Abstract P043

LUNG FUNCTION ASSESSMENT BY DIFFUSING CAPACITY OF THE LUNGS FOR CARBON MONOXIDE (DLCO) MEASUREMENT IN PATIENTS WITH CLASSICAL HODGKIN LYMPHOMA RECEIVING FIRST-LINE TREATMENT WITH NIVOLUMAB-AVD

Background: Nivolumab-AVD (NAVD) has shown outstanding efficacy in patients with advanced-stage classical Hodgkin Lymphoma (cHL), establishing a new standard of care. Pneumonitis is a well-recognized complication of bleomycin in patients previously treated with ABVD. Similarly,treatment with immune checkpoint inhibitors, can also lead to pneumonitis through an immune-mediated mechanism, raising concerns about potential pulmonary impairment during therapy.

Methods: The study included patients with stage III and IV cHL treated with NAVD as a first-line therapy. Single-breath Diffusing Capacity of the Lungs for Carbon Monoxide corrected for Hemoglobin (DLCOc-SB) measurements were performed at predefined time points: prior to treatment initiation, after four cycles of NAVD, and at treatment completion. Clinical evaluation and symptom assessment were constantly performed during treatment and afterwards to correlate functional changes with clinical findings.

Results: Among 40 patients who had completed treatment with NAVD up to the time of the present analysis, 19 had baseline and interim DLCOc-SB assessments and 10/19 also had at least 1 post- treatment assessment. Media age was 28 years (range 16–79), with 11% aged ≥60 years. The median value of DLCOc-SB at baseline was 83.8% of the predicted value [ (IQR) 79.5-95.7%; range 55.8-120.8%], while after four cycles of NAVD it was 80% (IQR 74.4-89.2%; range 56.3-117.2%). In fact 16/19 patients had a reduction in DLCOc-SB by a median of 4.5% (range 0.5-10.12%) and 3 had an increase of 0.3-3.7%. The difference was statistically significant (p<0.001 ). In the 10 patients with available post-treatment assessment the median DLCOc-SB was 82.9% (IQR 65.2-93.6%; range 49.3-106.3%) versus 83.3% (IQR 71.7-96.6%; range 55.8-120.8%) at baseline (p=0.33) and 78.9% (IQR 67.7-91.2%; range 56.3-117.2%) at the interim assessment (p=0.96). Comparing the baseline and post-treatment evaluation, 7/10 patients had a reduction in SLCOc-SB by a median of 5.1% (range 0.1-30.2%) and 3 had an increase of 6.8-8.8%. Comparing the interim and post-treatment evaluation, 5/10 patients had a reduction in DLCOc-SB by a median of 10.0% (range 0.6-27.6%) and 5/10 had an increase of 1.4-12.4% (median 9.8%). None of the patients developed clinical symptoms of pneumonitis and only 1/19 had a reduction in SLCOc-SB by >20%.

Conclusion: NAVD has a favorable pulmonary safety profile.