Abstract P110

How to manage BrECADD failure? Early Outcomes of Second-Line Treatment in classic Hodgkin Lymphoma

While PET-guided BrECADD achieves high primary cure rates in classic Hodgkin lymphoma (cHL), the few relapsing or primary refractory cases may be difficult to treat. In this setting, high-dose chemotherapy (HDCT) followed by autologous stem cell transplantation (autoSCT) is usually indicated. Herein, we analyze salvage strategies and early outcomes in patients after failure of BrECADD.

To better understand the optimal salvage strategy after BrECADD failure, we performed a retrospective multicenter real-world study. Inclusion criteria were (1) BrECADD as 1st line therapy, (2) refractory/relapsed cHL, (3) HDCT in 2nd line planned (intention-to-HDCT) or performed. Centers in Austria, Germany, Israel, and Switzerland were invited to contribute eligible cases. For this early-results analysis, data collection focused on patient and disease characteristics, salvage treatment approaches, treatment response and outcomes with descriptive analyses.

19 eligible patients were included at data cutoff on 22 April 2026. 13 (68%) completed therapy and for 6 (32%), treatment is ongoing. Salvage comprised conventional chemotherapy in 13 patients (68%; DHAP, n=10; DHAC, n=2; ASHAP, n=1) and PD1 inhibitor-based regimens in 6 patients (32%; Pembro-GVD, n=5; Nivo-ICE, n=1). Among patients who completed upfront conventional salvage, 3/10 (30%) experienced further progression and were subsequently switched to PD1 inhibitor-based therapy. After completion of therapy, relapse occurred in 1/10 patients (10%) treated with upfront conventional salvage, while no relapse was observed after upfront PD1 inhibitor-based salvage. Radiotherapy was administered in 4/13 patients (31%). Consolidation therapy included brentuximab vedotin in 4/13 (31%; received or ongoing), and pembrolizumab in 2/13 (15%; received or ongoing). Febrile neutropenia occurred in 5/19 patients (26%; grade 3 n=4, grade 4 n=1), neuropathy in 3/19 (16%; grade 2 n=3), and mucositis after HDCT in 2/13 (15%; grade 1 n=1, grade 2 n=1). Median observation time was 11 months (range 0-64; n=19) and median follow-up after HDCT was 12 months (range 2-63, n=13).

In conclusion, early outcomes after BrECADD failure appear overall favorable, with responses to both conventional and PD1 inhibitor-based salvage in selected patients. PD1-based approaches show activity, including in chemotherapy-refractory cases. Subgroup analyses remain limited by small numbers.