Department of Hematology and Medical Oncology, Emory Winship Cancer Institute, Atlanta, GA.
Hematology Am Soc Hematol Educ Program. 2021 Dec 10;2021(1):234-239. doi: 10.1182/hematology.2021000255.
Positron emission tomography (PET)-adapted chemotherapy and radiotherapy approaches are currently used for the initial treatment of early-stage Hodgkin lymphoma (HL) with progression-free survival and overall survival exceeding 85% and 95%, respectively. However, despite general agreement on the prognostic value of interim PET in HL, frontline treatment approaches vary among institutions with respect to how pretreatment clinical risk factors determine treatment selection, the definition of PET negativity, which chemotherapy regimen to initiate and how many cycles to administer, and when to incorporate radiation. Furthermore, as recent trials have confirmed improved efficacy and manageable toxicity when brentuximab and checkpoint inhibitors are combined with frontline regimens such as doxorubicin, vinblastine, and dacarbazine in advanced-stage HL, these agents are now under evaluation as frontline therapy in early-stage HL. A number of issues will affect the use of these agents in early-stage HL, including the costs, early and late toxicities with these agents, patient population (favorable or unfavorable risk groups), how to incorporate them (concurrently or sequentially), and whether they can ultimately replace cytotoxic therapy with similar efficacy and fewer late effects. Future treatment paradigms for early-stage HL may change significantly once randomized studies are completed incorporating these agents into frontline therapy. Ideally, frontline use of brentuximab and checkpoint inhibitors in early-stage HL will result in improved outcomes compared with current PET-adapted approaches with decreased risks of late toxicities that continue to afflict long-term survivors of HL.
正电子发射断层扫描 (PET)-适应的化疗和放疗方法目前用于早期霍奇金淋巴瘤 (HL) 的初始治疗，无进展生存率和总生存率分别超过 85%和 95%。然而，尽管普遍同意中期 PET 在 HL 中的预后价值，但由于预处理临床危险因素如何决定治疗选择、PET 阴性的定义、起始何种化疗方案以及给予多少个周期以及何时纳入放射治疗等因素，各机构的一线治疗方法存在差异。此外，由于最近的试验证实，在晚期 HL 中联合使用 Brentuximab 和检查点抑制剂与多柔比星、长春碱和达卡巴嗪等一线方案结合可提高疗效和可管理的毒性，这些药物现在正在早期 HL 中作为一线治疗进行评估。许多问题将影响这些药物在早期 HL 中的应用，包括成本、这些药物的早期和晚期毒性、患者人群（有利或不利的风险组）、如何将其纳入（同时或序贯）以及它们是否最终可以用类似疗效和更少的晚期影响的细胞毒性疗法来替代。一旦完成了将这些药物纳入一线治疗的随机研究，早期 HL 的未来治疗模式可能会发生重大变化。理想情况下，早期 HL 中 Brentuximab 和检查点抑制剂的一线使用将导致与当前的 PET 适应方法相比，无进展生存率提高，晚期毒性风险降低，HL 长期幸存者继续受到晚期毒性的影响。
