Vellemans Hélène, André Marc P E
Department of Hematology, CHU UCL, 530 Yvoir, Belgium.
Cancers (Basel). 2021 Jul 26;13(15):3745. doi: 10.3390/cancers13153745.
Hodgkin lymphoma (HL) is a lymphoid-type hematologic disease that is derived from B cells. The incidence of this lymphoid malignancy is around 2-3/100,000/year in the western world. Long-term remission rates are linked to a risk-adapted approach, which allows remission rates higher than 80%. The first-line treatment for advanced stage classical HL (cHL) widely used today is doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) or escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) chemotherapy. Randomized studies comparing these two regimens and a recently performed meta-analysis have demonstrated consistently better disease control with BEACOPP. However, this treatment is not the standard of care, as there is an excess of acute hematological toxicities and therapy-related myeloid neoplasms. Moreover, there is a recurrent controversy concerning the impact on overall survival with this regimen. More recently, new drugs such as brentuximab vedotin and checkpoint inhibitors have become available and have been evaluated in combination with doxorubicin, vinblastine, and dacarbazine (AVD) for the first-line treatment of patients with advanced cHL with the objective of tumor control improvement. There are still major debates with respect to first-line treatment of advanced cHL. The use of positron emission tomography-adapted strategies has allowed a reduction in the toxicity of chemotherapy regimens. Incorporation of new drugs into the treatment algorithms requires confirmation.
霍奇金淋巴瘤（HL）是一种起源于B细胞的淋巴样血液系统疾病。在西方世界，这种淋巴恶性肿瘤的发病率约为每年2 - 3/10万。长期缓解率与风险适应性治疗方法相关，该方法可使缓解率高于80%。目前广泛用于晚期经典型HL（cHL）的一线治疗是多柔比星、博来霉素、长春花碱和达卡巴嗪（ABVD）化疗或强化博来霉素、依托泊苷、多柔比星、环磷酰胺、长春新碱、丙卡巴肼和泼尼松（BEACOPP）化疗。比较这两种方案的随机研究以及最近进行的一项荟萃分析一致表明，BEACOPP的疾病控制效果更好。然而，这种治疗并非标准治疗方案，因为存在过多的急性血液学毒性和治疗相关的髓系肿瘤。此外，关于该方案对总生存期的影响一直存在争议。最近，诸如贝林妥欧单抗和检查点抑制剂等新药已可供使用，并已与多柔比星、长春花碱和达卡巴嗪（AVD）联合用于晚期cHL患者的一线治疗，目的是改善肿瘤控制。关于晚期cHL的一线治疗仍存在重大争议。采用正电子发射断层扫描适应性策略可降低化疗方案的毒性。将新药纳入治疗方案需要得到证实。
