Abstract P017

Frontline Use of Nivolumab with Doxorubicin, Vinblastine, and Dacarbazine inAdvanced-Stage Classical Hodgkin Lymphoma: A Real-World Analysis

Background: The combination of nivolumab with doxorubicin, vinblastine, and dacarbazine (N-AVD) represents a promising frontline therapeutic approach that has demonstrated high efficacy in the treatment of advanced-stage classical Hodgkin lymphoma (cHL). We assessed the real-world effectiveness and safety of frontline N-AVD treatment in patients with advanced-stage cHL.

Methods: A retrospective analysis was conducted on 61 cHL patients in clinical stages III/IV who received N-AVD treatment between 2023 and 2026 in the Czech Republic. Treatment response was assessed using 18F-FDG PET/CT imaging based on the Lugano criteria.

Results: Out of 61 patients 19 were aged < 60 and 42 were ≥ 60, with a median age of 67 years. Of the participants, 68.9% were diagnosed with stage IV disease and 75.4% presented with B symptoms. The PET-2 results showed rapid metabolic clearance in 85.7% of patients, whereas 11.9% demonstrated Deauville scores of 4 to 5. N-AVD demonstrated an overall response rate of 89.2%, with 86.5% of patients achieving a complete metabolic response at the end of treatment. After a median follow-up of 8.9 months, 5 (8.1%) patients progressed or relapsed, resulting in an estimated 1-year progression-free survival rate of 91.8%. Four patients died (two due to cardiotoxicity-related complications, one due to infection and one unknown cause) and the estimated 1-year overall survival rate was 93.4%. Grade ≥3 hematological toxicities were observed in 44.3% of cases (neutropenia 27.9%, anemia 11.5%, thrombocytopenia 4.9%). Non-hematologic toxicities including immune-related adverse events of grade ≥3 were reported in 16.4% of cases. Treatment discontinuation due to toxicity was reported in 11.5% of patients. This included two patients (3.2%) experiencing grade ≥3neurotoxicity and one patient (1.6%) with grade ≥3 ulcerative colitis. Patients aged ≥60 years had higher rates of severe hematologic toxicities, while younger patients experienced more immune-related adverse events. Treatment discontinuation rates were similar across both age groups.

Conclusions: The frontline N-AVD regimen demonstrated excellent response rates in patients with advanced-stage cHL. Extended follow-up is necessary to better assess the durability of responses, long-term toxicity, and overall survival outcomes.This work was supported by the grant AZV NU22-03-00182 from the Ministry of Health of the Czech Republic and by the Cooperatio Program, research area “Oncology and Haematology”