Nivolumab as a treatment for relapsed Hodgkin’s lymphoma

The authors examined the safety and effectiveness of nivolumab (Opdivo) in patients with relapsed Hodgkin’s lymphoma after allogenic stem cell transplantation. The authors concluded that this treatment is generally safe and effective. 

Hodgkin’s lymphoma (HL) is generally considered curable. However, some patients may not respond to first-line therapy, or they may relapse. One second-line treatment is allogenic stem cell (immature blood cell) transplantation (allo-SCT) from a genetically matched donor. Even after this treatment, however, some patients will relapse. These patients generally have poor outcomes and limited treatment options.

Nivolumab is a biological treatment that inhibits PD1, PD1 receptors are involved in blocking an immune system response. Inhibiting PD1 allows the immune system to attack the cancer. It has been used to successfully treat patients who have not responded to first-line therapy. It is more often used in patients who have not received allo–SCT because nivolumab may reactivate graft versus host disease (GvHD). GvHD is a condition where the donor stem cells attack the healthy cells of the patient. The safety and effectiveness of nivolumab for patients who have received allo-SCT but have relapsed is still being investigated. 

This study looked at the development of GvHD and survival outcomes for patients who received nivolumab after relapsing following allo-SCT.

The medical records of 20 patients were reviewed. All patients had previously received allo-SCT and had relapsed since then. 13 patients had a history of GvHD. All patients received nivolumab after relapsing. The average length of follow-up was 1 year.

6 (30%) patients developed GvHD after being treated with nivolumab. All 6 of those patients had previously had acute GvHD. Developing and being treated for GvHD did not affect the effectiveness of the nivolumab treatment. Three of the six patients were still showing a response after 1 year.

The one-year progression-free survival (time from treatment until disease progression) rate was 58.2%. After one year, 13 patients had responded to nivolumab. 6 of these patients were disease-free even after stopping treatment. The one-year overall survival (time from treatment until death from any cause) rate was 78.7%. 

The authors concluded that nivolumab is a suitable treatment option for patients with relapsed Hodgkin’s lymphoma, even after receiving allogenic stem cell transplantation. 

It is important to consider that nivolumab can potentially cause severe GvHD that cannot be treated with conventional steroid therapy.