Abstract P064

Time-of-Day Immunotherapy Administration and Outcomes in Classic Hodgkin Lymphoma

Introduction: Evidence in solid tumors suggests an association between earlier time of day administration of checkpoint inhibitor immunotherapy (TODA, CPI) and improved clinical outcomes, potentially driven by circadian immune variation. We hypothesized that a chronologic effect might be seen in classic Hodgkin lymphoma (cHL), where CPI are utilized in the frontline (1L) and relapsed/refractory (R/R) settings.

Methods: We included adult cHL patients who received CPI regimens at our institution with available infusion times and 1+ year of follow-up. N=5 were excluded due to CPI discontinuation after first infusion due to immune-related adverse event. We categorized patients as early or late TODA if the majority of infusions occurred before or after the cohort median infusion time, and also evaluated common literature TODA thresholds of 13:00, 14:00, 16:00. Progression-free survival (PFS) was assessed via log-rank test, cross-group outcomes via Fisher’s exact, and median infusion times via Wilcoxon rank-sum.

Results: Eighty patients were treated from 2016-2025 in the 1L (n=23) or R/R (n=57) settings, receiving total 568 infusions (median 4/pt) on clinical trial protocols (n=47) or per standard of care (n=33). Median age was 38 years (range 18 to >90), 48.8% female, and median follow-up was 29 months. 25% of patients had progression after CPI (n=20). Most events occurred in R/R patients (n=16) or 1L anthracycline-ineligible patients receiving BV-nivolumab (n=3), and more frequently with age >60 years (p=0.02). The median infusion TODA was 14:48 (IQR 13:12-16:17). PFS was similar for patients with early versus late TODA, defined by either cohort median (Fig 1A) or literature thresholds. No significant difference was seen in median infusion TODA for patients with or without subsequent progression (Fig 1B) or complete radiographic response (Fig 1C). Progression was rare after CPI/chemotherapy for both 1L patients (1/18, 5.6%) and R/R patients who underwent ASCT (1/14, 7.1%).

Conclusions: In contrast to data in solid tumors, no clear chronologic effect on outcomes was observed in this single institution retrospective study. Given favorable outcomes in Hodgkin lymphoma as compared to solid tumors, particularly with combination CPI-chemotherapy, further investigation could focus on large multicenter cohorts in the R/R setting where event rates are higher.