Info

🌱 來自: treatment of hodgkin lymphoma (HL)

Refractory_relapsed Hodgkin lymphoma

Management: Relapsed Classical Hodgkin Lymphoma

• salvage chemotherapy such as
  • ICE, DHAP, or GVD
  • followed by consolidative autologous stem cell transplant if responsive
• pre-SCT predictor of outcomes
  • PET-negative CR regardless of whether 1 or 2 salvage regimens is required
• Single agent Brentuximab can achieve CRs in 25–30% of pts & avoid multiagent chemotherapy in a subset of pts

(JCO 1993;11:1062) (Blood 2012;119:1665) (Lancet Oncol 2015;16:284)

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RFs for adverse outcome post relapse

• Remission duration <12 mos
• B-sx
• Extranodal disease

Rx In these pts,

• maintenance Brentuximab q3w × 12 mos improves PFS

(Blood 2001;97:616) (AETHERA, Lancet Oncol 2015)

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In pts relapsing after autologous SCT,

2 strategies are particularly effective:

• Brentuximab vedotin
  • 75% RR in post-ASCT setting
  • achieves long-term remissions about 20% CR

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• PD-1 blockade w/ nivolumab or pembrolizumab
  • 65–70% RR
  • achieves long-term (>1 y) remissions in at least 40% of pt
  • increased risk of post-allo SCT GVHD in pts w/ prior anti-PD-1

(Chen, Blood 2016) (Lancet Oncol 2016:17:1283; JCO 2016;34:2698)