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14th International Symposium on Hodgkin Lymphoma

Oct. 03.-05. 2026
Gürzenich, Cologne

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Saturday 03.10.2026

Scientific Session Satellite Symposium Main Program Workshop
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Session details 08:30–11:00
Workshop 1 (Parallel Sessions)

Workshop on ctDNA in HL

Room:Marsilius Saal (Gürzenich) Separate registration required Separate registration required
Session details 08:30–11:00
Scientific Session 1 (Parallel Sessions)

EHA-LYG/GHSG Joint Session: EHA Clinical Practice Guidelines in Lymphoid Malignancies - From Recommendations to Patient Care

Room:Großer Saal (Gürzenich)
Session details 08:30–11:00
Workshop 2 (Parallel Sessions)

Individualization of Radiation Therapy for Hodgkin Lymphoma

Room:Ratsstube (Gürzenich) Separate registration required Separate registration required
Session details 11:30–13:00
Satellite Symposium

Moving Targets: Rethinking Cellular Therapy Delivery in Aggressive B-Cell Lymphomas

Room:Großer Saal (Gürzenich)
Session details 13:15–14:45
Scientific Session 2

Early Stages

Room:Großer Saal (Gürzenich)
Session details 15:00–16:30
Satellite Symposium

Raising the bar in cHL: From frontline treatment to long-term impact

Room:Großer Saal (Gürzenich)
Session details 17:00–18:30
Main Program

Opening Ceremony with Keynote Lecture & Awards

Room:Großer Saal (Gürzenich)
Session details 18:30–20:00
Main Program

Poster Session & Welcome Reception

Room:Foyer (Ground Floor) (Gürzenich)
All poster presenters are required to be present at their poster boards from 18:30 to 20:00.

Please join the poster presentation and take the chance to discuss the results with your colleagues.

Sunday 04.10.2026

Scientific Session Satellite Symposium Main Program Workshop
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Session details 08:00–09:15
Scientific Session 3

HL in Children and Adolescents

Room:Großer Saal (Gürzenich)
  • 08:00

    Treatment Evolution in Pediatric Hodgkin Lymphoma: From Research to Real-World Impact

  • 08:20

    Precision Medicine in Pediatric HL / Harmonized Pediatric HL Protocol in South Africa

  • 09:15

    abstract talk Abstract Talk: T071 The Genomic Landscape of Pediatric High-Risk Hodgkin Lymphoma: A Liquid Biopsy Study of COG AHOD1331

  • 09:30

    abstract talk Abstract Talk: T072 Body-Size Normalisation of Metabolic Tumour Volume in Paediatric Hodgkin Lymphoma: Does MTV/BSA Improve Prognostic Stratification and Reclassify Smaller Children?

Session details 08:00–10:00
Workshop 3

Closed Workshop on Grassroot Initiative in Classic Hodgkin Lymphoma

Room:Ratsstube (Gürzenich) Separate registration required Separate registration required
Session details 09:30–10:30
Satellite Symposium

New concepts for the treatment of B-cell lymphomas

Room:Großer Saal (Gürzenich)
  • 09:30

    DLBCL – The current and future role of ADCs in the context of T-cell engaging therapies

  • 10:00

    cHL – Treatment strategies for PD-1 inhibition in the relapsed / refractory setting

Session details 10:45–12:00
Scientific Session 4

Translating ctDNA into clinical routine

Room:Großer Saal (Gürzenich)
  • 10:45

    Circulating Tumor DNA: New insights from the SWOG S1826 study.

  • 11:05

    Circulating Tumor DNA Analysis for Classification and MRD Assessment – Experience of the German Hodgkin Study Group

  • 11:25

    Workshop Report

  • 12:00

    abstract talk Abstract Talk: T048 A Reproducible Mutation- versus Copy-Number-Enriched Genomic Axis Underlies Molecular Subtypes of Classic Hodgkin Lymphoma

Session details 12:15–13:30
Scientific Session 5

Biology & Pathology

Room:Großer Saal (Gürzenich)
Session details 13:45–15:15
Satellite Symposium

From Evidence to Experience: How Long-Term and Real-World Data for ADCETRIS® (brentuximab vedotin) May Inform Frontline Practice in Advanced Hodgkin Lymphoma

Room:Großer Saal (Gürzenich)
Session details 15:30–17:00
Scientific Session 6

Living Beyond Lymphoma

Room:Großer Saal (Gürzenich)
Session details 17:00–18:30
Scientific Session 7

Advanced Stages

Room:Großer Saal (Gürzenich)
  • 17:00

    Unmet Needs and Future Perspectives with BrECADD: Improving Outcomes of HD21

  • 17:20

    Unmet Needs and Future Perspectives with Nivo-AVD: Unanswered Questions from SWOG S1826

  • 18:25

    abstract talk Abstract Talk: T001 CHOP/miniCHOP And Tislelizumab in EldeRly patients with classical Hodgkin Lymphoma (cHL). A report of the phase II CATER-HL trial (HD12) from the Australasian Lymphoma and Leukaemia Group (ALLG)

  • 18:40

    abstract talk Abstract Talk: T002 Simplified Geriatric Assessment (sGA) in Older Patients With Classical Hodgkin Lymphoma (cHL): The Prospective ELDHL Project of the Fondazione Italiana Linfomi (FIL)

  • 18:55

    abstract talk Abstract Talk: T003 Durable Remissions and Late Immune-Related Toxicities After Frontline Pembrolizumab + AVD in Classic Hodgkin Lymphoma

Monday 05.10.2026

Scientific Session Satellite Symposium Main Program Workshop
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Session details 08:00–09:15
Scientific Session 8

Special Cases & Situations

Room:Großer Saal (Gürzenich)
Session details 09:30–10:30
Scientific Session 9

NLPHL

Room:Großer Saal (Gürzenich)
Session details 10:45–12:15
Scientific Session 10

Relapsed & Refractory HL

Room:Großer Saal (Gürzenich)
Session details 12:15–13:00
Main Program

Best of ISHL14

Room:Großer Saal (Gürzenich)

Gürzenich: Basement

Allocations

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Ratsstube

Saturday, 03.10.2026

Sunday, 04.10.2026

Gürzenich: Ground Floor

Allocations

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Marsilius Saal

Saturday, 03.10.2026

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Foyer (Ground Floor)

