[Clinical study of brentuximab vedotin combined with the ifosfamide and gemcitabine regimen in the treatment of children with relapsed or refractory classic Hodgkin lymphoma].
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Objective: To evaluate the efficacy and safety of brentuximab vedotin (BV) combined with the IGE regimen (ifosfamide, gemcitabine) in the treatment of children's relapsed or refractory classic Hodgkin lymphoma (cHL). Methods: In this case series study, clinical data including age, sex, symptoms, pathological sub-type, clinical stage, previous clinical stage and treatment of the relapsed or refractory cHL children diagnosed and treated at Beijing Children's Hospital Affiliated to Capital Medical University from June 2022 to August 2025 were collected. All 23 children received 1 to 4 cycles of chemotherapy with BV plus the IGE regimen. Children were followed up until December 31st, 2025, and infusion reactions during treatment and adverse reactions after administration were recorded. Results: Among 23 children, there were 16 males and 7 females, the age was 14.8 (12.1, 16.7) years, and there were 3 children of refractory and 20 children of relapsed cHL. Pathological sub-types included 13 children of nodular sclerosis, 1 child of lymphocyte depletion, 7 children of mixed cellularity, and 2 children of lymphocyte-rich type. At initial diagnosis, 3 children presented with stage Ⅱ, 8 with stage Ⅲ, and 12 with stage Ⅳ. All 23 children received chemotherapy, among whom 14 had prior radiotherapy, 3 had programmed death 1 inhibitor treatment (1 of whom underwent autologous hematopoietic stem cell transplantation). At relapse or refractory disease, clinical stage was stage Ⅱ in 5 children, stage Ⅲ in 4 children, and stage Ⅳ in 14 children. A total of 84 cycles of BV combined with IGE regimen chemotherapy were administered. All children received involved-field radiotherapy after chemotherapy. Twenty-one children avoided hematopoietic stem cell transplantation, and 3 received single-agent BV maintenance therapy. All 22 evaluable children achieved a treatment response after 2 cycles of chemotherapy, and 14 (64%) achieved complete metabolic response (CMR). The follow-up time was 15 (9, 24) months; all 23 children achieved event-free survival, with an overall CMR rate of 91% (21/23). A total of 144 cases of grade 3 or above adverse events were recorded, predominantly myelosuppression, and none of which affected subsequent sequential treatment. Serum immunoglobulin levels (IgA, IgG, IgM) in children remained within the normal range before and after treatment. The pre-treatment total B-cell count was 166×10⁶ (38×10⁶, 259×10⁶)/L, which decreased to 17×10⁶ (5×10⁶, 21×10⁶)/L during treatment and recovered to 214×10⁶ (142×10⁶, 266×10⁶)/L at 3 months post-chemotherapy. Both natural killer cells and total T-cell counts were reduced at baseline, declined further during therapy, and returned to pre-treatment baseline levels at 6 months and 9 months after chemotherapy, respectively. Conclusion: BV combined with the IGE regimen has demonstrated marked efficacy and a favorable tolerable safety profile in the treatment of relapsed or refractory cHL in children while reducing the proportion of patients requiring hematopoietic stem cell transplantation.