Abstract In relapsed–refractory (R/R) Hodgkin lymphoma (HL), the incorporation of immune checkpoint inhibitors (ICIs) to chemotherapy has increased the CMR rates to 95% (in the setting of Pembro-GVD) and post-autologous stem cell transplant (ASCT) progression-free survival (PFS) rates to 70% to 100% (in the setting of Nivo-ICE and Pembrolizumab–Gemcitabine, Vinorelbine, and liposomal doxorubicin Pembro-GVD). This study aimed to analyze the response and survival in patients with primary R/R HL who received ICI with or without chemotherapy. This retrospective study was conducted in the Medical Oncology Department of a tertiary cancer center in India. It included patients with R/R HL treated with ICI in the salvage setting. We analyzed 15 patients. Among the 15 patients enrolled, there were 9 males and 6 females (M:F = 1.33) with a median age of 28 years. Six patients had early-stage, unfavorable disease, and nine had advanced disease. All patients received Doxorubicin, Bleomycin, Vinblastine, Dacarbazine (ABVD) as the first-line treatment. After first-line chemotherapy, seven patients attained CMR, and eight had persistent disease. Of the eight patients who had primary refractory disease, the second-line treatment was salvage chemoimmunotherapy in four patients (three Nivolumab, Ifosfamide, Carboplatin, Etoposide NICE, one Pembro-GVD), Nivolumab in one, and chemotherapy alone in three patients. In the chemoimmunotherapy group, all attained CMR. The remaining three patients treated with salvage chemotherapy showed persistent disease on reevaluation. All of them later received chemoimmunotherapy (two Pembro-GVD and one NICE) and attained CMR. The patient treated with Nivolumab alone had disease progression and later received NICE, Pembro-GVD regimen, Brentuximab Vedotin, and had persistent disease. Among the seven patients who relapsed after primary treatment, one patient was treated with NICE, one received Nivolumab, and the other five patients were treated with chemotherapy. All patients on salvage chemotherapy had persistent disease, and four received chemoimmunotherapy as the third-line treatment. One patient was treated with Nivolumab alone after multiple prior lines of treatment and attained CMR. All patients post-ICI ± chemotherapy attained CMR. The study showed an overall response rate of 93%, with a 1-year PFS and overall survival of 93% and 100%, respectively. In our study, it is evident that chemoimmunotherapy remains the best salvage option in R/R HL, with CMR rates of more than 90%.
Nair et al. (Thu,) studied this question.