Saturday, 03.10.2026

Gürzenich: First Floor

Allocations

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Großer Saal

Saturday, 03.10.2026

Sunday, 04.10.2026

Monday, 05.10.2026

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Isabellensaal

Exhibition

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Advanced stages

Selected for Oral Presentation

  • Show Details

    T001 (T001) CHOP/miniCHOP And Tislelizumab in EldeRly patients with classical Hodgkin Lymphoma (cHL). A report of the phase II CATER-HL trial (HD12) from the Australasian Lymphoma and Leukaemia Group (ALLG)

    • Tara Cochrane
    • Sze Ting Lee
    • Robin Gasiorowski
    • Shane A Gangatharan
    • Fernando Roncolato
    • William EP Renwick
    • Jock Simpson
    • Amanda Johnston
    • Uwe Hahn
    • Philip Wong
    • Masa Lasica
    • Ann Solterbeck
    • Robert Traficante
    • Sally Mapp
    • Bianca Devitt
    • Dhvani Pandya
    • Julia Carlson
    • Tracey Gerber
    • Mark Hertzberg
    • Eliza Hawkes
    • Colm Keane
  • Show Details

    T002 (T002) Simplified Geriatric Assessment (sGA) in Older Patients With Classical Hodgkin Lymphoma (cHL): The Prospective ELDHL Project of the Fondazione Italiana Linfomi (FIL)

    • Vittorio Ruggero Zilioli
    • Francesco Merli
    • Alessandra Tucci
    • Stefano Luminari
    • Giuseppe Colloca
    • Cristina Muzi
    • Benedetta Puccini
    • Chiara Pagani
    • Candida Vitale
    • Francesca Gaia Rossi
    • Erika Meli
    • Anna Guidetti
    • Simone Maifredi
    • Dario Marino
    • Alberto Fabbri
    • Nilla Maschio
    • Manuel Gotti
    • Andrea Bernardelli
    • Salvatrice Mancuso
    • Anna Mele
    • Guido Gini
    • Ilaria Del Giudice
    • Sara Bigliardi
    • Elisabetta Scarpa
    • Barbara Botto
    • Gloria Margiotta-Casaluci
    • Andrea Maria Soccodato
    • Monica Tani
    • Arcangelo Liso
    • Michał Kurlapski
    • Leonardo Flenghi
    • Anna Merli
    • Antonello Sica
    • Francesca Ricci
    • Francesca Perutelli
    • Roberta Battistini
    • Andrés José Maria Ferreri
    • Daniele Laszlo
    • Francesco Gaudio
    • Manuela Zanni
    • Emanuele Cencini
    • Valentina Tabanelli
    • Luca Guerra
    • Claudio Agostinelli
    • Luigi Marcheselli
    • Caterina Mammi
    • Michele Spina
    • Annalisa Arcari
  • Show Details

    T003 (T003) Durable Remissions and Late Immune-Related Toxicities After Frontline Pembrolizumab + AVD in Classic Hodgkin Lymphoma

    • Ryan Lynch
    • Thomas Kuczmarski
    • Chaitra Ujjani
    • Christina Poh
    • Edus Warren
    • Stephen Smith
    • Mazyar Shadman
    • Brian Till
    • Vikram Raghunathan
    • Yolanda Tseng
    • Hongyan Du
    • Heather Rasmussen
    • Jenna Voutsinas
    • Ajay Gopal

Posters

  • Show Details

    P004 (P004) Low-dose nivolumab combined with AVD chemotherapy (Nivo40-AVD) for advanced classic Hodgkin lymphoma: interim results

    • Mobil Akhmedov
    • Pervin Zeynalova
    • Mariya Vernyuk
    • Sergey Semochkin
    • Liliya Khairullina
    • Irina Cherkashina
    • Alevtina Chervontseva
    • Vladimir Lunin
    • Alexander Fedenko
    • Andrey Kaprin
  • Show Details

    P005 (P005) Real-World Tolerability and Efficacy of BrECADD in Advanced-Stage Hodgkin Lymphoma: A Multicenter Brazilian Experience

    • Giovanna Peruzini
    • Matheus Garcia
    • Ruddy de Barros
    • Thiana de Moura
    • Rafaella Samico
    • Natalia Zing
    • Raquel Brito
    • Vanessa Bovolenta
    • Jayr Schimdt
    • Arthur Braga
    • Thais Fisher
    • Talita Silveira
  • Show Details

    P006 (P006) BrECADD in Three Days: Condensing an Intensive First-Line Regimen in Classic Hodgkin Lymphoma

    • Christian Peter Jaworek
    • Maja Supprian
    • Paul J. Bröckelmann
    • Hishan Tharmaseelan
    • Justin Ferdinandus
    • Dennis Eichenauer
    • Anne Sophie Robertz
    • Janina Jablonski
    • Vincent Combüchen
    • Jan-Oliver Staak
    • Karin Töpelt
    • Jan-Michel Heger
    • Jon Felix Rischewski
    • Jannik Stemler
    • Wolfram Klapper
    • Bastian von Tresckow
  • Show Details

    P007 (P007) Six Cycles of Pembrolizumab (PEM) Induction Followed by Abbreviated AVD: A Phase II Trial of Front-Line PET-adapted Therapy in Early Unfavorable and Advanced-Stage Classic Hodgkin Lymphoma (cHL)

    • Megan Melody
    • Hatice Savas
    • Joseph Schroers-Martin
    • Reem Karmali
    • Yangruijue Ma
    • Caroline Mangan
    • Wajiha Zehra
    • Ryan Avery
    • Kenneth Carson
    • Fahad Faruqi
    • Habib Shaikh
    • Ruohui Chen
    • Renee Cheng
    • Leo Gordon
    • Ranjana Advani
    • Jane Winter
  • Show Details

    P008 (P008) Real-world experience with first-line Nivolumab-AVD in advanced-stage Classical Hodgkin Lymphoma

    • Francisca De Asis Maria Hernández Mohedo
    • Laura Curras Sanchez
    • Laura Jimenez Blanco
    • Ana Isabel Martinez Conejo
    • Maria Teresa Escudero Soler
    • Maria Luisa Rubio de la Rubia
    • Carlos Ramos Font
    • Jose Manuel Puerta Puerta
  • Show Details

    P009 (P009) PRECISE-HL Trial: Personalized Reduction of Chemotherapy Intensity through ctDNA Evaluation in Advanced Hodgkin Lymphoma

    • Ryan Lynch
    • David Russler-Germain
    • Joseph Schroers-Martin
    • Alison Moskowitz
    • Reid Merryman
    • Azra Borogovac
    • Hongyan Du
    • Heather Rasmussen
    • Ranjana Advani
    • Ash A. Alizadeh
    • Philippe Armand
    • Nancy Bartlett
    • Alex Herrera
    • Sarah Rutherford
    • David Kurtz
    • Ted Gooley
    • Jenna Voutsinas
    • Ajay Gopal
  • Show Details

