Abstract: Much progress has been made in the diagnosis and treatment of Hodgkin′s lymphoma, which has become a highly curable malignancy. However, prolonged survival makes clinicians pay more attention to long-term toxicities of treatment. Consequently, individualized treatment based on disease stage and risk factors is a research hotspot at present. This article reviews recent advances in the individualized treatment of early-stage classical Hodgkin′s lymphoma.
Shen Jinwen,Zhu Yuan. Advances in treatment of early-stage classical Hodgkin′s lymphoma[J]. Chinese Journal of Radiation Oncology, 2017, 26(5): 578-581.
[1] Stathis A,Younes A.The new therapeutical scenario of Hodgkin lymphoma[J].Ann Oncol,2015,26(10):2026.DOI:10.1093/annonc/mdv256. [2] Ansell SM.Hodgkin Lymphoma:Diagnosis and Treatment[J].Mayo Clin Proc.2015,90(11):1574-1583.DOI:10.1016/j.mayocp.2015.07.005. [3] Hoppe RT,Advani RH,Ai WZ,et al. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology. Hodgkin lymphoma,version 3.2016[DB/OL][2016-11-15].https://www.nccn.org/. [4] Eichenauer DA,Engert A,Dreyling M,et al. Hodgkin′s lymphoma:ESMO Clinical Practice Guidelines for diagnosis,treatment and follow-up[J].Ann Oncol,2011,22 Suppl 6(9):645-646.DOI:10.1093/annonc/mdu181. [5] Connors JM.Risk assessment in the management of newly diagnosed classical Hodgkin lymphoma[J].Blood,2015,125(11):1693-1702.DOI:10.1182/blood-2014-07-537480. [6] Remer M,Johnson PW.Risk-and response-adapted strategies for the management of Hodgkin lymphoma[J].Chin Clin Oncol,2015,4(1):13.DOI:10.3978/j.issn.2304-3865.2015.03.04. [7] Engert A,Plütschow A,Eich HT,et al. Reduced treatment intensity in patients with early-stage Hodgkin′s lymphoma[J].N Engl J Med,2010,363(7):640-652.DOI:10.1056/NEJMoa1000067. [8] Behringer K,Goergen H,Hitz F,et al. Omission of dacarbazine or bleomycin,or both,from the ABVD regimen in treatment of early-stage favourable Hodgkin′s lymphoma (GHSG HD13):an open-label,randomised,non-inferiority trial[J].Lancet,2014,385(9976):1418-1427.DOI:10.1016/S0140-6736(14)61469-0. [9] Meyer RM,Gospodarowicz MK,Connors JM,et al. ABVD alone versus radiation-based therapy in limited-stage Hodgkin′s lymphoma[J].N Engl J Med,2012,366(5):399-408.DOI:10.1056/NEJMoa1111961. [10] Herbst C,Rehan FA,Skoetz N,et al. Chemotherapy alone versus chemotherapy plus radiotherapy for early stage Hodgkin lymphoma[J/OL].Cochrane Database Syst Rev,2011,4(2):CD007110-CD007110.DOI:10.1002/14651858.CD007110.pub2. [11] von Tresckow B,Plütschow A,Fuchs M,et al. Dose-intensification in early unfavorable Hodgkin′s lymphoma:final analysis of the German Hodgkin Study Group HD14 trial[J].J Clin Oncol,2012,30(9):907-913.DOI:10.1200/JCO.2011.38.5807. [12] Eich HT,Diehl V,G rgen H,et al. Intensified chemotherapy and dose-reduced involved-field radiotherapy in patients with early unfavorable Hodgkin′s lymphoma:final analysis of the German Hodgkin Study Group HD11 trial[J].J Clin Oncol,2010,28(27):4199-4206.DOI:10.1200/JCO.2010.29.8018. [13] Hutchings M,Loft A,Hansen M,et al. FDG-PET after two cycles of chemotherapy predicts treatment failure and progression-free survival in Hodgkin lymphoma[J].Blood,2006,107(1):52-59.DOI:10.1182/blood-2005-06-2252. [14] Raemaekers JM,André MP,Federico M,et al. Omitting radiotherapy in early positron emission tomography–negative