Advances in the pathophysiology and treatment of relapsed/refractory Hodgkin's lymphoma with an emphasis on targeted therapies and transplantation strategies.
Advances in the pathophysiology and treatment of relapsed/refractory Hodgkin's lymphoma with an emphasis on targeted therapies and transplantation strategies.
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DOI：
10.2147/blctt.s105458
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Boussiotis VA
中科院分区：
文献类型：
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作者：
Karantanos T;Politikos I;Boussiotis VA
霍奇金淋巴瘤(HL)是高度可治愈的一线治疗。然而，少数患者患有难治性疾病或在完成一线治疗后复发。这些患者接受挽救化疗后的自体干细胞移植(ASCT)，这仍然是治疗难治性或复发性HL的标准治疗方案。然而，在ASCT后，很大比例的此类患者会进展，而异基因造血干细胞移植仍然是这种情况下唯一的治疗方法。难治性或复发性HL的病理生理学研究进展为开发与细胞毒化疗相比具有较强抗HL活性和良好毒性的新型靶向治疗提供了理论基础。Brentuximab vedotin和基于程序性细胞死亡-1的免疫疗法在治疗难治性或复发性HL方面已被证明有效，而其他几种药物在早期临床试验中显示出良好的前景。其中几种药物正在与移植策略相结合，以改善难治性或复发性HL的预后。在这篇综述中，我们总结了难治性/复发性HL的发病机制和现有治疗策略的结果，重点是靶向治疗和造血干细胞移植。
Hodgkin’s lymphoma (HL) is highly curable with first-line therapy. However, a minority of patients present with refractory disease or experience relapse after completion of frontline treatment. These patients are treated with salvage chemotherapy followed by autologous stem cell transplantation (ASCT), which remains the standard of care with curative potential for refractory or relapsed HL. Nevertheless, a significant percentage of such patients will progress after ASCT, and allogeneic hematopoietic stem cell transplantation remains the only curative approach in that setting. Recent advances in the pathophysiology of refractory or relapsed HL have provided the rationale for the development of novel targeted therapies with potent anti-HL activity and favorable toxicity profile, in contrast to cytotoxic chemotherapy. Brentuximab vedotin and programmed cell death-1-based immunotherapy have proven efficacy in the management of refractory or relapsed HL, whereas several other agents have shown promise in early clinical trials. Several of these agents are being incorporated with transplantation strategies in order to improve the outcomes of refractory or relapsed HL. In this review we summarize the current knowledge regarding the mechanisms responsible for the development of refractory/relapsed HL and the outcomes with current treatment strategies, with an emphasis on targeted therapies and hematopoietic stem cell transplantation.