P045 | FIRST-LINE NIVOLUMAB-AVD FOR ADVANCED CLASSICAL HODGKIN LYMPHOMA IN ELDERLY PATIENTS: A SINGLE-CENTRE EXPERIENCE

Background The phase-III SWOG S1826 study established nivolumab-AVD (N-AVD) as a less-toxic, first-line option for advanced classical Hodgkin lymphoma (cHL), including patients ≥ 60 years. On the basis of those data, our centre introduced an attenuated-dose N-AVD programme for elderly or comorbid patients. Methods We retrospectively reviewed all adults who started six 28-day cycles of N-AVD between April and September 2024 at our institution. Nivolumab (240 mg, day 1) was combined with doxorubicin, vinblastine and dacarbazine (AVD, days 1 & 15). Baseline characteristics (including International Prognostic Score, IPS), pre-planned dose attenuations, PET-adapted responses, toxicities and subsequent therapies were extracted from the electronic record. Results Seven patients were identified (median age 70 years, range 66–85; 4 male). All had stage III/IV disease; median IPS 3 (range 2–5), with 5/7 (71 %) IPS ≥ 3. Significant co-morbidities included cirrhosis, cardiovascular disease, diabetes and prior stroke or solid tumour. AVD was started at 50 % of standard doses in four patients, 75 % in one, and full dose in two; nivolumab was given in full in all. G-CSF prophylaxis was used in six cases. Interim PET-CT showed complete metabolic response (CMR) in 3/7 (43 %) and partial response in 4/7 (57 %). End-of-treatment PET demonstrated CMR in 5/7 (71 %); the remaining two patients had progressive disease (PD) after the sixth cycle. One PD patient commenced bendamustine, the other received consolidative radiotherapy and is awaiting reassessment. After a median follow-up of 10 months (range 5–11), all patients are alive and the five CMR patients remain relapse-free. Grade ≥ 3 neutropenia occurred in 4/7 (57 %); two patients developed pneumonia. No immune-related adverse events ≥ grade 2 were observed. Conclusions Attenuated-dose N-AVD was feasible in this frail, older cHL cohort and yielded a 71 % CMR rate. Toxicities were primarily haematological and manageable with G-CSF and dose attenuation. These real-world data support prospective evaluation of N-AVD as front-line therapy for elderly or comorbid cHL patients.