stage Ⅰ/Ⅱ Hodgkin lymphoma is associated with an increased risk of early relapse:clinical results of the preplanned interim analysis of the randomized EORTC/LYSA/FIL H10 trial[J].J Clin Oncol,2014,32(12):1188-1194.DOI:10.1200/JCO.2013.51.9298. [15] Radford J,Illidge T,Counsell N,et al. Results of a trial of PET-directed therapy for early-Stage Hodgkin′s lymphoma[J].N Engl J Med,2015,372(17):1598-1607.DOI:10.1056/NEJMoa1408648. [16] Narang AK,Terezakis SA.Contemporary radiation therapy in combined modality therapy for Hodgkin lymphoma[J].J Natl Compr Canc Netw,2015,13(5):597-605. [17] Girinsky T,van der Maazen R,Specht L,et al. Involved-node radiotherapy (INRT) in patients with early Hodgkin lymphoma:concepts and guidelines[J].Radiother Oncol,2006,79(3):270-277.DOI:10.1016/j.radonc.2006.05.015. [18] Maraldo MV,Aznar MC,Vogelius IR,et al. Involved node radiation therapy:an effective alternative in early-stage Hodgkin lymphoma[J].Int J Radiat Oncol Biol Phys,2013,85(4):1057-1065.DOI:10.1016/j.ijrobp.2012.08.041. [19] Yahalom J,Illidge T,Specht L,et al. Modern radiation therapy for extranodal lymphomas:field and dose guidelines from the International Lymphoma Radiation Oncology Group[J].Int J Radiat Oncol Biol Phys,2014,89(4):854-862.DOI:10.1016/j.ijrobp.2013.05.005. [20] Hoppe BS,Hoppe RT.Expert radiation oncologist interpretations of involved-site radiation therapy guidelines in the management of Hodgkin lymphoma[J].Int J Radiat Oncol Biol Phys,2015,92(1):40-45.DOI:10.1016/j.ijrobp.2015.02.008. [21] Hoppe BS,Flampouri S,Su Z,et al. Consolidative involved-node proton therapy for Stage IA-ⅢB mediastinal Hodgkin lymphoma:preliminary dosimetric outcomes from a Phase Ⅱ study[J].Int J Radiat Oncol Biol Phys,2012,83(1):260-267.DOI:10.1016/j.ijrobp.2011.06.1959. [22] Paumier A,Ghalibafian M,Gilmore J,et al. Dosimetric benefits of intensity-modulated radiotherapy combined with the deep-inspiration breath-hold technique in patients with mediastinal Hodgkin′s lymphoma[J].Int J Radiat Oncol Biol Phys,2012,82(4):1522-1527.DOI:10.1016/j.ijrobp.2011.05.015. [23] Alperovich A,Younes A.Targeting CD30 Using Brentuximab Vedotin In The Treatment Of Hodgkin lymphoma[J].Cancer J,2016,22(1):23-26.DOI:10.1097/PPO.0000000000000168. [24] Ansell SM,Lesokhin AM,Borrello I,et al. PD-1 Blockade With Nivolumab In Relapsed Or Refractory Hodgkin′s lymphoma[J].N Engl J Med,2015,372(4):311-319.DOI:10.1056/NEJMoa1411087. [25] Meadows SA,Vega F,Kashishian A,et al. PI3Kδ inhibitor,GS-1101(CAL-101),attenuates pathway signaling,induces apoptosis,and overcomes signals from the microenvironment in cellular models of Hodgkin lymphoma[J].Blood,2012,119(8):1897-1900.DOI:10.1182/blood-2011-10-386763. [26] Younes A,Sureda A,Benyehuda D,et al. Panobinostat in patients with relapsed/refractory Hodgkin′s lymphoma after autologous stem-cell transplantation:results of a phase Ⅱ study[J].J Clin Oncol,2012,30(18):2197-2203.DOI:10.1200/JCO.2011.38.1350. [27] Guarini A,Minoia C,Giannoccaro M,et al.mTOR as a target of everolimus in refractory/relapsed Hodgkin lymphoma[J].Curr Med Chem,2012,19(7):945-954. [28] Kumar A,Casulo C,Yahalom J,et al. Brentuximab vedotin and AVD followed by involved-site radiotherapy in early stage,unfavorable risk Hodgkin lymphoma[J].Blood,2016,128(11):1458-1464.DOI:10.1182/blood-2016-03-703470.