < 0·001). BV is an effective, non-toxic bridge to immediate SCT in 34% and deferred SCT in 27%. 39% never reached SCT with a PFS of 3·0 months, demonstrating the unmet need to improve outcomes in those unsuitable for SCT post-BV.
当标准化疗失败时，复发或难治性经典型霍奇金淋巴瘤（cHL）的预后较差。本妥昔单抗（BV）是一种抗CD30单克隆抗体药物偶联物，被批准用于自体干细胞移植（ASCT）后复发或在那些不适合ASCT的患者接受过两种先前治疗后的复发情况。评估BV实现治愈性干细胞移植（SCT）能力的数据有限。我们在英国范围内对99例未接受过SCT的复发/难治性cHL患者进行了一项回顾性研究。所有患者均接受过2线先前治疗，被认为适合移植，但缓解程度不足无法进行移植。中位年龄为32岁。大多数患者为结节硬化亚型，东部肿瘤协作组体能状态为0 - 1，且处于晚期疾病阶段。中位无进展生存期（PFS）为5.6个月，中位总生存期（OS）为37.2个月。总缓解率为56%（完全缓解率为29%；部分缓解率为27%）。61%的患者接受了SCT：34%在BV治疗后立即接受SCT，27%在BV治疗反应不佳但经挽救后接受了延期SCT。接受SCT巩固治疗的患者的PFS和OS优于未接受SCT的患者（P < 0.001）。BV是34%患者立即接受SCT和27%患者延期接受SCT的有效且无毒的桥梁。39%的患者从未接受SCT，PFS为3.0个月，这表明在BV治疗后不适合SCT的患者中改善预后的需求尚未得到满足。
