Nivolumab as maintenance therapy for relapsed and refractory classical Hodgkin lymphoma

Introduction. Systemic chemotherapy (CT) has significantly improved the treatment outcomes of classical Hodgkin lymphoma (cHL). However 20–30% of patients experience disease relapse and 10% develop refractory disease. The choice of secondline therapy for patients with relapsed or refractory (r/r) cHL often depends on the experience of the hospital and physician.

Aim: To evaluate the effectiveness of autologous hematopoietic stem cell transplantation (auto-HSCT) and the role maintenance therapy of nivolumab according to the Nivo-BeGEV protocol in r/r cHL.

Materials and methods. From 2019 to 2025, 134 patients with r/r cHL who received immunochemotherapy according to the Nivo-BeGEV protocol were included in a prospective clinical study. The median age was 32.5 years (range 18–64), 63 (47%) were female and 71 (53%) male. Auto-HSCT was not performed in 19 (14.1%) patients, however they received maintenance therapy of nivolumab. Auto-HSCT was performed in 115 patients, of whom 57 (49.6%) received nivolumab maintenance therapy, while 58 (50.4%) did not.

Results. In the group of r/r cHL patients without risk of relapse and progression, no adverse events were recorded. For patients treated with the Nivo-BEGEV protocol followed by auto-HSCT and nivolumab maintenance progression-free survival (PFS) rates were 94% at 12 months, 89% at 24 months and 89% at 36 months. Patients who underwent only auto-HSCT or only nivolumab maintenance had PFS rates of 88%, 78% and 71% respectively (p = 0.1617).

Conclusion. The study demonstrates the high significance of performing auto-HSCT combined with nivolumab maintenance therapy in patients with r/r cHL.

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