■大约10%-30%的霍奇金淋巴瘤(HL)患者在一线标准治疗后经历复发或难治性(R/R)疾病。Brentuximabvedotin(BV)和免疫检查点抑制剂(ICIs)在R/RHL的挽救治疗中具有重要作用。然而,BV和/或ICI治疗难治性HL的后续治疗具有挑战性.
■我们回顾性分析了两个机构的R/RHL患者,经历过BV或ICI治疗失败,此后接受放疗(RT)。总反应率(ORR),响应持续时间(DOR),无进展生存期(PFS),分析总生存期(OS)。
■总的来说,纳入19例患者。一线全身治疗包括阿霉素,博来霉素,长春碱,和达卡巴嗪(ABVD,84.2%);AVD加ICIs(10.5%);和博来霉素,依托泊苷,阿霉素,环磷酰胺,长春新碱,丙卡巴嗪,和泼尼松(BEACOPP,5.3%)。一线治疗后,15例(78.9%)和4例(21.1%)患者患有难治性疾病和复发,分别。R/RHL诊断后,六(31.6%),两个(10.5%),11例(57.9%)患者同时接受BV和ICIs,BV单药治疗,和ICI单一疗法,分别。所有患者均接受强度调节RT(n=12,63.2%)或体积调节电弧治疗(VMAT;n=7,36.8%)。ORR和完全缓解(CR)率为100%;DOR至RT的中位数为17.2个月(范围,7.9-46.7个月)。两名患者在辐射领域外表现出进展;一名患者在领域内广泛,场外,节点,结外复发.中位随访时间为16.2个月(范围,9.2-23.2个月),1年PFS和OS分别为84.4%和100%,分别。PFS与结外受累(P=0.019)和大体肿瘤体积(P=0.044)相关。所有患者耐受RT良好,无≥3级不良事件。
■RT对于治疗BV或ICIs难治性HL是有效且安全的,并且有可能成为HL综合策略的一部分。
UNASSIGNED: Approximately 10%-30% of patients with Hodgkin\'s lymphoma (HL) experience relapse or refractory (R/R) disease after first-line standard therapy. Brentuximab vedotin (BV) and immune checkpoint inhibitors (ICIs) have important roles in the salvage treatment of R/R HL. However, subsequent treatment for HL refractory to BV and/or ICI treatment is challenging.
UNASSIGNED: We retrospectively analyzed patients in two institutions who had R/R HL, experienced BV or ICI treatment failure, and received radiotherapy (RT) thereafter. The overall response rate (ORR), duration of response (DOR), progression-free survival (PFS), and overall survival (OS) were analyzed.
UNASSIGNED: Overall, 19 patients were enrolled. First-line systemic therapy comprised doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD, 84.2%); AVD plus ICIs (10.5%); and bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP, 5.3%). After first-line therapy, 15 (78.9%) and four patients (21.1%) had refractory disease and relapsed, respectively. After R/R HL diagnosis, six (31.6%), two (10.5%), and 11 (57.9%) patients received BV and ICIs concurrently, BV monotherapy, and ICI monotherapy, respectively. All patients received intensity-modulated RT (n = 12, 63.2%) or volumetric modulated arc therapy (VMAT; n = 7, 36.8%). The ORR as well as the complete response (CR) rate was 100%; the median DOR to RT was 17.2 months (range, 7.9-46.7 months). Two patients showed progression outside the radiation field; one patient had extensive in-field, out-of-field, nodal, and extranodal relapse. With a median follow-up time of 16.2 months (range, 9.2-23.2 months), the 1-year PFS and OS were 84.4% and 100%, respectively. PFS was associated with extranodal involvement (P = 0.019) and gross tumor volume (P = 0.044). All patients tolerated RT well without adverse events of grade ≥ 3.
UNASSIGNED: RT is effective and safe for treating HL refractory to BV or ICIs and has the potential to be part of a comprehensive strategy for HL.