    P010 (P010) Frontline Escalation to BrECADD in Advanced Hodgkin Lymphoma: Multicenter Real-World Experience

    • Tzvika Porges
    • Tsofia Levi
    • Tareq Buqai
    • Eldad J Dann
  • Show Details

    P011 (P011) Interim analysis of the A-AVD PET2 adapted in patients with stage IV classical Hodgkin lymphoma. The AVATAR program

    • Andrea Visentin
    • Alessandro Cellini
    • Francesco Angotzi
    • Martina De Ferrari
    • Mattia D'Antiga
    • Anna Giordano
    • Nicolo' Danesin
    • Marco Pizzi
    • Gaia Grassetto
    • Federica Vianello
    • Francesco Piazza
    • Andrea Gallamini
    • Livio Trentin
  • Show Details

    P012 (P012) KEYNOTE-204 final analysis: An open-label, phase 3 study of pembrolizumab (pembro) versus brentuximab vedotin (BV) in relapsed or refractory (R/R) classic Hodgkin lymphoma (cHL)

    • John Kuruvilla
    • Armando Santoro
    • Jan Walewski
    • Robin Gasiorowski
    • Nathalie Johnson
    • Vladimir Melnichenko
    • Valeria Buccheri
    • Patricia Giacon
    • Laura Maria Fogliatto
    • Iara Goncalves
    • Guilherme Perini
    • Sergey Alekseev
    • Neta Goldschmidt
    • Iryna Kriachok
    • Judyta Strzala
    • Michael Dickinson
    • Anna Lojko-Dankowska
    • Andrew McDonald
    • Muhit Ozcan
    • Razi Ghori
    • Doyun Park
    • Rushdia Yusuf
    • Pier Luigi Zinzani
  • Show Details

    P013 (P013) Subcutaneous Pembrolizumab (Pembro) in Relapsed or Refractory Classic Hodgkin Lymphoma (cHL) or Primary Mediastinal Large B-cell Lymphoma (PMBCL): Additional Follow-Up From a Phase 2 Study

    • Elizabeth H. Phillips
    • Gabriel Barragán Ibáñez
    • Ewa Paszkiewicz-Kozik
    • Wojciech Jurczak
    • Mauricio Chandia Cabas
    • Sergio Portiño
    • Elifcan Aladag Karakulak
    • Sebastian Giebel
    • Anna Sureda
    • Tae Min Kim
    • Brenda González-García
    • Norma Gutiérrez
    • Sebastian Hidalgo
    • Kirit Ardeshna
    • Antonia Rodríguez Izquierdo
    • Bastian von Tresckow
    • Gina Song
    • Jessica Flynn
    • Katherine Ryland
    • Rushdia Yusuf
    • Muhit Ozcan
  • Show Details

    P014 (P014) Changes in Patient Reported Outcomes and Treatment Tolerance with a Structured Diet and Exercise Plan

    • Michele Stanchina
    • Melissa Lopez-Pentecost
    • Akina Natori
    • Juan Alderuccio
    • Asaad Trabolsi
    • Alvaro Alencar
    • Emily Panzner
    • Grey Freylersythe
    • Tracy Crane
    • Craig Moskowitz
  • Show Details

    P015 (P015) High efficacy and acceptable toxicity of BrECADD regimen in advanced-stage classical Hodgkin lymphoma

    • Heidi Mocikova
    • Lubica Gaherova
    • Barbara Brizova
    • Katerina Steinerova
    • Jozef Michalka
    • Zdenek Kral
    • Marie Lukasova
    • Vit Prochazka
    • Alice Sykorova
    • Pavla Stepankova
    • Katarina Hradská
    • Juraj Duras
    • Blanka Vackova
    • Jan Koren
    • Tomas Kozak
  • Show Details

    P016 (P016) FENIX Score: A Novel PET-Derived Signature Predicting Neurotoxicity in Advanced Hodgkin Lymphoma Treated with A+AVD

    • Matteo Cristante
    • Federico Fallanca
    • Teresa Calimeri
    • Andrés José Maria Ferreri
    • Fabrizio Marino
  • Show Details

    P017 (P017) Frontline Use of Nivolumab with Doxorubicin, Vinblastine, and Dacarbazine inAdvanced-Stage Classical Hodgkin Lymphoma: A Real-World Analysis

    • Ľubica Gahérová
    • Tomáš Kozák
    • Jozef Michalka
    • Marcela Cermanová
    • Zdeněk Král
    • Blanka Vacková
    • Jan Kořen
    • Alice Sýkorová
    • Katarína Hradská
    • Kateřina Steinerová
    • Marie Lukášová
    • Heidi Móciková
  • Show Details

    P018 (P018) Interim PET remains clinically informative during frontline nivolumab-based therapy in advanced-stage classical Hodgkin lymphoma

    • Anna Kravtsova
    • Daria Koroleva
    • Olga Shchetsova
    • Madina Bagova
    • Aminat Magomedova
    • Oleg Margolin
    • Ekaterina Gitelzon
    • Alexey Subbotin
    • Evgeny Zvonkov
    • Yana Mangasarova
  • Show Details

    P019 (P019) Real-World Treatment Options and Outcomes of Hodgkin Lymphoma in Hungary

    • Zsófia Miltényi
    • Fanni Borics
    • Dávid Tóthfalusi
    • Boglárka Fülöp-Dobó
    • László Imre Pinczés
    • Árpád Illés
  • Show Details

    P020 (P020) Efficacy and Safety of the combination of Programmed Death -1 inhibitors (PD-1i) with chemotherapy for the treatment of classical Hodgkin’s Lymphoma (cHL). A single center experience

    • Kassiani Papanastassi
    • Pavlos-Panagiotis Triantafyllou
    • Chara Giatra
    • Natassa – Eleni Loutsidi
    • Alexandros Tolias
    • Antonis Patrinos
    • Eleni Tsitziloni
    • Leonidas Kotsifas
    • Evaggelia Giannikou
    • Maria Vasilleiou
    • Christos Massaoutis
    • Phoebi Rondogianni
    • Ioannis Baltadakis
    • Maria Bouzani
  • Show Details

    P022 (P022) Association of Patlak-derived dynamic FDG PET parameters with Deauville response categories and kinetic heterogeneity of residual PET-positive findings in classical Hodgkin lymphoma: a prospective single-center pilot study

    • Gregor Horňák
    • Veronika Hanáčková
    • Marie Lukášová
    • Jaroslav Ptáček
    • Vít Procházka
    • Milan Kamínek
  • Show Details

    P023 (P023) Real-World Effectiveness and Safety of the BrECADD Regimen in Advanced Hodgkin Lymphoma. A Multicenter Observational Study of the Polish Lymphoma Research Group.

