在自体干细胞移植之前使用基于检查点抑制剂的挽救方案可以提高复发/难治性经典霍奇金淋巴瘤的无事件生存率。
Checkpoint inhibitor-based salvage regimens prior to autologous stem cell transplant improve event-free survival in relapsed/refractory classic Hodgkin lymphoma.
发表日期：2023 Mar
作者：
Sanjal H Desai, Michael A Spinner, Kevin David, Veronika Bachanova, Gaurav Goyal, Brad Kahl, Kathleen Dorritie, Jacques Azzi, Vaishalee P Kenkre, Sally Arai, Cheryl Chang, Brendon Fusco, Nuttavut Sumransub, Haris Hatic, Raya Saba, Uroosa Ibrahim, Elyse I Harris, Harsh Shah, Jacob Murphy, Stephen Ansell, Deepa Jagadish, Victor Orellana-Noia, Catherine Diefenbach, Siddharth Iyenger, K C Rappazzo, Rahul Mishra, Yun Choi, Grzegorz S Nowakowski, Ranjana H Advani, Ivana N Micallef
来源：
AMERICAN JOURNAL OF HEMATOLOGY
摘要：
新型拯救疗法的临床试验展现了对于复发/难治性移植适应症经典霍奇金淋巴瘤（R/R cHL）的鼓舞人心的结果，但是与传统化疗的比较缺乏。因此，本文中我们报道了一个多中心回顾性队列的最终分析，研究评估R/R cHL的不同拯救治疗类型在自体干细胞移植（ASCT）之前的疗效。本研究纳入了在美国14家机构进行ASCT的R/R cHL患者。将不同靶向药物、化疗或检查点抑制剂联合拯救治疗的患者与接受传统化疗的患者相比较疗效。研究的终点包括事件无进展生存期（EFS）、无进展生存期（PFS）和总生存期（OS）。所有终点都是基于复发来定义的。共有936名患者，其中728名接受了传统化疗，73名接受了Brentuximab vedotin（BV）联合化疗，70名接受了单用BV，65名接受了检查点抑制剂（CPI）基于方案的拯救治疗。当根据复发时间、ASCT前反应和BV维持治疗使用进行调整后，接受CPI基于方案拯救治疗的患者比接受传统化疗、BV联合化疗和单用BV的患者在2年EFS上有卓越的表现（分别为79.7％、49.6％、62.3％和36.9％，p＜0.0001）。在ASCT前进行了1线拯救治疗的649名患者中，CPI基于方案的拯救治疗与传统化疗相比，在2年PFS上表现更好（98％对68.8％，风险比：0.1，95％置信区间：0.03-0.5，p＜0.0001）。ASCT前拯救治疗方案并不会影响OS。在这项大型多中心回顾性研究中，CPI基于方案的拯救治疗相比其他拯救方案，不受ASCT前反应的影响，能够改善EFS和PFS。这些数据支持先使用CPI基于方案的拯救治疗对R/R cHL进行更早的治疗。 © 2023 Wiley Periodicals LLC.
Clinical trials of novel salvage therapies have encouraging outcomes for relapsed/refractory transplant-eligible classic Hodgkin lymphoma (R/R cHL) but comparison with conventional chemotherapy is lacking. Herein, we report the final analysis of a multicenter retrospective cohort of R/R cHL assessing outcomes by type of salvage therapy before autologous stem cell transplant (ASCT). R/R cHL patients who underwent ASCT at 14 institutions across the United States were included. Outcomes were compared among patients receiving conventional chemotherapy, brentuximab vedotin (BV) + chemotherapy, BV alone, and a checkpoint inhibitor (CPI)-based regimens before ASCT. Study endpoints included event-free survival (EFS), progression-free survival (PFS), and overall survival (OS). All endpoints are defined from relapse. Of 936 patients, 728 received conventional chemotherapy, 73 received BV + chemotherapy, 70 received BV alone, and 65 received CPI-based regimens prior to ASCT. When adjusted for time to relapse, pre-ASCT response and use of BV maintenance, patients receiving CPI-based regimens had superior 2-year EFS compared to conventional chemotherapy, BV + chemotherapy, and BV alone (79.7, 49.6, 62.3, and 36.9%, respectively, p < .0001). Among 649 patients transplanted after 1 line of salvage therapy, CPI-based regimens were associated with superior 2-year PFS compared to conventional chemotherapy (98% vs. 68.8%, hazard ratio: 0.1, 95% confidence interval: 0.03-0.5, p < .0001). OS did not differ by pre-ASCT salvage regimen. In this large multicenter retrospective study, CPI-based regimens improved EFS and PFS compared to other salvage regimens independent of pre-ASCT response. These data support earlier sequencing of CPI-based regimens in R/R cHL in the pre-ASCT setting.© 2023 Wiley Periodicals LLC.