Abstract P019

Pembrolizumab + AVD in classic Hodgkin lymphoma: Low rates of febrile neutropenia despite frequent grade 4 neutropenia

Background: Concurrent checkpoint inhibition (CPI) and chemotherapy has demonstrated high efficacy in the frontline setting for patients with classic Hodgkin lymphoma (CHL). While historical data have supported ABVD treatment without granulocyte-colony stimulating factor (G-CSF) despite neutropenia, management in CPI-based combinations is currently undefined. In patients treated with CPI and chemotherapy, grade ≥3 neutropenia was common (47%), while febrile neutropenia rates were low (5%, Herrera et al ASCO 2023). However, there are limited data regarding the nature of febrile neutropenia (FN) episodes and correlation with other factors such as preceding neutropenia and granulocyte-colony stimulating factor (G-CSF) use.

Methods: We reviewed laboratory data for all patients enrolled in a clinical trial of 2-6 cycles of pembrolizumab and AVD (NCT03331341). We obtained clinical data, including absolute neutrophil count measured regularly throughout treatment, from the patients’ electronic medical records. We evaluated the timing and severity of neutropenia for the duration of treatment. We collected additional pertinent clinical data from the electronic medical record and from the clinical trial’s electronic data capture database.

Results: Baseline characteristics of this cohort (N=50) have previously been reported (Lynch et al., ASH 2023). In 43 patients who did not receive G-CSF for primary prophylaxis, the mean total duration of grade 4 neutropenia was 45.6 days (range: 0 - 147 days), and FN occurred in 5 (12%) of patients. FN rate was 11.6% (Table 1). Of those who did not receive primary G-CSF prophylaxis, 3 (7%) patients experienced a grade ≥3 infection. FN rates for the 7 patients who received primary prophylaxis with G-CSF was 0%, though one of these patients did experience non-neutropenic sepsis due to a colonic abscess. These patients received G-CSF for a mean of 4.7 cycles of chemotherapy (87% of total chemotherapy cycles), while patients treated with G-CSF for secondary prophylaxis received G-CSF for a mean of 3 cycles. For the 5 patients who developed FN, none were previously on G-CSF, and they were neutropenic for 0 to 100 days prior to their fever. Additional data is presented in Table 1.

Conclusion: Although rates of grade 4 neutropenia were high at 70% in patients treated with pembrolizumab + AVD, febrile neutropenia and infections were uncommon despite low rates of G-CSF use and appeared similar to historical data with ABVD.