PharmatecaPharmatecaФарматека2073-40342414-9128Bionika Media31220910.18565/pharmateca.2019.7.64-72ArticlesСтатьиResearch ArticleImmunotherapy for classic Hodgkin’s lymphomaИммунотерапия классической лимфомы ХоджкинаFilatovaLarisa V.ФилатоваЛ. В

MD, Leading researcher at the Scientific Department of Innovative Methods of Therapeutic Oncology and Rehabilitation; Associate Professor at the Department of Oncology

д.м.н., ведущий науч. сотр. научного отдела инновационных методов терапевтической онкологии и реабилитации; доцент кафедры онкологии

Larisa_Filatova@list.ruN.N. Petrov National Medical Research Center of OncologyНациональный медицинский исследовательский центр онкологии им. Н.Н. ПетроваNorth-Western State Medical University n.a. I.I. MechnikovСеверо-Западный государственный медицинский университет им. И.И. Мечникова15072019267VOL 26, NO7 (2019)ТОМ 26, №7 (2019)647203032023Copyright ©; 2019, Bionika MediaCopyright ©; 2019, ООО «Бионика Медиа»2019Bionika MediaООО «Бионика Медиа»https://journals.eco-vector.com/2073-4034/article/view/312209

High-dose chemotherapy with autologous hematopoietic stem cell transplantation (HDC with auto-HSCT) is the current standard for the treatment of primary refractory forms and the first recurrences of Hodgkin’s lymphoma (HL). HDC with auto-HSCT is effective for 50-60% of patients with the first late chemotherapy-sensitive recurrence of HL. Modern therapies for treating HL with high efficacy and low toxicity are particularly relevant for patients with HL who are not candidates for HDC with auto-HSCT, as well as for the occurrence of recurrent HL after HDC with auto-HSCT. Allogeneic hematopoietic stem cell transplantation (alloHSCT) can be performed in patients with recurrent HL after HDC with auto-HSCT with preserved chemo-sensitivity, preferably in young patients in a framework of prospective clinical studies. Brentuximab vedotin is registered for the treatment of patients with classical HL after failure (progression or early recurrence) of HDC with auto-HSCT or patients not candidates for HDC with auto-HSCT, if two or more chemotherapy lines fail, for consolidation after the HDC with auto-HSCT in patients with HL with a high risk of recurrence or progression, in first-line therapy with advanced stages of HL, most preferably for young patients, patients with a high risk of recurrence. In patients with HL recurrence, high activity of PD-1/PD-L1 checkpoint inhibitors that activate antitumor immunity (nivolumab, pembrolizumab) was noted. The therapeutic efficacy of PD-1/PD-L1 checkpoint inhibitors does not depend on the response to previous therapy regimens (primary refractoriness or refractoriness to brentuximab vedotin). Promising areas of HL therapy are associated with the further study of new tumor cell targets and their signaling pathways.

Высокодозная химиотерапия с аутологичной трансплантацией гемопоэтических стволовых клеток (ВДХТ с аутоТГСК) служит современным стандартом лечения первично рефрактерных форм и первых рецидивов лимфомы Ходжкина (ЛХ). ВДХТ с аутоТГСК эффективна для 50-60% пациентов при первом позднем химиочувствительном рецидиве ЛХ. Современные методы терапии лечения ЛХ. с высокой эффективностью и низкой токсичностью особенно актуальны для пациентов с ЛХ, которые не являются кандидатами для ВДХТ с аутоТГСК, а также при возникновении рецидивов ЛХ. после ВДХТ с аутоТГСК. Аллогенные трансплантации гемопоэтических стволовых клеток (аллоТГСК) могут проводиться при рецидивах ЛХ. после ВДХТ с аутоТГСК с сохраненной химиочувствительностью, предпочтительно для молодых пациентов в рамках проспективных клинических исследований. Брентуксимаб ведотин зарегистрирован для лечения пациентов с классической ЛХпосле неудачи (прогрессирование или ранний рецидив) ВДХТ с аутоТГСК или пациентов - не кандидатов для ВДХТ с аутоТГСК, при неудаче двух и более линий химиотерапии (ХТ), для консолидации после ВДХТ с аутоТГСК у пациентов с ЛХ. с высоким риском возникновения рецидива или прогрессирования, в терапии первой линии при распространенных стадиях ЛХ, наиболее предпочтительно для молодых пациентов, пациентов с высоким риском возникновения рецидива. Высокая активность отмечена у ингибиторов контрольных точек PD-1/PD-L1, активирующих противоопухолевый иммунитет (ниволумаб, пембролизумаб), у пациентов с рецидивами ЛХ. Терапевтическая эффективность ингибиторов контрольных точек PD-1/PD-L1 не зависит от ответа на предшествовавшие режимы терапии (первичная рефрактерность или рефрактерность к брентуксимабу ведотину). Перспективные направления терапии ЛХ. связаны с дальнейшим изучением новых мишеней опухолевых клеток и их сигнальных путей.

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