Nivolumab for relapsed or refractory Hodgkin lymphoma: Real-life experience
AuthorBeköz, Hüseyin Saffet
Fıratlı Tuğlular, Tülin
Sönmez, Mehmet Giray
Kaya, Ali Hakan
Arat Ersöz, Mutlu
Pepedil Tanrıkulu, Funda
Kurt Yüksel, M
Doğu, Mehmet Hilmi
Kabukçu Hacıoğlu, Sibel
Köseoğlu, Fatoş Dilan
Toprak, Selami Koçak
Yilmaz, Mehmet Birhan
Demirkol, Mehmet Onur
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CitationBeköz, H. S., Karadurmuş, N., Paydaş, S., Türker, A., Toptaş, T., Fıratlı Tuğlular, T. ... Ferhanoğlu, B. (2017). Nivolumab for relapsed or refractory Hodgkin lymphoma: Real-life experience. Annals of Oncology, 28(10), 2496-2502. https://dx.doi.org/10.1093/annonc/mdx341
Background: Reed-Sternberg cells of classical Hodgkin's lymphoma (cHL) are characterized by genetic alterations at the 9p24.1 locus, leading to over-expression of programmed death-ligand 1 and 2. In a phase 1b study, nivolumab, a PD-1-blocking antibody, produced a high response in patients with relapsed or refractory cHL, with an acceptable safety profile. Patients and methods: We present a retrospective analysis of 82 patients (median age: 30 years; range: 18-75) with relapsed/refractory HL treated with nivolumab in a named patient program from 24 centers throughout Turkey. The median follow-up was 7 months, and the patients had a median of 5 (2-11) previous lines of therapy. Fifty-seven (70%) and 63 (77%) had been treated by stem-cell transplantation and brentuximab vedotin, respectively. Results: Among 75 patients evaluated after 12 weeks of nivolumab treatment, the objective response rate was 64%, with 16 complete responses (CR; 22%); after 16 weeks, it was 60%, with 16 (26%) patients achieving CR. Twenty patients underwent subsequent transplantation. Among 11 patients receiving allogeneic stem-cell transplantation, 5 had CR at the time of transplantation and are currently alive with ongoing response. At the time of analysis, 41 patients remained on nivolumab treatment. Among the patients who discontinued nivolumab, the main reason was disease progression (n = 19). The safety profile was acceptable, with only four patients requiring cessation of nivolumab due to serious adverse events (autoimmune encephalitis, pulmonary adverse event, and two cases of graft-versus-host disease aggravation). The 6-month overall and progression-free survival rates were 91.2% (95% confidence interval: 0.83-0.96) and 77.3% (0.66-0.85), respectively. Ten patients died during the follow-up; one of these was judged to be treatment-related. Conclusions: Nivolumab represents a novel option for patients with cHL refractory to brentuximab vedotin, and may serve as a bridge to transplantation; however, it may be associated with increased toxicity.
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SourceAnnals of Oncology
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