Tun Aung M, Wang Yucai, Matin Aasiya, Inwards David J, Habermann Thomas M, Micallef Ivana, Johnston Patrick B, Porrata Luis, Paludo Jonas, Bisneto Jose Villasboas, Rosenthal Allison, Tun Han W, Cerhan James R, Witzig Thomas E, Nowakowski Grzegorz S, Ansell Stephen M
Division of Hematology, Mayo Clinic, Rochester, MN, USA.
Division of Hematologic Malignancies and Cellular Therapeutics, The University of Kansas, Westwood, KS, USA.
Hemasphere. 2023 Apr 4;7(4):e869. doi: 10.1097/HS9.0000000000000869. eCollection 2023 Apr.
Immune checkpoint inhibitors (ICIs) and brentuximab vedotin (BV) are novel agents for classic Hodgkin lymphoma, including relapse after autologous stem cell transplant (ASCT). However, their impact on survival post-ASCT relapse, in comparison with conventional therapy, is less known due to the lack of randomized controlled trials. Clinical characteristics and outcomes of 115 patients with relapse (or progression) after ASCT are studied. After a median follow-up of 8.59 years from post-ASCT relapse, the median progression-free survival (PFS) and overall survival (OS) were 0.91 and 5.07 years, respectively. Median lines of therapy after post-ASCT relapse was 2 (range, 1-12). The median PFS was not reached (NR) versus 1.11 versus 0.50 versus 0.85 versus 0.78 years ( = 0.006) and OS was NR versus 7.60 versus 3.08 versus 3.51 versus 3.17 years ( = 0.28) in patients first treated with ICIs versus BV versus investigational agents versus chemotherapy versus radiation therapy (RT). First-line treatment with novel agents (ie, ICIs and BV) was associated with superior outcomes compared with investigational agents and chemotherapy/RT with a median PFS of 1.65 versus 0.50 versus 0.79 years ( = 0.003) and a median OS of 7.60 versus 3.08 versus 3.32 years ( = 0.08). Regardless of lines of therapy, the treatment with ICIs had the most favorable outcome with a median PFS and OS of 3.98 and NR years, respectively. Allogeneic stem cell transplant (allo-SCT) was done in 23 patients (20%), and the median post-allo-SCT PFS and OS were 1.31 and 2.35 years, respectively. In conclusion, survival following post-ASCT relapse improves significantly when patients receive novel agents.
免疫检查点抑制剂（ICIs）和维布妥昔单抗（BV）是用于经典型霍奇金淋巴瘤的新型药物，包括自体干细胞移植（ASCT）后的复发情况。然而，由于缺乏随机对照试验，与传统疗法相比，它们对ASCT后复发患者生存的影响尚鲜为人知。我们研究了115例ASCT后复发（或进展）患者的临床特征和结局。从ASCT后复发起，中位随访8.59年，无进展生存期（PFS）和总生存期（OS）的中位数分别为0.91年和5.07年。ASCT后复发后的中位治疗线数为2（范围1 - 12）。初治使用ICIs、BV、研究性药物、化疗或放射治疗（RT）的患者，其PFS中位数未达到（NR），分别为1.11年、0.50年、0.85年、0.78年（P = 0.006）；OS分别为NR、7.60年、3.08年、3.51年、3.17年（P = 0.28）。与研究性药物及化疗/RT相比，初治使用新型药物（即ICIs和BV）的患者结局更佳，PFS中位数分别为1.65年、0.50年、0.79年（P = 0.003），OS中位数分别为7.60年、3.08年、3.32年（P = 0.08）。无论治疗线数如何，使用ICIs治疗的结局最为有利，PFS和OS中位数分别为3.98年和未达到。23例患者（20%）接受了异基因干细胞移植（allo - SCT），allo - SCT后的PFS和OS中位数分别为1.31年和2.35年。总之，ASCT后复发的患者接受新型药物治疗时，生存期显著改善。
