维布妥昔单抗联合化疗治疗儿童难治及复发霍奇金淋巴瘤10例分析

Analysis of 10 cases of brentuximab vedotin combined with chemotherapy in the treatment of children withrefractory and orrelapsed classic Hodgkinlymphoma

目的评估CD30抗体-药物偶联物(ADC)维布妥昔单抗(BV)联合化疗治疗儿童难治或复发经典性霍奇金淋巴瘤(R/R cHL)的有效性和安全性。方法回顾性分析2021年10月至2023年8月在首都医科大学附属北京儿童医院诊治的10例R/R cHL患儿的临床资料(包括年龄、性别、B症状、临床分期、既往治疗情况等),10例患儿均接受至少2周期BV联合化疗,根据化疗药物强度的不同决定与其同疗程应用的BV剂量,每3周1次应用BV者剂量为1.8 mg/kg,每2周1次应用BV者剂量为1.2 mg/kg。每2个周期评估患儿缓解情况,随访至2024年5月31日。记录用药期间有无输注反应及用药后的不良反应。结果10例患儿中男7例,女3例;年龄5.3~16.9岁;难治6例,复发4例;结节硬化型6例,混合细胞型2例,富于淋巴细胞型1例,淋巴细胞消减型1例。临床分期Ⅳ期5例,Ⅲ期5例。既往接受治疗以化疗为主,4例患儿曾接受放疗,1例患儿曾接受程序性死亡受体1(PD-1)抗体治疗。随访时间为9~27个月,共计43周期单独应用BV或BV联合不同方案化疗,疗程数为2~10个,10例患儿均无事件生存,9例患儿持续完全缓解。BV均顺利完成输注,共记录到28例次患儿发生3级以上的不良事件,以骨髓抑制为主,均与化疗相关,均未影响序贯治疗。结论BV治疗儿童难治及复发CD30阳性霍奇金淋巴瘤的早期显效,安全性可耐受。

Objective:To evaluate the efficacy and safety of CD30 antibody-drug conjugates(ADC)brentuximab vedotin(BV)combined with chemotherapy in children with refractory or relapsed classic Hodgkin′s lymphoma(R/R cHL).Methods:Clinical data(including age,gender,B symptoms,clinical stage,previous treatment,etc.)of the 10 R/R cHL children diagnosed and treated at Beijing Children′s Hospital Affiliated to Capital Medical University from October 2021 to August 2023 were analyzed retrospectively.According to the different intensity of chemotherapy drugs,the dose of BV applied in the same course of treatment was 1.8 mg/kg for BV applied once every 3 weeks,and 1.2 mg/kg for BV applied once every 2 weeks.All 10 patients received at least 2 cycles of BV combined with chemotherapy and were evaluated every 2 cycles.The patients were followed up until May 31,2024.The infusion reactions and adverse reactions after treatment were recorded.Results:In all 10 patients,there were 7 males and 3 females,the age ranged from 5.3-16.9 years,and there were 6 cases of refractory and 4 cases of relapsed.There were 6 cases of nodular sclerosis type,2 cases of mixed cell type,1 case of lymphocyte-rich type,and 1 case of lymphodepletion type.There were 5 cases of stageⅣand 5 cases of stageⅢ.Previous treatment was mainly chemotherapy,4 cases received radiotherapy and 1 case received programmed cell death protein 1(PD-1)antibody therapy.The follow-up time ranged from 9 to 27 months.A total of 43 courses with 49 doses of BV alone or combined with chemotherapy were recorded,and the number of courses was 2 to 10 times.All 10 children responded to the treatment,and 9 achieved complete remission.BV infusion was successfully completed in all cases.A total of 28 cases of grade 3 or above adverse events were recorded,mainly myelosuppression,all of which were related to chemotherapy and did not affect sequential treatment.Conclusion:Brentuximab vedotin has demonstrated efficacy and a tolerable safety profile in the treatment of refractory and relapsed CD30-positive Hodgkin′s lymphoma in children.