    • Justyna Rybka
    • Tomasz Wróbel
    • Anna Czyż
    • Kacper Bułdyś
    • Iwona Grygoruk-Wiśniowska
    • Monika Długosz-Danecka
    • Mateusz Sawicki
    • Katarzyna Malesa
    • Jarosław Dybko
    • Ewa Paszkiewicz-Kozik
    • Michał Kurlapski
    • Kamila Kruczkowska-Tarantowicz
    • Agnieszka Kołkowska-Leśniak
    • Ewa Lech-Marańda
    • Emilia Migryt-Rogala
    • Justyna Gil
    • Agnieszka Kopacz
    • Anna Kopińska
    • Agnieszka Janus
    • Agnieszka Giza
    • Jan Maciej Zaucha
  • Show Details

    P024 (P024) Anthracycline-containing regimens confer better survival in risk-matched, advanced stage older patients with classic Hodgkin lymphoma; comorbidity, not age, predicts cardiac toxicity

    • Aisling Barrett
    • Amy Kirkwood
    • Pam McKay
    • Wendy Osborne
    • Nimish Shah
    • Fatima Jamil
    • Ravindu De Silva
    • Joanna Fawcett
    • Nicola Crosbie
    • Jacinta Hardman
    • Sarah Idris
    • ChenXi Lee
    • Edward Truelove
    • Amjad Hmaid
    • Sunil Iyengar
    • Laura McDonald
    • Fiona Miall
    • Heather Laing
    • Georgina Talbot
    • Syed Hasan
    • Shuyang Dai
    • Anna Santarsieri
    • Sai Lon Wann
    • Maria Marzolini
    • James Paterson
    • Sarah Lawless
    • David Waddell
    • Rachel Trickey
    • Tessa Davies
    • Vivek Radhakrishnan
    • Srishma Sridhar
    • Elizabeth H. Phillips
    • Chiara Dallatorre
    • Peter Toth
    • Pierre McCarthy
    • Emily Chernucha
    • Moitreyo Pandit
    • Laura Percy
    • Jack Easton
    • Rory McCulloch
    • Julia Wolf
    • Matthew Wells
    • David Quinn
    • Andrea Kuhnl
    • Charlotte Subklewe
    • Lucy Cook
    • Oscar Atkins
    • Eve Gallop-Evans
    • Katja Williams
    • Cathy Burton
    • Graham P. Collins
  • Show Details

    P025 (P025) Validation of the Hodgkin lymphoma Simplified Frailty Score for Patients Receiving Modern Regimens

    • Katherine Sobol
    • Efrat Luttwak
    • Tiffany Chang
    • Nivetha Ganeson
    • Pallawi Torka
    • Alison Moskowitz
  • Show Details

    P026 (P026) Fitness-adapted, pembrolizumab-based therapy for untreated classical Hodgkin Lymphoma (cHL) patients (Pts) 60 years of age and above: a multicenter prospective study

    • Craig Portell
    • Bethany Horton
    • David Brighton
    • Jakub Svoboda
    • Victor Orellana-Noia
    • Andrew M. Evens
  • Show Details

    P027 (P027) Cost-effectiveness analysis of N-AVD vs BrECADD in advanced-stage classic Hodgkin lymphoma

    • Jowon Laura Kim
    • Amar H. Kelkar
    • Susan Parsons
    • Alison Moskowitz
    • Kishan Patel
    • Adrienne Nedved
    • Arushi Khurana
    • JC C. Villasboas Bisneto
    • Jonas Paludo
    • Jithma P. Abeykoon
    • Yun Kyoung Tiger
    • Paul J. Hampel
    • Yucai Wang
    • Yi Lin
    • N. Nora Bennani
    • Luis F. Porrata
    • Gita Thanarajasingam
    • Carrie A. Thompson
    • Patrick B. Johnston
    • Ivana N. Micallef
    • Thomas M. Habermann
    • Thomas E. Witzig
    • Philippe Armand
    • Stephen M. Ansell
    • Urshila Durani
  • Show Details

    P028 (P028) First-line BrECADD in routine clinical practice: excellent treatment deliverability and early efficacy in advanced-stage classical Hodgkin lymphoma

    • Ida Hude Dragičević
    • Klaudia Babić Čukman
    • Sandra Bašić-Kinda
    • Barbara Dreta
    • Dino Dujmović
    • Josip Batinić
    • Margareta Dobrenić
    • Lea Galunić-Bilić
    • Igor Aurer
  • Show Details

    P029 (P029) Ten-year follow-up of ECHELON-1: overall survival and long-term safety with Brentuximab vedotin plus AVD versus ABVD in patients with previously untreated advanced classic Hodgkin lymphoma

    • Stephen M. Ansell
    • David J. Straus
    • Joseph M. Connors
    • Wojciech Jurczak
    • Won Seog Kim
    • Andrea Gallamini
    • Marco Picardi
    • Tatyana Feldman
    • Kerry J. Savage
    • Radhakrishnan Ramchandren
    • Pier Luigi Zinzani
    • Jeremy S. Abramson
    • Graham P. Collins
    • Jonathan W. Friedberg
    • Andrew Grigg
    • Mehmet Turgut
    • Martin Hutchings
    • Ranjana Advani
    • Adriana Scheliga
    • Andrew M. Evens
    • Rizvan Bush
    • Farhad Sedarati
    • Fei Jie
    • Michelle Fanale
    • John Radford
  • Show Details

    P030 (P030) Outcome and Prognostic Value of PET-2 in Stage IV Classical Hodgkin Lymphoma Treated with Frontline Brentuximab Vedotin Plus AVD: A Real-World Multinational GELTAMO-GATLA Study

    • Jose Ignacio Trucco
    • Marta Peña
    • Maria Teresa Marti
    • Laura Korin
    • Maria Rocio Figueroa Mora
    • Carmen Martinez
    • Guadalupe Antelo Perez
    • Marta Zerga
    • Maria Belen Navarro
    • Carolina Mahuad
    • Cecilia Carpio
    • Carmen Maria Alonso Prieto
    • Lorena Fiad
    • Maria Jimena Cannata-Ortiz
    • Malena Rocca
    • Nicolas Kellenher
    • Mariana Rosenhain
    • Blanca Sanchez Gonzalez
    • Luciano Salvano
    • Lucia Villalon Blanco
    • Javier Romano
    • Veronica Musso
    • Alessandra Comai
    • Fernando Warley
    • Carlos Santorum
    • Florencia Negri Aranguren
    • Maria Orlova
    • Amalia Cerutti
    • Valeria Drouet
    • Lautaro Sardu
    • Trinidad Viviani
    • Julia Valerga Couste
    • Eva Domingo-Doménech
    • Anna Sureda
    • Astrid Pavlovsky
  • Show Details

