A case report and literature review of primary resistant Hodgkin lymphoma: a response to anti-PD-1 after failure of autologous stem cell transplantation and brentuximab vedotin.
A case report and literature review of primary resistant Hodgkin lymphoma: a response to anti-PD-1 after failure of autologous stem cell transplantation and brentuximab vedotin.
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原发性耐药霍奇金淋巴瘤病例报告及文献综述：自体干细胞移植和brentuximab vedotin失败后对抗PD-1的反应
DOI：
10.2147/ott.s112472
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发表时间：
2016
影响因子：
4
通讯作者：
Chen B
中科院分区：
文献类型：
--
作者：
Xu P;Wang F;Guan C;Ouyang J;Shao X;Chen B
何杰金淋巴瘤（HL）是一种高度可治愈的血液系统恶性肿瘤，约70%的病例可以通过联合化疗伴或不伴放疗治愈。但是，原发性耐药疾病患者的治愈率<30%。对于这些患者，高剂量化疗后自体干细胞移植（ASCT）被认为是标准治疗。如果患者未能响应ASCT或复发后不久，他们通常会接受另一个ASCT，异基因干细胞移植或新的药物治疗。本病例报告介绍了一例54岁的原发性耐药HL患者，该患者在ASCT复发后接受维布妥昔单抗单药治疗。尽管接受了维布妥昔单抗治疗，但疾病继续进展。在这种高度耐药疾病的患者中，治疗选择有限。根据患者的身体状况和意愿，可以给予pembrolizumab（一种程序性细胞死亡蛋白-1抑制剂）作为挽救治疗。但是，出乎我们的意料，患者在四个周期的pembrolizumab治疗后获得了非常好的部分缓解。在pembrolizumab治疗中未观察到严重不良事件。该病例为治疗原发性耐药霍奇金淋巴瘤提供了一种新的有效策略。
Hodgkin lymphoma (HL) is a highly curable hematologic malignancy, and ~70% of cases can be cured with combination chemotherapy with or without radiation. However, patients with primary resistant disease have a cure rate of <30%. For such patients, high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is considered to be the standard treatment. If patients fail to respond to ASCT or relapse soon thereafter, they usually receive another ASCT, allogeneic stem cell transplantation or treatment with novel agents. This case report presents the case of a 54-year-old patient with primary resistant HL who received single-agent treatment, brentuximab vedotin, after ASCT relapse. Despite treatment with brentuximab vedotin, the disease continued to progress. In patients with such highly resistant disease, the treatment options are limited. Depending on the physical condition and the willingness of the patient, pembrolizumab, a programmed cell death protein-1 inhibitor, can be given as salvage therapy. But, out of our expectation, the patient achieved a very good partial response after four cycles of pembrolizumab. No serious adverse events were observed with pembrolizumab treatment. This case provides support for a new and effective strategy for treating primary resistant Hodgkin lymphoma.