Modified Protocol of Nivolumab in Relapsed/Refractory Hodgkin Lymphoma: A Brief Communication of Real World Data

Abstract

Immune check point inhibitors such as nivolumab are changing the treatment paradigm of relapsed/refractory Hodgkin lymphoma (r/rHL). Data from single arm studies have shown nivolumab to be an effective and safe therapy. Real world data from resource constrained settings are limited. Our study is a retrospective single center analysis of nivolumab in r/rHL from India. Data regarding baseline and pretreatment characteristics were collected for 20 patients treated with nivolumab from January 2016 to March 2021. Of 20, 15 patients received nivolumab in modified protocol, because of financial limitations. Postnivolumab therapy, the overall response rate was 90%, with 40% in complete remission. The median progression free survival was 13.1 month (95% confidence interval 8.33 mo, not reached) and median overall survival not reached, at a follow up of 24.3 months. No patients discontinued nivolumab because of side effects. Univariate and multivariate analysis showed no effect of dose reduction or increased duration of administration. Most common adverse effect seen was autoimmune hypothyroidism. Possible delayed immune-related side effects were seen in 3 out 5 patients in peritransplant period, in those who received nivolumab as salvage regimen before autologous stem cell transplant. In conclusion, nivolumab shows comparable efficacy and safety even with compromised dosing and schedule of administration of the drug in real world setting.

Demyelinating polyneuropathy combined with brachial plexopathy after nivolumab therapy for hodgkin lymphoma: a case report

“…Growing evidence supports its administration as a second or first-line drug in newly diagnosed HL [ 15 ]. In a recent retrospective study, nivolumab showed comparable safety and efficacy in treating patients with refractory HL [ 16 ]. However, it is known for its various immune-related complications.…”

Current Immunotherapy Progress in the Hodgkin Lymphoma

“…Furthermore, a small subset of patients who had finished two years of therapy and were then monitored but continued to progress could undergo retreatment. Another more recent research showed that nivolumab is a viable and effective treatment for relapsed/refractory Hodgkin lymphoma (r/rHL) [8]. A remarkable 90% of patients responded to nivolumab therapy overall, with 40% experiencing complete remission after it was stopped.…”