    P031 (P031) Multistate Modeling of Disease Trajectories for Advanced-Stage Hodgkin Lymphoma Patients Receiving PET Response-Adapted Therapy

    • Zhu
    • Jenny
    • Cui
    • Hocine Tighiouart
    • Nicholas Counsell
    • Sara Rossetti
    • Jenica Upshaw
    • Amy Kirkwood
    • Hongli Li
    • Ranjana Advani
    • Olivier Casanovas
    • James Cerhan
    • Massimo Federico
    • Andrea Gallamini
    • Hervé Ghesquieres
    • Eliza Hawkes
    • David Hodgson
    • Martin Hutchings
    • Peter Johnson
    • Brian Link
    • Eric Mou
    • John Radford
    • Kerry J. Savage
    • Deborah Stephens
    • Pier Luigi Zinzani
    • Matthew Maurer
    • Cedric Rossi
    • Andrew M. Evens
    • Susan Parsons
    • Angie Mae Rodday
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    P032 (P032) ABVD versus a risk-stratified and a response adapted strategy– addressing the dilemma in Advanced Hodgkin Lymphoma: A Phase III Randomized Study

    • Hasmukh Jain
    • Aravind Padmanabhan
    • Alok Shetty
    • Lingaraj Nayak
    • Bhausaheb Bagal
    • Jayashree Thorat
    • Thomas Eipe
    • Supriya More
    • Nisha Khatavkar
    • Prasanth Ganesan
    • Sreeraj Vasudevan
    • Jayant Goda
    • Sumeet Gujral
    • Tanuja Shet
    • Jyothi Kode
    • Archi Agrawal
    • Venkatesh Rangarajan
    • Sneha Shah
    • Neha Sharma
    • Epari Sridhar
    • Siddhartha Laskar
    • Manju Sengar
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    P033 (P033) Evaluating the outcomes of elderly Hodgkin Lymphoma patients: a focus on sequential Brentuximab-AVD

    • Alessandro Cellini
    • Francesco Angotzi
    • Martina De Ferrari
    • Nicolo' Danesin
    • Mattia D'Antiga
    • Arianna Bevilacqua
    • Anna Giordano
    • Marco Pizzi
    • Filippo Crimi'
    • Gaia Grassetto
    • Federica Vianello
    • Francesco Piazza
    • Livio Trentin
    • Andrea Visentin
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    P034 (P034) Netupitant/palonosetron for prevention of chemotherapy-induced nausea and vomiting in Hodgkin lymphoma treated with ABVD or BV-AVD: a single-centre observational study

    • Alessandro Cellini
    • Francesco Angotzi
    • Ivan Zatta
    • Martina De Ferrari
    • Andrea Serafin
    • Arianna Bevilacqua
    • Nicolo' Danesin
    • Giovanni Leone
    • Mattia D'Antiga
    • Anna Giordano
    • Francesco Piazza
    • Francesca Temporin
    • Livio Trentin
    • Andrea Visentin
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    P035 (P035) In-Field Recurrence Patterns Following Consolidation Radiotherapy after BrECADD in Advanced-Stage Hodgkin Lymphoma: A Secondary Analysis of the Randomized Phase 3 GHSG HD21 Trial

    • Johannes Rosenbrock
    • Maja Supprian
    • Michael Oertel
    • Justin Ferdinandus
    • Hishan Tharmaseelan
    • Christian Peter Jaworek
    • Simone Ferdinandus
    • Jasmin Weindler
    • Paul J. Bröckelmann
    • Hendrik Dapper
    • Carsten Kobe
    • Michael Fuchs
    • Emmanouil Fokas
    • Peter Borchmann
    • Hans Theodor Eich
    • Christian Baues
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    P036 (P036) Interim PET-Adapted De-escalation Chemotherapy Regimen for Advanced Stage Classical Hodgkin Lymphoma Using Brentuximab Vedotin, Pembrolizumab, Doxorubicin, and Dacarbazine: Phase 2 Study — Updated Follow-up

    • Hun Ju Lee
    • Gregory Ravizzini
    • Jennifer Ramos
    • Javier Retamales
    • Ayushi Chauhan
    • Luis Fayad
    • Ranjit Nair
    • Jason Westin
    • Jared Henderson
    • Christopher Flowers
    • Michael Wang
    • Luis Malpica
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    P037 (P037) PET-Adapted EACODD-14 Regimen in Early Unfavorable and Advanced Stages of Classical Hodgkin Lymphoma: Efficacy and Survival in the Multicenter HL-Russia-1 Study

    • Nikita Shorokhov
    • Elena Demina
    • Gayane Tumyan
    • Valeria Spirko
    • Elena Pavluchenko
    • Kamil Kaplanov
    • Alena Bobrova
    • Elena Baryakh
    • Diana Ivanova
    • Natalia Mikhailova
    • Evgeniya Borzenkova
    • Tatyana Pospelova
    • Maria Voytko
    • Olga Smirnova
    • Elsa Kankumasheva
    • Elsa Siraeva
    • Vitaliy Kanin
    • Alexandra Saidullaeva
    • Arina Adolf
    • Irina Matveeva
    • Nikita Mochkin
    • Vladimir Melnichenko
    • Vladislav Sarzhevskiy
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    P038 (P038) Frontline nivolumab-AVD in older patients with advanced classical Hodgkin lymphoma: real-word experience from a single Italian centre

    • Tanja Lazic
    • Stefano Luminari
    • Alberto Bavieri
    • Silvia Gambara
    • Maria Elena Nizzoli
    • Laura Arletti
    • Angela Ferrari
    • Fiorella Ilariucci
    • Francesco Merli
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    P039 (P039) Has Frontline Brentuximab Vedotin Plus AVD Altered the Historical Adverse Prognostic Impact of Stage IV Disease in Classical Hodgkin Lymphoma? A Dual-Center Real-World Experience

