357 | A SHORT (x3) NIVOLUMAB BEFORE BGD CHEMOTHERAPY IMPROVES THE REMISSION RATE IN RELAPSED/REFRACTORY HODGKIN LYMPHOMA: N‐BURGUND TRIAL OF THE POLISH LYMPHOMA RESEARCH GROUP

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Background: In the phase 2 cohort of the GHSG HD21 trial, PET-guided treatment with 4-6x brentuximab vedotin, etoposide, cyclophosphamide, doxorubicin, dacarbazine and dexamethasone (BrECADD) was feasible and highly effective in patients with advanced-stage Hodgkin lymphoma (AS-cHL) at the age of 61-75 years.We demonstrated absence of residual metabolic tumor volume (MTV) after two cycles of chemotherapy in a majority of younger patients with AS-cHL, which was associated with favorable outcome.Aims: Here, we analyze the MTV at baseline and during treatment of AS-cHL patients in the HD21 older cohort.Methods: Patients with AS-cHL aged 61-75 years were enrolled in a phase II single-arm cohort of the HD21 trial (NCT02661503).Patients with negative PET/CT, that is, Deauville score (DS) 1-3, after 2x BrECADD received a total of 4x BrECADD, while PET2-positive patients received 6x BrECADD.We centrally measured MTV before treatment (MTV-0) and after 2x BrECADD (MTV-2) encompassing all sites of disease visible on PET with a standard uptake value above 4 (MTV4.0).Analyses were done using descriptive statistics.Kaplan-Meier analyses were used to analyse progression-free (PFS) and disease-specific survival (DSS), and Cox regressions were used to quantify associations of MTV.Results: MTV-0 could be measured in 62 (75%) of the 83 patients included in the intention-to-treat cohort.MTV-2 could be measured in 79 of 80 patients with centrally reviewed PET-2.Both MTV-0 and MTV-2 were measured in 60 patients.Median MTV-0 was 195 mL (range 5-1525).Patients with a complete response after 2x BrECADD had a median MTV-0 of 165 mL (range 5-1525) and patients with partial response (PR) had a median of 198 mL (56-1238).MTV-0 was not predictive of response at interim or end of treatment in this small cohort.In total, 60/79 (76%) of all MTV-2 evaluable patients had no residual MTV-2.Among 31 patients with PR, 12 (39%) had no measurable MTV-2.The 2-year PFS estimates for patients with and without measurable MTV-2 were 89% (95% CI: 75-100) and 92% (95% CI: 84-100), respectively, with a hazard ratio of 1.63 (95% CI: 0.41-6.53).The 2-year DSS estimates for patients with and without measurable MTV-2 were 91% (95% CI: 74-100) and 98% (95% CI: 95-100), respectively, with a hazard ratio of 3.26 (95% CI: 0.20-52.12).Conclusions: PET-guided BrECADD achieves early deep remissions in older patients with AS-cHL, irrespective of initial lymphoma burden.Most patients had no measurable MTV-2, including many patients with PR according to Deauville criteria.The observed high PFS and DSS rates in this group encourage the evaluation of MTV-2 to guide individualized treatment also in older patients with AS-cHL.

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