Nivolumab may represent an important treatment strategy for patients with relapsed or refractory classical Hodgkin lymphoma (HL), and may be prescribed as a retreatment among those who develop adverse events, according to research published in the American Journal of Blood Research.1

Patients with chemotherapy-refractory HL who do not benefit from autologous stem cell transplantation (ASCT) have a poor prognosis. Although nivolumab, a checkpoint inhibitor targeting PD-1, is approved for patients with relapsed/refractory HL who fail ASCT and brentuximab vedotin, this immunotherapy is more frequently viewed as a bridging therapy to allogeneic SCT than a standalone therapy.

There is, furthermore, data suggesting that nivolumab may lead to severe immune-related adverse events in this patient population, particularly after allo-SCT. Data suggest that these patients may develop severe and refractory graft vs host disease, a life-threatening complication linked with transplantation. There is, however, no conclusive evidence as to whether nivolumab provides an overall survival benefit among these patients.

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The authors of the present paper argued that, among those with HL who develop severe immune-related adverse events with nivolumab, patients may be rechallenged after ASCT consolidation. One patient treated at a practice in Italy upon whom this strategy was used had an ongoing complete response at least 20 months post-rechallenge. The authors also noted the experiences of other practices, which have had similar results with nivolumab retreatment.

A study prescribed nivolumab 40 mg every 2 weeks in a group of 30 patients with relapsed/refractory HL.2 The complete response rate noted was 43.3%, and the median progression-free survival was 18.4 months. A total of 4 of the 30 patients, however, had a grade 3-4 adverse event.

“In conclusion, nivolumab has undoubtedly improved the prognosis of [relapsed/refractory] HL, especially in chemo-refractory patients or in cases who failed ASCT,” the authors wrote. “We believe that this drug should not only represent a bridge to allo-SCT, but it may play an important role also beyond the approved indication and current standard clinical care.”


  1. Cencini E, Bocchia M, Fabbri A. Nivolumab in relapsed/refractory Hodgkin lymphoma: towards a new treatment strategy? Am J Blood Res. 2021;11(3):261-265.
  2. Lepik KV, Fedorova LV, Kondakova EV, et al. A phase 2 study of nivolumab using a fixed dose of 40 mg (Nivo40) in patients with relapsed/refractory Hodgkin lymphoma. Hemasphere. 2020;4(5):e480. doi:10.1097/HS9.0000000000000480