    • Martha Cecilia Berliner
    • Tanja Lazic
    • Roberta Sciarra
    • Alessandro Mazzacane
    • Sofia Pedrali
    • Nicolò Rampi
    • Chiara Rusconi
    • Luca Arcaini
    • Stefano Luminari
    • Manuel Gotti
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    P040 (P040) Hyperbilirubinemia in Classical Hodgkin Lymphoma: Impact of Severity on Hepatic Recovery and Clinical Outcomes

    • Yash Patel
    • Kavitha Lakshmi
    • Anu Korula
    • Vikram Mathews
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    P041 (P041) INTERIM AND END-OF-TREATMENT (EOT) PET/CT ASSESSMENT AFTER NIVOLUMAB, DOXORUBICIN, VINBLASTINE, AND DACARBAZINE (N-AVD) IN ADVANCED-STAGE CLASSICAL HODGKIN LYMPHOMA (CHL): A SINGLE-CENTER EXPERIENCE

    • Piperidou Alexia
    • Athanasios Liaskas
    • Anastasia Kopsaftopoulou
    • Maria Dimitrakoudi
    • Eliana Konstantinou
    • Marina Belia
    • Maria Arapaki
    • Rodanthi Fioretzaki
    • Aikaterini Kolotsiou
    • Alexandros Machairas
    • Georgia Poultsaki
    • Chryzovalantou Chatzidimitriou
    • John Asimakopoulos
    • Angeliki Georgopoulou
    • Calliope Zerzi
    • Panayiotis Tsaftaridis
    • Fotios Panitsas
    • Aikaterini Benekou
    • Panayiota Petsa
    • Helen Plata
    • Aikaterini Bitsani
    • Maria Dimou
    • Marina Siakantaris
    • Maria Angelopoulou
    • Theodoros Vassilakopoulos
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    P042 (P042) Association of quantitative FDG-PET parameters and serum TARC with outcome in advanced classic Hodgkin lymphoma: A biomarker analysis of the EORTC-1537-COBRA trial

    • Sophie Teesink
    • Lydia Visser
    • Laure Musekera
    • Anna Sureda
    • Susana Carvalho
    • Andrey Vranovsky
    • Annika Loft
    • Anne Arens
    • Sanne Tonino
    • Ward Sents
    • Cédric Mallien
    • Berthe Aleman
    • Walter Noordzij
    • Catherine Fortpied
    • Martin Hutchings
    • Arjan Diepstra
    • Wouter Plattel
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    P043 (P043) LUNG FUNCTION ASSESSMENT BY DIFFUSING CAPACITY OF THE LUNGS FOR CARBON MONOXIDE (DLCO) MEASUREMENT IN PATIENTS WITH CLASSICAL HODGKIN LYMPHOMA RECEIVING FIRST-LINE TREATMENT WITH NIVOLUMAB-AVD

    • Athanasios Liaskas
    • Alexia Piperidou
    • Georgia Poultsaki
    • Maria Dimitrakoudi
    • Anastasia Kopsaftopoulou
    • Rodanthi Fioretzaki
    • Alexandros Machairas
    • Marina Belia
    • Maria Arapaki
    • Eliana Konstantinou
    • Giannis Assimakopoulos
    • Panayiotis Tsaftaridis
    • Fotios Panitsas
    • Aikaterini Bitsani
    • Maria Dimou
    • Marina Siakantaris
    • Maria Angelopoulou
    • Theodoros Vassilakopoulos
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    P044 (P044) HIV-associated Hodgkin lymphoma: real-world treatment outcomes and infectious complications – a multicentre study by the Polish Lymphoma Research Group

    • Agnieszka Giza
    • Magdalena Zapala
    • Joanna Drozd-Sokolowska
    • Magdalena Witkowska
    • Jan Maciej Zaucha
    • Malgorzata Sobczyk-Kruszelnicka
    • Anastazja Szlauer-Stefanska
    • Anna Kopinska
    • Magdalena Zawartko
    • Magdalena Witak- Jedra
    • Kamil Wisniewski
    • Kamil Wdowiak
    • Jarosław Grzyb
    • Anna Parfieniuk-Kowerda
    • Natalia Leonczuk
    • Alicja Wandalowicz
    • Monika Joks
    • Justyna Rybka
    • Judyta Strzala
    • Agnieszka Szeremet
    • Aleksandra Szymczak
    • Marcin Czarnecki
    • Marta Głuchowska
    • Jarosław Dybko
    • Dagmara Zimowska-Curylo
    • Ewa Lech-Maranda
    • Tomasz Sacha
    • Milosz Parczewski
    • Monika Bociaga-Jasik
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    P045 (P045) Frontline BV-AVD in Classical Hodgkin Lymphoma: A Multicenter Real-World Comparison with the ABVD Regimen

    • Fatma Keklik Karadag
    • Merve Yuksel
    • Umut Yılmaz
    • Meral Ulukoylu Menguc
    • Denis Çetin
    • Ajda Gunes
    • Batuhan Bulan
    • Taner Tan
    • Sureyya Yigitkaya
    • Hacer Berna Afacan Ozturk
    • Ezel Elgün
    • Deniz Gören
    • Ulviyya Hasanzade
    • Hale Bulbul Dilmen
    • Utku Iltar
    • Merve Ecem Erdogan Yon
    • Guldane Cengiz Seval
    • Ozan Salim
    • Orhan Kemal Yücel
    • Ekin Kircali
    • Zafer Serenli Yeğen
    • Haşim Atakan Erol
    • Ayse Uysal
    • Burak Deveci
    • Omur Kayıkcı
    • Zehra Narli Özdemir
    • Esin Oğuz Kozan
    • Mehmet Baysal
    • Ayse Hilal Eroğlu Küçükdiler
    • Zuhal Demirci
    • Irfan Yavasoglu
    • Pelin Aytan
    • Deniz Ozmen Ibis
    • Murat Ozbalak
    • Fahir Ozkalemkas
    • Ahmet Kursad Gunes
    • Ömür Gökmen Sevindik
    • Gulsum Ozet
    • Zafer Gulbas
    • Olga Meltem Akay
    • Muhlis Cem Ar
    • Ahmet Emre Eskazan
    • Elif Birtas Atesoglu
    • Burhan Ferhanoglu
    • Guray Saydam
    • Muhit Ozcan
    • Ozgur Mehtap
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P004 (P004)

Low-dose nivolumab combined with AVD chemotherapy (Nivo40-AVD) for advanced classic Hodgkin lymphoma: interim results

