Abstract P137

Anti PD1 containing salvage regimen is highly effective in chemorefractory HL patients

Despite the introduction of new drugs, relapsed/refractory Hodgkin Lymphoma (R/R HL) remains challenging. Pembro-GVD (pembrolizumab, gemcitabine, vinorelbine and liposomal doxorubicine) has emerged as an effective salvage regimen before consolidation with high dose chemotherapy and autologous stem cell transplantation (ASCT). However, there are limited real life data regarding its efficacy and safety in 3rd line. We present a retrospective, unicentric analysis of 10 R/R HL who received pembro-GVD in 3rd line (2nd salvage) between 7/2023 and 9/2025. We evaluated overall response rate (ORR) and complete response rate (CRR) by PET-CT scan according to Lugano criteria, as well as transplant rate. Refractory disease was defined as progression at end of treatment in PET/CT. Toxicity and treatment discontinuation was assessed per cycle. Median age at diagnosis was 34,9 (20-56) years and 7/10 patients were males. At diagnosis, 8/10 presented with advanced disease (6 in stage III-IV), 8/10 with B symptoms and 3/10 with bulky disease. They were all treated with a PET-guided strategy, starting with 2 cycles of ABVD, and 4/10 intensified to escBEACOPDAC. Six patients had refractory disease, 2 an early relapse (<6 months) and 2 a late relapse. As 1st salvage, all patients received a platinum-based regimen associated to brentuximab vedotin; 8 were refractory. Median number of pembro-GVD cycles was 3 (2-4). Response was assessed after 2 cycles in 8 patients and after 3 cycles in 2: ORR was 100% and CR rate 80%. Six patients continued pembro monotherapy until ASCT (median: 2 cycles). All but one patient proceeded to ASCT in response. After ASCT, all patients achieved CR. After a median follow-up of 18,5 months all patients but one maintained CR. Adverse events occurred in 8/10 patients at any time during treatment: 7 immuno-related (four G3-4) and 7 haematological toxicities (one G2 and 6 G3-4; two febrile neutropenia). Dose reduction or treatment delays occurred in 5 patients; treatment was discontinued due to toxicity after 3rd cycle in 4 patients. No deaths occurred. In this small series of patients with adverse prognosis, pembro-GVD in 3rd line was effective as salvage regimen and allowed consolidation with ASCT with continuous CR in most patients. The incidence of adverse events was higher than in other series. Considering the early response to pembro-GVD, patients should quickly proceed to ASCT consolidation after cycle 2 to minimize toxicity.