Abstract P033

Evaluating the outcomes of elderly Hodgkin Lymphoma patients: a focus on sequential Brentuximab-AVD

Background: Older patients with classical Hodgkin lymphoma (cHL) have inferior outcomes and limited tolerance to conventional chemotherapy, due to poor performance status (PS) and possibly due to differences in the underlying disease biology. Sequential brentuximab vedotin (BV) before and after AVD (sBV-AVD) has shown promising activity in older patients, but real-world data remain limited.

Aim: To assess the outcomes of elderly cHL patients treated with sBV-AVD in a real-wold setting.

Methods: A single-centre, retrospective study was conducted at our tertiary centre, enrolling consecutive cHL patients treated with sBV-AVD between Jan 2022 and Mar 2026(AM Evens, JCO 2018). Primary endpoints were overall- and cancer-specific survival (censoring non-HL deaths, CSS), as well as event-free survival (EFS), with events defined as progression, death or the start of a new therapy.

Results: Fifteen patients were enrolled in the study, with 13 (86%) having stage IV disease. Median age at enrollment was 72 years (60-86), and 8 (53%) were female. Most subjects (80%) presented with B symptoms, whereas only 2 (13%) had bulky disease. Median ECOG PS at baseline was 2, with 9 (60%) individuals having a PS ≥3. After a median follow-up of 15 months (range 1-52), 2 subjects died (one from HL progression and one from a second primacy malignancy) and 2 experienced progression. Fifteen-month EFS and OS were 67% (95% CI 45-100) and 83% (95% CI 63-100), respectively, while 15-month CSS was 93% (95% CI 81-100). An improvement in PS after the 2 lead-in BV doses was documented in all but 3 patients (one who died shortly after the 1st BV infusion, and one who started BV with a PS of 0; Wilcoxon p<0.001), and median PS were 2 and 1 before and after the lead-in BV. Overall, the sequential regimen was well tolerated. Infections were the most common adverse event, with 7 total cases being reported across 5 patients, 2 of which were septic events happening during the BV lead-in. Notably, no cases of febrile neutropenia were recorded. Peripheral neuropathy was documented in 6 patients (3 G2, 3 G1), appearing in half the cases after the second lead-in BV infusion.

Conclusion: sBV-AVD appeared to be effective and well tolerated in this real-world cohort of elderly cHL patients. Of note, the initial BV infusions were associated with a notable improvement in patient performance, which led to full delivery of the following AVD cycles with only mild complications.