Background: Nivolumab plus AVD (N-AVD) is currently approved for newly diagnosed advanced-stage classical Hodgkin lymphoma (cHL). However, substantially lower nivolumab doses (0.1–0.33 mg/kg) have demonstrated clinical activity in relapsed/refractory settings. We evaluated the efficacy and safety of a low-dose nivolumab regimen (Nivo40-AVD) in untreated advanced cHL. Methods: This is an interim analysis of an investigator-initiated phase II trial (NCT06984146). Eligible patients were ≥18 years with stage IIB disease with bulky mediastinal mass and/or extranodal involvement, or stage III–IV cHL, with adequate cardiac function and no history of autoimmune disease. Exclusion criteria were uncontrolled infection, decompensated organ failure unrelated to lymphoma, pregnancy, and inability to consent. Treatment consisted of six cycles of Nivo40-AVD (nivolumab 40 mg; doxorubicin 25 mg/m2; vinblastine 6 mg/m2; dacarbazine 375 mg/m2 on days 1 and 15). PET/CT was performed after cycle 2 and at the end of treatment. Consolidative radiotherapy was permitted for partial response. The primary endpoint was 2-year progression-free survival (PFS); secondary endpoints included overall response rate (ORR), complete response (CR), overall survival (OS), and adverse events rate. Results: At data cutoff, 35/54 patients were enrolled; 20 (57%) completed therapy and were evaluable. Median age was 36 years (range 19–73). Most patients had stage IV disease (55%), B-symptoms (80%), extranodal involvement (70%), and nodular sclerosis subtype (95%); 75% were female. EBV positivity was observed in 15%. Median nivolumab dose was 0.56 mg/kg (range 0.35–0.74). ORR was 100%, with CR in 90% of patients. At a median follow-up of 10 months, PFS was 100%. Grade 3–4 adverse events included neutropenia (65%) and transaminitis (10%). Conclusions: Low-dose nivolumab combined with AVD is feasible and demonstrates promising efficacy as frontline therapy for advanced cHL. Follow-up is ongoing. Updated results will be presented at the meeting.
  • Mobil Akhmedov
  • Pervin Zeynalova
  • Mariya Vernyuk
  • Sergey Semochkin
  • Liliya Khairullina
  • Irina Cherkashina
  • Alevtina Chervontseva
  • Vladimir Lunin
  • Alexander Fedenko
  • Andrey Kaprin
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P005 (P005)

Real-World Tolerability and Efficacy of BrECADD in Advanced-Stage Hodgkin Lymphoma: A Multicenter Brazilian Experience

Background: Since the introduction of the ABVD and BEACOPP regimen, Hodgkin Lymphoma (HL) has achieved high cure rates. Since then, new therapeutic regimens have been investigated aiming to improve outcomes and reduce toxicity ( mainly with intensive regimen), particularly in advanced-stage HL. In this context, the HD21 trial comparing BrECADD regimen (brentuximab vedotin, etoposide, cyclophosphamide, doxorubicin, dacarbazine, and dexamethasone) with BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone), demonstrated lower toxicity, as well as improved 4-year progression-free survival (94.3% vs. 90.9%) and maintain overall survival (98.6% vs. 98.2%). The main treatment-related adverse events (AEs) include anemia, thrombocytopenia, neutropenia, and neuropathy, with dose reductions required due to AEs in 34% of patients treated with BEACOPP and 21% of those receiving BrECADD. These results suggest that the BrECADD combination may preserve or even improve therapeutic efficacy, while reducing the incidence of adverse events and, consequently, the need for dose modifications. Aims: To describe the initial real-world data on the use of the BrECADD regimen for advanced-stage HL in Brazilian centers. Methods: This is an observational, retrospective study conducted across six private Brazilian referral centers in Onco-Hematology. A total of 22 patients diagnosed and treated at these institutions between September 2023 and January 2026 were included. Results: Among the 22 patients included, the first one was treated at sep/ 2023. Five had not yet completed the therapeutic protocol or realized final PET. The median age of the cohort was 36 years (range: 17–51 years), with 14 females and 8 males. Performance status was assessed using the Eastern Cooperative Oncology Group (ECOG) scale, with 100% of patients classified as ECOG 0 at treatment initiation. Regarding disease staging, most patients presented with advanced disease, with Ann Arbor stage IV observed in 68.2% (15 patients). The International Prognostic Score (IPS), 68.2% of patients had an IPS of 0–2, while 31.8% had an IPS ≥3. As preliminary results, 3/22 (13,63%) patients had iPET positive and realized 6 cycles of treatment. One of this patients had PET with Deauville 4 at the end of the treatment and was sent to radiotherapy ( now is waiting for final evaluation). No one patient had refractory disease or recidive (this is a very premature real life cohor
  • Giovanna Peruzini
  • Matheus Garcia
  • Ruddy de Barros
  • Thiana de Moura
  • Rafaella Samico
  • Natalia Zing
  • Raquel Brito
  • Vanessa Bovolenta
  • Jayr Schimdt
  • Arthur Braga
  • Thais Fisher
  • Talita Silveira
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P006 (P006)

BrECADD in Three Days: Condensing an Intensive First-Line Regimen in Classic Hodgkin Lymphoma

Intensive multi-agent treatment regimens have substantially improved outcomes in advanced-stage classic Hodgkin lymphoma (cHL). BrECADD is the first-line regimen that demonstrated the highest efficacy in cHL reported to date (Borchmann et al., Lancet 2024). The regimen combines brentuximab vedotin (BV) with etoposide, cyclophosphamide, doxorubicin, dacarbazine and dexamethasone given in 21-day intervals with cytotoxic agents during the first four days. Simplifying multi-day treatment schedules has the potential to reduce treatment burden and logistical demands in routine clinical practice. We thus developed a condensed BrECADD protocol with BV being administered alongside etoposide, cyclophosphamide, doxorubicin and dexamethasone on day 1 of each cycle, reducing i.v. administration days to only three (-25%). From January 2024 to February 2026, 22 patients were treated with the newly developed 3-day BrECADD protocol. Data was retrospectively collected from medical records for patients treated at the University Hospital in Cologne. Primary objective was to describe feasibility and safety. Secondary objectives included evaluation of treatment response, one-year-progression free survival (PFS) and one-year-overall survival (OS). A total of 96 treatment cycles were administered across the 22 patients. CTCAE Grade ≥3 adverse events occurred in 13 patients (59%), with hematological toxicities being most frequent. Five patients (23%) had grade ≥3 infections (3 viral, 2 bacterial), and 4 patients (18%) had febrile neutropenia without pathogen detection. After 2 treatment cycles of BrECADD, a complete remission (CR) was achieved in 18 patients (82%). Irradiation due to PET-positive residual disease was performed in 2 patients (9%). No treatment discontinuations occurred. With a median follow up of 19 months (min-max: 4-26), one-year PFS and OS were both 100%. Based on these encouraging results, the condensed 3-day protocol is considered feasible and beneficial for logistical considerations in clinical practice. We thus recommend the condensed 3-day protocol for future BrECADD use.
  • Christian Peter Jaworek
  • Maja Supprian
  • Paul J. Bröckelmann
  • Hishan Tharmaseelan
  • Justin Ferdinandus
  • Dennis Eichenauer
  • Anne Sophie Robertz
  • Janina Jablonski
  • Vincent Combüchen
  • Jan-Oliver Staak
  • Karin Töpelt
  • Jan-Michel Heger
  • Jon Felix Rischewski
  • Jannik Stemler
  • Wolfram Klapper
  • Bastian von Tresckow
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P007 (P007)

