Abstract P114

Low-Dose Nivolumab Combined with Salvage Chemotherapy in Relapsed/Refractory Classic Hodgkin Lymphoma: Outcomes from a Tertiary Care Centre in North India

Background: Immune checkpoint inhibitors (ICIs) have established activity in relapsed/refractory classic Hodgkin lymphoma (r/r cHL). Outcomes of patients receiving salvage with a combination of ICIs with chemotherapy are excellent. However, ICIs are often unavailable to a large population globally due to their high cost, leading to regional innovations including utilisation of a lower dose of these drugs. We report outcomes of low-dose nivolumab combined with salvage chemotherapy in r/r cHL at a tertiary care centre in North India.

Methods: This was a retrospective analysis of patients with r/r cHL treated with low dose nivolumab-based therapy between 2020 and 2026. Nivolumab was given at a fixed dose of 40 mg per cycle along with chemotherapy (without steroids). Progression-free survival (PFS), event-free survival (EFS, with receipt of next therapy counted as an event), and overall survival (OS) were calculated by the Kaplan–Meier method.

Results: The cohort comprised of 27 patients: 15 males (55.6%) and 12 females; median age 27 years (IQR 22–31). Most patients had advanced-stage disease at baseline (n=17, 63.0%) and refractory disease to ABVD (n=20, 74.1%). Nivolumab was used as second-line therapy in 16 patients (59.3%), third-line in 8 (29.6%), and fourth-line in 3 (11.1%). The median Nivolumab dosing was 0.66 mg/kg per patient (IQR- 0.57-0.71) with a median cumulative Nivolumab dose of 120 mg (IQR- 120-240mg). Patients received a median of 3 cycles of therapy (range 2–6). Chemotherapy combinations included gemcitabine and cisplatin (n=9) or vinorelbine, ifosfamide, bendamustine and etoposide (n=18).

Complete response (CR) was achieved in 22 patients (81.5%) and overall response rate was 96.3% (n=26). Nineteen patients (70.4%) proceeded to auto-HSCT. At a median follow-up of 31 months (range 3–75), 2-year PFS was 83.6% (95% CI 61.9–93.6%), 2-year EFS was 73.0% (95% CI 51.5–86.2%), and 2-year OS was 94.4% (95% CI 66.6–99.2%). Grade III/IV toxicity occurred in 3 patients (11.1%); there were no treatment-related deaths.

Conclusion: Low-dose nivolumab combined with chemotherapy achieves high response rates and favourable survival with acceptable toxicity in patients with r/r cHL. In settings where standard-dose ICIs are inaccessible, this is a practical and cost-effective bridging approach to auto-HSCT. Prospective evaluation in larger cohorts is warranted.