Background: Nivolumab (anti PD-1 antibody), is an immune check point inhibitor, that restores effective anti-tumor immune response and is effective in patients with relapsed/refractory HL. Combining Nivolumab with chemotherapy (eg. Ifosfamide+Carboplatin+Etoposide) is an effective salvage therapy in relapsed/refractory HL and serves as a bridge to autologous stem cell transplant in these patients.
Objective: To assess the effectiveness of Nivolumab based salvage therapy in patients with relapsed/refractory Hodgkin lymphoma.
Methods: This is a retrospective analysis wherein hospital records of patients with biopsy proven relapsed/refractory Hodgkin lymphoma treated with nivolumab based salvage regimen were reviewed.
Results: From December 2020 till June 2023, a total of 15 patients received Nivolumab based therapy for relapsed/refractory Hodgkin lymphoma. Median age was 28 years (range 7-52), 80% were male and 20% were female, 47% (7 out of 15) had primary refractory disease and 53% had relapsed disease (20% had early relapse while 33% had late relapse); at baseline 93% had stage 4 disease, 60% had bulky disease and 60% had extra nodal involvement. 73% (11 out of 15) patients received Nivo-ICE regimen while 13.3% received Nivo-AVD and 6.7% received Nivo-BV and Nivo monotherapy each. Mean dose of Nivolumab was 2.3mg/kg. Majority of the patients (67%) received nivolumab as a part of their third line salvage regimens. The adverse events observed were Febrile neutropenia (40%), immunologic events (27%) (skin rash, arthralgias), transaminitis (27%), autoimmune thyroiditis (6.7%). With nivolumab based salvage therapy, Overall response rate of 67% (10 out of 15) was observed, Complete metabolic response (CMR) and partial metabolic response (PMR) was observed in 40% and 27% patients respectively. 20% (3 out of 15) patients had progressive disease after receiving 3 cycles of nivolumab based salvage, while 2 patients expired after first cycle of Nivo-ICE, cause of death being gram negative sepsis in both patients. Out of 10 who achieved remission, 7 (70%) proceeded for autologous hematopoietic stem cell transplant. All transplanted patients but one remain in CR with a median follow up time of 20 months (Range 5-34 months). Post transplant relapse was observed in 1 patient after a progression free survival of 34.
Conclusion: Nivolumab based salvage therapy is highly effective across all age groups and serves as a bridge to transplant thereby prolonging the PFS.
Sanjeev Sanjeev, Deep Gala, Sauvik Saha, Manish Kumar Singh, Aftab Nazar, Manish ora, Dinesh chandra, Khaliqur Rahman, Ruchi Gupta, Rajesh Kashyap