Use of N-AVD combination in first-line therapy of classical Hodgkin's lymphoma. Results of a single-center retrospective study based on the Leningrad Regional Clinical Hospital

Abstract

Background. For several decades, the ABVD regimen and several modifications of BEACOPP with or without subsequent radiation therapy have been the cornerstone of treatment for adult patients with classical Hodgkin lymphoma (cHL) [1]. Further progress in cHL treatment is associated with the development of immunotherapy and, in the future, the abandonment of "classical" cytotoxic agents [2]. New targeted agents are highly effective and can potentially help reduce toxicity [3]. Objective of the study. To analyze the efficacy and safety of the N-AVD regimen in the first-line therapy for cHL. Materials and methods. A single-center retrospective study collected data on 26 patients with cHL who received N-AVD therapy in the Leningrad Regional Clinical Hospital from 03.2023 to 02.2025. Inclusion criteria: age ≥18 years, diagnosis of cHL established on the basis of histological and immunohistochemical examination of tumor tissue biopsy, absence of previous treatment and ECOG performance status 0-2. The recruitment of patients with widespread stages of cHL, in accordance with the GHSG criteria, stages III-IV according to Ann Arbor or IIB with massive mediastinum or with extranodal lesions was supposed. The treatment regimen included intravenous administration of nivolumab at a dose of 3 mg/kg + AVD. Patients with stage IIB were planned to receive 4 cycles of N-AVD followed by external beam radiation therapy (RT) to the areas of the initial lesion. In the case of stages III-IV, we focused on 6 cycles of N AVD, RT - optionally to residual masses. Treatment efficacy was monitored after every 2 cycles of N-AVD using PET-CT. Results and discussion. As a result of the implementation of the entire therapy program, including the RT stage, the CR rate was 96%. With a median follow-up of 11.9 months, all 25 patients assessed for efficacy were alive and remained under observation. One-year PFS was 95.7 ± 4.3%. The most common AEs were stage 3-4 neutropenia. Of the immune-mediated AEs (iAEs), two cases of stage 2 and 3 autoimmune thyroiditis and stage 3 acute pericarditis should be noted. The iAEs were not the reason for discontinuation of specific therapy. Conclusion. The results demonstrated the efficacy of the N-AVD regimen in patients with widespread stages of cHL, which is not inferior to that of standard chemotherapy. The use of the N-AVD regimen is associated with the risk of developing iAEs that require special attention. This study leaves open the question of the advisability of consolidation RT in patients receiving N-AVD therapy; additional clinical data and longer follow-up periods are required.

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