新型药物时代复发难治性霍奇金淋巴瘤患者接受异基因造血干细胞移植的相关结局。
Outcomes associated with allogeneic hematopoietic stem cell transplantation for relapsed and refractory Hodgkin lymphoma in the era of novel agents.
机构信息
Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA.
Division of Hematology and Medical Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA.
出版信息
Cancer Med. 2023 Apr;12(7):8228-8237. doi: 10.1002/cam4.5631. Epub 2023 Jan 18.
BACKGROUND
Relapsed or refractory Hodgkin lymphoma (R/R HL) is a challenging disease with limited treatment options beyond brentuximab vedotin and checkpoint inhibitors. Herein we present the time-trend analysis of R/R HL patients who received allogeneic hematopoietic cell transplantation (allo-HCT) at our center from 2001-2017.
METHODS
The patients were divided into two distinct treatment cohorts: era1 (2001-2010), and era2 (2011-2017). The primary endpoint was overall survival (OS). Secondary endpoints included progression-free survival (PFS), non-relapse mortality (NRM), and cumulative incidence of acute and chronic graft versus host disease (GVHD).
RESULTS
Among the 51 patients included in the study, 29 were in era1, and 22 were in era2. There was decreased use of myeloablative conditioning in era2 (18% vs. 31%) compared to era1 and 95% of patients in era2 previously received brentuximab Vedotin (BV). Haploidentical donors were seen exclusively in era2 (0% vs. 14%) and more patients received alternative donor transplants (7% vs. 32%) in era2. The 4-year OS (34% vs. 83%, p < 0.001) and 4-year PFS (28% vs. 62%, p = 0.001) were significantly inferior in era1 compared to era2. The incidence of 1-year NRM was lower in era2 compared to era1 (5% vs. 34%, p = 0.06). The cumulative incidence of acute GVHD at day 100 was similar in both eras (p = 0.50), but the incidence of chronic GVHD at 1 year was higher in era2 compared to era1 (55% vs. 21%, p = 0.03).
CONCLUSIONS
Despite the advent of novel therapies, allo-HCT remains an important therapeutic option for patients with R/R HL.
背景
复发或难治性霍奇金淋巴瘤（R/R HL）是一种具有挑战性的疾病，除了 Brentuximab vedotin 和检查点抑制剂之外，治疗选择有限。在此，我们报告了 2001-2017 年在我们中心接受异基因造血细胞移植（allo-HCT）的 R/R HL 患者的时间趋势分析。
方法
患者分为两个不同的治疗队列：时代 1（2001-2010 年）和时代 2（2011-2017 年）。主要终点是总生存（OS）。次要终点包括无进展生存（PFS）、非复发死亡率（NRM）以及急性和慢性移植物抗宿主病（GVHD）的累积发生率。
结果
在研究中纳入的 51 例患者中，29 例在时代 1，22 例在时代 2。与时代 1 相比，时代 2 中使用清髓性调理方案的比例降低（18%对 31%），并且时代 2 中 95%的患者之前接受过 Brentuximab Vedotin（BV）。在时代 2 中仅观察到单倍体相合供体（0%对 14%），并且在时代 2 中更多的患者接受了替代供体移植（7%对 32%）。时代 1 的 4 年 OS（34%对 83%，p<0.001）和 4 年 PFS（28%对 62%，p=0.001）明显低于时代 2。时代 2 的 1 年 NRM 发生率低于时代 1（5%对 34%，p=0.06）。两个时代 100 天急性 GVHD 的累积发生率相似（p=0.50），但时代 2 中慢性 GVHD 的发生率高于时代 1（55%对 21%，p=0.03）。
结论
尽管出现了新的治疗方法，但 allo-HCT 仍然是 R/R HL 患者的重要治疗选择。
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