Institute of Haematology, "L. e A. Seràgnoli", University of Bologna, Bologna, Italy.
Br J Haematol. 2019 Jan;184(1):93-104. doi: 10.1111/bjh.15639. Epub 2018 Nov 8.
Autologous stem cell transplantation is the standard salvage strategy for young and fit patients with Hodgkin lymphoma failing induction therapy, and is effective in nearly 50% of cases. The quality of response at transplantation is the most relevant prognostic aspect, as patients in complete response can obtain better outcomes. Therefore, first-line salvage treatments applied before transplantation need to produce high quality responses without excessive myelotoxicity and without affecting peripheral blood stem cell mobilisation. In this sense, the incorporation of new agents active in Hodgkin lymphoma, such as brentuximab vedotin and anti-programmed death 1 antibodies, in conventional regimens, may help to enhance complete remission rates. Working on conditioning regimen and applying a post-autologous consolidation treatment (for example with brentuximab vedotin) are two ways for improving transplant outcomes, particularly in patients displaying high-risk features for early relapse or progression. Allogeneic transplantation maintains its curative potential also in the era of new drugs, although its most correct timing and the most suitable sequence of post-autologous salvage treatments still remain to be determined.
自体干细胞移植是诱导治疗失败的年轻和身体状况良好的霍奇金淋巴瘤患者的标准挽救治疗策略，在近 50%的病例中有效。移植时的反应质量是最相关的预后因素，因为完全缓解的患者可以获得更好的结果。因此，在移植前应用的一线挽救治疗需要产生高质量的反应，而不会产生过度的骨髓毒性，也不会影响外周血造血干细胞动员。从这个意义上说，在常规方案中加入新的在霍奇金淋巴瘤中有效的药物，如 Brentuximab vedotin 和抗程序性死亡 1 抗体，可能有助于提高完全缓解率。优化预处理方案并应用自体干细胞移植后巩固治疗（例如使用 Brentuximab vedotin）是改善移植结果的两种方法，特别是对于那些具有早期复发或进展高风险特征的患者。异体移植在新药时代仍然保持其治疗潜力，尽管其最佳时机和最适合的自体干细胞移植后挽救治疗的顺序仍有待确定。
