Watkins Marcus P, Fanale Michelle A, Bartlett Nancy L
Washington University School of Medicine, St. Louis, MO.
The University of Texas MD Anderson Cancer Center, Houston, TX.
Clin Lymphoma Myeloma Leuk. 2018 Feb;18(2):81-90. doi: 10.1016/j.clml.2018.01.001. Epub 2018 Jan 4.
Until recently, advances in classic Hodgkin lymphoma (HL) treatment primarily consisted of minor modifications of highly effective decades-old chemotherapy and radiation approaches. In early-stage disease, excellent outcomes have been reported with fewer cycles of chemotherapy, lower doses, smaller radiation fields and in some circumstances, radiation elimination. In advanced-stage disease, maintaining the dose intensity of standard chemotherapy regimens has resulted in modest improvements in outcomes. During the past decade, the use of early interim positron emission tomography (PET) scans to escalate or de-escalate treatment has been the subject of intense investigation with the goal of maximizing efficacy and minimizing toxicity. Important updates from recent PET-directed trials include; elimination of bleomycin in patients with advanced-stage HL and negative interim PET findings, the benefit of therapy escalation in patients with unfavorable early-stage HL and positive interim PET findings, and the minimal benefit of consolidative radiotherapy in patients with unfavorable early-stage HL and negative interim PET findings. A more nuanced approach to consolidative radiotherapy is required for patients with favorable early-stage disease based on age, disease sites, secondary cancer risk, and cardiovascular disease. Brentuximab vedotin and nivolumab/pembrolizumab have provided promising new options with surprisingly high response rates and modest toxicity for patients with relapsed HL whose disease does not respond to standard treatments. Incorporating these agents into earlier therapy is an area of active investigation for all stages of HL. Although the overall prognosis for HL patients has seen incremental improvement, efforts to optimize treatment with more effective and less toxic approaches continue.
直到最近，经典型霍奇金淋巴瘤（HL）治疗的进展主要包括对数十年前高效的化疗和放疗方法进行细微调整。在早期疾病中，已有报道称采用较少化疗周期、较低剂量、较小放疗范围，在某些情况下甚至取消放疗，可取得优异的治疗效果。在晚期疾病中，维持标准化疗方案的剂量强度已使治疗效果有适度改善。在过去十年中，使用早期中期正电子发射断层扫描（PET）来调整治疗强度一直是深入研究的课题，目的是使疗效最大化和毒性最小化。近期PET导向试验的重要更新包括：晚期HL且中期PET结果为阴性的患者可取消使用博来霉素；早期HL预后不良且中期PET结果为阳性的患者强化治疗有益；早期HL预后不良且中期PET结果为阴性的患者巩固放疗获益极小。对于早期疾病预后良好的患者，基于年龄、疾病部位、继发癌症风险和心血管疾病，需要采取更细致入微的巩固放疗方法。对于复发HL且疾病对标准治疗无反应的患者，维布妥昔单抗和纳武单抗/派姆单抗提供了有前景的新选择，其缓解率惊人地高且毒性适度。将这些药物纳入早期治疗是HL各阶段积极研究的领域。尽管HL患者的总体预后已逐步改善，但仍在继续努力采用更有效、毒性更小的方法优化治疗。
