Abstract P008

Real-world experience with first-line Nivolumab-AVD in advanced-stage Classical Hodgkin Lymphoma

Introduction: Classical Hodgkin lymphoma (cHL) has high cure rates, although outcomes remain poorer in advanced stages and in patients with high baseline metabolic tumor burden (3). Novel first-line regimens combining immunotherapy and chemotherapy have improved efficacy and reduced toxicity (ECHELON-1, HD21 and SWOG S1826), but real-world data are still limited (1,2,4,5).

Objective: To evaluate the efficacy and safety of first-line Nivolumab-AVD in high-risk advanced cHL (stages III–IV and IIB with risk factors) with high metabolic tumor burden on baseline PET (metabolic tumor volume (MTV) and total lesion glycolysis (TLG)), at our center.

Materials and methods: Retrospective study of patients with cHL treated with first-line Nivolumab-AVD (SWOG S1826 regimen) between 2024 and 2026. Clinical, metabolic imaging, response and survival data, were analyzed descriptively. Efficacy was assessed according to Lugano 2014 criteria, and adverse events (AEs) according to CTCAE v5.

Results: Seven of eight patients were analyzed; one was excluded due to grade 4 non–immune-mediated toxic hepatitis after cycle 1. Median age was 24 years (18–58), 52% were male, nodular sclerosis was the most frequent subtype (71%). None of the patients were EBER or HIV-positive. All patients had advanced disease (stages III–IV), except one high-risk stage IIB case. Median IPS was 4 and median MTV was 309. Extranodal involvement was present in all patients, while 86% had B symptoms, 71% bulky disease, and 43% splenic involvement.

After a median follow-up of 16 months, six patients completed treatment and one completed 3 cycles with complete metabolic response (CMR) on interim PET (iPET). Median iPET MTV was 0 (0–16.5); CMR was observed in 4 patients with Deauville score (DS) 2-3 while three patients obtained DS4. In this regard, recent studies such as HD21 have combined DS and MTV on iPET for a more accurate evaluation of response to immunotherapy. End-of-treatment PET (EOT-PET) showed a 100% CMR rate, with estimated 2-year progression-free survival and overall survival of 100%. All patients received G-CSF prophylaxis. Two patients developed grade 1-2 immune-mediated AEs after completing treatment (thyroiditis and pneumonitis). No consolidative radiotherapy was administered.

Conclusion: First-line Nivolumab-AVD demonstrated excellent real-world efficacy and favorable tolerability in high-risk advanced cHL across all ages, outperforming historical results with ABVD regimen.