Nontransplant Treatment for Relapsed Pediatric Hodgkin Lymphoma—Less Is More

Ce dossier présente notamment 2 essais incluant 28 et 59 patients atteints d'un lymphome de Hodgkin récidivant ; le premier évalue l'efficacité d'une approche sans greffe combinant nivolumab et brentuximab védotin, et le deuxième évalue la possibilité d'identifier, via la réponse à la tomographie par émission de positons au fludésoxyglucose-18, les patients pouvant éviter une greffe et/ou une chimiothérapie à forte dose

Résumé en anglais

Current up-front therapeutic approaches for classic Hodgkin lymphoma (cHL) in children and young adults aim to reduce treatment intensity to minimize long-term treatment-related morbidity. This strategy assumes that patients who relapse can still achieve durable remission with a combination of high-dose chemotherapy (HDC) and autologous stem cell transplant (ASCT). Although this goal is achievable for most children and young adults with relapsed cHL, it comes at the cost of significant nonrelapse morbidity, which can shorten life expectancy and compromise quality of life. ASCT is known to have a 9.6-fold increased late mortality compared with the general population, and nonrelapse mortality accounts for 56% of deaths more than 2 years after autologous hematopoietic cell transplant. This understanding fueled the interest and multiple clinical attempts to identify patients with relapsed and therapy-refractory cHL who could be salvaged without HDC/ASCT and with measurable success. This Editorial reviews the latest transplant-free salvage strategies for relapsed cHL in children and young adults, potentially redefining the existing standard-of-care protocols.