Low-dose pembrolizumab and nivolumab were efficacious and safe in relapsed and refractory classical Hodgkin lymphoma: experience in a resource-constrained setting

Lymphoma
13/08/2020

Hematol Oncol. 2020 Aug 12. doi: 10.1002/hon.2787. Online ahead of print.

ABSTRACT

The efficacy and safety of low-dose anti-PD1 antibodies in relapsed/refractory classical Hodgkin lymphoma (cHL) require confirmation. Pembrolizumab (100 mg every three weeks, Q3W) or nivolumab (40 mg Q2W) were administered to patients with relapsed/refractory cHL. In the pembrolizumab cohort (N=11), who had failed a median of 3 (1-6) therapies (brentuximab vedotin, BV: 91%; autologous hematopoietic stem cell transplantation, auto-HSCT: 18%), the overall-response rate (ORR) by positron emission


tomography computed tomography was 100% (metabolic complete response, mCR: 73%; partial response, PR: 27%). Median cumulative dose for achieving best response was 400 (300-800) mg. Median progression-free-survival (PFS) was 35 months. Median overall-survival (OS) was not reached. Adverse events (AEs) of grade 1-2 were observed in 3 patients. In the nivolumab cohort (N=6), who had failed a median of 3 (2-6) therapies (BV: 50%; auto-HSCT: 17%, allogeneic HSCT: 34%), the ORR was 100% (mCR: 67%; PR: 17%; indeterminate response: 17%). Median cumulative dose for achieving best response was 160 (160-360) mg. Median PFS was 33 months. Median OS was not reached. AEs of grade 1-2 were observed in 4 patients, 2 of whom had pre-existing autoimmune conditions. Five patients with Epstein-Barr virus (EBV) positive Reed-Sternberg cells underwent monitoring of plasma EBV DNA, which became negative in four mCR patients but remained positive in one PR patient who died ultimately from refractory lymphoma. Low-dose pembrolizumab and nivolumab were highly efficacious and safe in relapsed/refractory cHL. These observations have significant financial implications in resource-constrained settings. This article is protected by copyright. All rights reserved.