放疗在接受布仑妥昔单抗韦多汀和/或免疫检查点抑制剂治疗后的难治性霍奇金淋巴瘤患者中的作用

IF 7.6 Q1 ONCOLOGY Journal of the National Cancer Center Pub Date : 2024-03-01 DOI:10.1016/j.jncc.2023.11.001

Ruizhi Zhao , Han Shao , Guiqing Shi , Yanyan Qiu , Tianlan Tang , Yuping Lin , Silin Chen , Cheng Huang , Siqin Liao , Jinhua Chen , Haiying Fu , Jianzhi Liu , Benhua Xu , Tingbo Liu , Yujing Zhang , Yong Yang

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引用次数: 0

摘要

背景约有10%-30%的霍奇金淋巴瘤（HL）患者在接受一线标准治疗后复发或难治（R/R）。布伦妥昔单抗维多汀（BV）和免疫检查点抑制剂（ICIs）在R/R HL的挽救治疗中发挥着重要作用。方法我们回顾性分析了两家机构的R/R HL患者，这些患者经历了BV或ICI治疗失败，之后接受了放疗（RT）。我们分析了总反应率（ORR）、反应持续时间（DOR）、无进展生存期（PFS）和总生存期（OS）。一线系统治疗包括多柔比星、博来霉素、长春新碱和达卡巴嗪（ABVD，84.2%）；AVD加ICIs（10.5%）；博来霉素、依托泊苷、多柔比星、环磷酰胺、长春新碱、丙卡巴嗪和泼尼松（BEACOPP，5.3%）。经过一线治疗后，分别有 15 名（78.9%）和 4 名（21.1%）患者出现难治性疾病和复发。R/R HL确诊后，分别有6名（31.6%）、2名（10.5%）和11名（57.9%）患者同时接受了BV和ICI治疗、BV单药治疗和ICI单药治疗。所有患者都接受了强度调控 RT（12 人，63.2%）或容积调控弧治疗（VMAT；7 人，36.8%）。ORR和完全缓解（CR）率均为100%；RT的中位延迟时间为17.2个月（范围为7.9-46.7个月）。两名患者在放射野外出现进展；一名患者出现广泛的放射野内、放射野外、结节和结节外复发。中位随访时间为16.2个月（9.2-23.2个月），1年的PFS和OS分别为84.4%和100%。PFS与结节外受累（P = 0.019）和肿瘤总体积（P = 0.044）有关。所有患者对RT的耐受性良好，未出现≥3级的不良反应。结论RT治疗BV或ICIs难治性HL有效且安全，有望成为HL综合治疗策略的一部分。

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The role of radiotherapy in patients with refractory Hodgkin's lymphoma after treatment with brentuximab vedotin and/or immune checkpoint inhibitors

Background

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.

Methods

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.

Results

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.