Castagna Luca, Santoro Armando, Carlo-Stella Carmelo
Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan 20089, Italy.
Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan 20090, Italy.
J Blood Med. 2020 Oct 27;11:389-403. doi: 10.2147/JBM.S250581. eCollection 2020.
Relapse/refractory Hodgkin lymphoma patients are still a clinical concern. Indeed, despite more effective first-line chemotherapy regimens and better stratification of unresponsive patients by clinical factors and use of early PET, roughly one-third of such patients need salvage chemotherapy and consolidation with high-dose chemotherapy. In this paper, the authors review the different salvage treatments, with special emphasis on newer combinations with brentuximab vedotin or check point inhibitors. The overall response rate is constantly increasing, with a complete remission rate approaching 80%. Functional response evaluation by PET imaging is a strong predictive factor of longer survival, and more sophisticated tools, such as detection of circulating tumour DNA, are emerging to refine the disease-status assessment after treatment. Consolidation by high-dose chemotherapy is still considered the standard of care in chemosensitive patients, leading to a high fraction of patients towards long-term disease control. Maintenance therapy with BV is now approved, reducing disease relapse/progression. An increasing number of Hodgkin lymphoma patients will be cured after first- and second-line therapy, and long-term toxicity needs to be continuously assessed and avoided.
复发/难治性霍奇金淋巴瘤患者仍是临床关注的问题。事实上,尽管一线化疗方案更有效,且通过临床因素和早期PET对无反应患者进行了更好的分层,但仍有大约三分之一的此类患者需要挽救性化疗并接受大剂量化疗巩固治疗。在本文中,作者回顾了不同的挽救性治疗方法,特别强调了与维布妥昔单抗或检查点抑制剂的新联合方案。总体缓解率不断提高,完全缓解率接近80%。通过PET成像进行功能反应评估是生存期延长的有力预测因素,并且正在出现更复杂的工具,如循环肿瘤DNA检测,以完善治疗后疾病状态的评估。大剂量化疗巩固治疗仍被认为是化疗敏感患者的标准治疗方法,可使很大一部分患者实现长期疾病控制。目前,维布妥昔单抗维持治疗已获批准,可减少疾病复发/进展。越来越多的霍奇金淋巴瘤患者将在一线和二线治疗后治愈,长期毒性需要持续评估并加以避免。
J Blood Med. 2020-10-27
Cancer Chemother Pharmacol. 2002-5
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2020-2
Asian Pac J Cancer Prev. 2023-8-1
Bone Marrow Transplant. 2023-10
Front Oncol. 2023-1-26
Immunotargets Ther. 2022-2-23
Bone Marrow Transplant. 2020-8