Most patients with classic Hodgkin lymphoma (cHL) are cured with combination chemotherapy, but approximately 10–20% will relapse, and another 5–10% will have primary refractory disease. The treatment landscape of relapsed/refractory (R/R) cHL has evolved significantly over the past decade following the approval of brentuximab vedotin (BV), an anti-CD30 antibody-drug conjugate, and the PD-1 inhibitors nivolumab and pembrolizumab. These agents have significantly expanded options for salvage therapy prior to autologous hematopoietic cell transplantation (AHCT), post-transplant maintenance, and treatment of relapse after AHCT, which have led to improved survival in the modern era. In this review, we highlight our approach to the management of R/R cHL in 2023 with a focus on choosing first salvage therapy, post-transplant maintenance, and treatment of relapse after AHCT. We also discuss the management of older adults and transplant-ineligible patients, who require a separate approach. Finally, we review novel immunotherapy approaches in clinical trials, including combinations of PD-1 inhibitors with other immune-activating agents as well as novel antibody-drug conjugates, bispecific antibodies, and cellular immunotherapies. Ongoing studies assessing biomarkers of response to immunotherapy and dynamic biomarkers such as circulating tumor DNA may further inform treatment decisions and enable a more personalized approach in the future.
大多数经典型霍奇金淋巴瘤（cHL）患者可通过联合化疗治愈，但约10%-20%会复发，另有5%-10%会出现原发性难治性疾病。随着抗CD30抗体药物偶联物维布妥昔单抗（BV）及PD-1抑制剂纳武利尤单抗和帕博利珠单抗的获批，近十年来复发/难治性（R/R）cHL的治疗格局发生了显著变化。这些药物极大地拓展了自体造血细胞移植（AHCT）前的挽救治疗、移植后维持治疗以及AHCT后复发治疗的方案选择，从而改善了当代患者的生存预后。本综述重点阐述2023年R/R cHL的治疗策略，聚焦于首次挽救治疗的选择、移植后维持治疗及AHCT后复发治疗。同时探讨老年患者及不适合移植患者的个体化管理方案。最后，我们综述了临床试验中的新型免疫疗法，包括PD-1抑制剂与其他免疫激活剂的联合应用，以及新型抗体药物偶联物、双特异性抗体和细胞免疫疗法。当前针对免疫治疗生物标志物（如循环肿瘤DNA等动态标志物）的研究，有望进一步指导治疗决策，推动未来个体化精准治疗的发展。
Optimizing Treatment for Relapsed/Refractory Classic Hodgkin Lymphoma in the Era of Immunotherapy
肿瘤(癌症)患者之家