随着布伦妥单抗-维多星和程序死亡-1 (PD-1) 抑制剂的批准，复发/难治型（R/R）经典霍奇金淋巴瘤（cHL）的治疗方式在过去十年中发生了显著变化。我们评估了我们医院从2011年到2020年接受自体造血干细胞移植（AHCT）的R/R cHL患者（N=183）相对于2001年到2010年（N=159）的结果和实践模式的变化，并评估了两个时期的进展无病生存期（PFS）和总生存期 （OS）的预后因素。现代时代的OS优于过去时代（4年生存率为89.1％ vs 79.0％，HR 0.53，95％ CI 0.33-0.85，p = 0.011），趋势表明2年后无复发死亡率下降。在 AHCT 后进展的患者中，现代时代的 4 年进展后生存率从 43.3% 上升到 71.4%，反映了 BV 和 PD-1 抑制剂的使用增加。在现代时代接受移植的患者中进行的多因素分析显示，年龄 ≥45 岁、原发难治病和 AHCT 前未完全缓解与较差的 PFS 相关，而接受 PD-1 抑制剂为基础的方案 AHCT 前则与更优 PFS 相关（HR 0.21，95％ CI 0.05-0.80，p = 0.030）。复发时的组织外病变与更劣的 OS 相关（HR 3.12，95％ CI 1.25-7.77，p = 0.014）。我们的研究证明，现代时代接受 AHCT 的 R/R cHL 患者的生存率得到了改善，其原因是更有效的挽救方案使得 AHCT 前的疾病控制更好，并且 AHCT 后进展的患者的预后也有所改善。在 AHCT 前采用基于 PD-1 抑制剂的挽救方案，其结果是出色的，支持在第二线设置中进行免疫治疗的随机试验。 版权所有 © 2023年美国血液学协会。

The treatment landscape of relapsed/refractory (R/R) classic Hodgkin lymphoma (cHL) has evolved significantly over the past decade following the approval of brentuximab vedotin (BV) and the programmed death-1 (PD-1) inhibitors. We evaluated how outcomes and practice patterns have changed for R/R cHL patients who underwent autologous hematopoietic cell transplantation (AHCT) at our institution from 2011-2020 (N=183) compared to 2001-2010 (N=159) and evaluated prognostic factors for progression-free survival (PFS) and overall survival (OS) in both eras. OS was superior in the modern era (4-year estimates 89.1% vs 79.0%, HR 0.53, 95% CI 0.33-0.85, p=0.011) with a trend towards lower non-relapse mortality beyond 2 years post-transplant. Among patients who progressed after AHCT, 4-year post-progression survival increased from 43.3% to 71.4% in the modern era, reflecting increasing use of BV and the PD-1 inhibitors. In multivariable analysis for patients transplanted in the modern era, age ³45 years, primary refractory disease, and lack of complete remission pre-AHCT were associated with inferior PFS, while receipt of a PD-1 inhibitor-based regimen pre-AHCT was associated with superior PFS (HR 0.21, 95% CI 0.05-0.80, p=0.030). Extranodal disease at relapse was associated with inferior OS (HR 3.12, 95% CI 1.25-7.77, p=0.014). Our study demonstrates improved survival for R/R cHL after AHCT in the modern era attributed to more effective salvage regimens allowing for better disease control pre-AHCT and improved outcomes for patients who progressed after AHCT. Excellent outcomes were observed with PD-1 inhibitor-based salvage regimens pre-AHCT and support a randomized trial evaluating immunotherapy in the second line setting.Copyright © 2023 American Society of Hematology.