Samara Yazeed, Mei Matthew
Division of Hematology and Medical Oncology, Harbor-UCLA Medical Center, Torrance, CA 90502, USA.
Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA 91010, USA.
Cancers (Basel). 2022 Mar 29;14(7):1738. doi: 10.3390/cancers14071738.
Standard treatment for relapsed and/or refractory (/) Hodgkin lymphoma (HL) consists of salvage therapy, historically consisting of multiagent cytotoxic chemotherapy, followed by autologous stem cell transplantation (autoHCT) in responding patients. With this approach, most patients can proceed to autoHCT, of whom approximately half are cured. However, the introduction of the novel agents brentuximab vedotin (BV) and the checkpoint inhibitors (CPI) nivolumab and pembrolizumab has changed the decision making and peri-transplant decision making, as early incorporation of one or more of these agents can reduce or even eliminate the need for cytotoxic chemotherapy prior to autoHCT. Furthermore, post-autoHCT maintenance therapy with BV has also been shown to decrease relapse in high-risk rel/ref HL patients. In this review, we survey the current data regarding autoHCT in HL with a focus on pre-autoHCT salvage as well as maintenance strategies, and we also talk about the emerging data challenging the long-held dogma of chemosensitivity being a requirement for successful autoHCT.
复发和/或难治性霍奇金淋巴瘤(HL)的标准治疗包括挽救性治疗,传统上是多药细胞毒性化疗,随后对有反应的患者进行自体干细胞移植(autoHCT)。采用这种方法,大多数患者可以进行autoHCT,其中约一半可治愈。然而,新型药物本妥昔单抗(BV)以及检查点抑制剂(CPI)纳武利尤单抗和帕博利尤单抗的引入改变了决策制定和移植前后的决策,因为早期加入这些药物中的一种或多种可以减少甚至消除autoHCT前进行细胞毒性化疗的必要性。此外,BV进行autoHCT后维持治疗也已被证明可降低高危复发/难治性HL患者的复发率。在本综述中,我们调查了HL中有关autoHCT的当前数据,重点是autoHCT前的挽救治疗以及维持策略,并且我们还讨论了挑战长期以来认为化学敏感性是成功进行autoHCT的必要条件这一教条的新出现的数据。