Six Cycles of Pembrolizumab (PEM) Induction Followed by Abbreviated AVD: A Phase II Trial of Front-Line PET-adapted Therapy in Early Unfavorable and Advanced-Stage Classic Hodgkin Lymphoma (cHL)

Background: In NU16H08 (NCT03226249), 3 cycles of pembrolizumab (PEM) resulted in complete (37%) or near complete (25%) metabolic responses (CMR) in two thirds of untreated patients (pts) w/classic Hodgkin lymphoma (cHL) and 100% PFS/OS at 5yrs when followed by 4-6 cycles of AVD (ASH 2024, abst# 1664). Based on these findings, we hypothesized that PEM x 6 would yield a higher CMR rate than PEM x 3 and allow for a larger subset of pts to receive an abbreviated course of AVD while preserving efficacy. Methods: Adult pts > 18yrs w/untreated stage III/IV cHL or stage I/II cHL w/at least 1 NCCN unfavorable risk factor received PEM X 6 followed by 2-6 AVD cycles (+/- PEM consolidation) based on response, stage, and bulk (see SCHEMA). The primary objective was CMR rate after PEM induction by PET scan, w/secondary objectives including efficacy of PEM followed by abbreviated AVD, safety, and PFS/OS. Exploratory objectives included clearance of circulating tumor DNA (ctDNA) as a predictor of response and association w/PET results. Results: Thirty pts were enrolled: median age of 29 (25–33), 63% female, 50% stage III/IV, 50% w/early-stage unfavorable cHL (9 bulky, 5 B-symptoms, 7 ESR>50). 26 pts completed all PEM x 6; 2 pts went off study after PEM x 1 (1w/grade 3 encephalitis, 1 w/grade 3 headache). Two pts transitioned to AVD after PEM x 3 (1 w/grade 3 pancreatitis, 1 w/progression of disease). PET scans following PEM x 6 (PET #2) were centrally reviewed: CMR (Deauville 1–3) in 27% (n=8; 95% CI: 12%–46%), partial metabolic response (Deauville 4–5) in 60% (n=18). Three pts (10%) had an overall reduction in disease burden w/PEM, but new PET+ sites (progressive disease). Two pts were PET+ (Deauville 4) after AVD x 2 and escalated to BrECADD; 1 pt completed 4 cycles and 1 pt received 2 and transitioned to proton irradiation due to toxicity. CMR was 100% for all pts at end of treatment (n=28) who received AVD following PEM. At a median follow-up of 15.1 months (range 1.0–24.2), no pt has progressed or relapsed; median PFS has not been reached. Conclusions: Induction with PEM x 6 was not more effective than PEM x 3 in producing CMR. Planned correlative analysis of ctDNA may provide a better assessment of disease status post-PEM, aiding in future de-escalation strategies. Upfront treatment with PEM was associated with significant toxicities, possibly reflecting the robust immune response in this young patient population.
  • Megan Melody
  • Hatice Savas
  • Joseph Schroers-Martin
  • Reem Karmali
  • Yangruijue Ma
  • Caroline Mangan
  • Wajiha Zehra
  • Ryan Avery
  • Kenneth Carson
  • Fahad Faruqi
  • Habib Shaikh
  • Ruohui Chen
  • Renee Cheng
  • Leo Gordon
  • Ranjana Advani
  • Jane Winter
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P008 (P008)

Real-world experience with first-line Nivolumab-AVD in advanced-stage Classical Hodgkin Lymphoma

Introduction: Classical Hodgkin lymphoma (cHL) has high cure rates, although outcomes remain poorer in advanced stages and in patients with high baseline metabolic tumor burden (3). Novel first-line regimens combining immunotherapy and chemotherapy have improved efficacy and reduced toxicity (ECHELON-1, HD21 and SWOG S1826), but real-world data are still limited (1,2,4,5). Objective: To evaluate the efficacy and safety of first-line Nivolumab-AVD in high-risk advanced cHL (stages III–IV and IIB with risk factors) with high metabolic tumor burden on baseline PET (metabolic tumor volume (MTV) and total lesion glycolysis (TLG)), at our center. Materials and methods: Retrospective study of patients with cHL treated with first-line Nivolumab-AVD (SWOG S1826 regimen) between 2024 and 2026. Clinical, metabolic imaging, response and survival data, were analyzed descriptively. Efficacy was assessed according to Lugano 2014 criteria, and adverse events (AEs) according to CTCAE v5. Results: Seven of eight patients were analyzed; one was excluded due to grade 4 non–immune-mediated toxic hepatitis after cycle 1. Median age was 24 years (18–58), 52% were male, nodular sclerosis was the most frequent subtype (71%). None of the patients were EBER or HIV-positive. All patients had advanced disease (stages III–IV), except one high-risk stage IIB case. Median IPS was 4 and median MTV was 309. Extranodal involvement was present in all patients, while 86% had B symptoms, 71% bulky disease, and 43% splenic involvement. After a median follow-up of 16 months, six patients completed treatment and one completed 3 cycles with complete metabolic response (CMR) on interim PET (iPET). Median iPET MTV was 0 (0–16.5); CMR was observed in 4 patients with Deauville score (DS) 2-3 while three patients obtained DS4. In this regard, recent studies such as HD21 have combined DS and MTV on iPET for a more accurate evaluation of response to immunotherapy. End-of-treatment PET (EOT-PET) showed a 100% CMR rate, with estimated 2-year progression-free survival and overall survival of 100%. All patients received G-CSF prophylaxis. Two patients developed grade 1-2 immune-mediated AEs after completing treatment (thyroiditis and pneumonitis). No consolidative radiotherapy was administered. Conclusion: First-line Nivolumab-AVD demonstrated excellent real-world efficacy and favorable tolerability in high-risk advanced cHL across all ages, outperforming historical results with ABVD regimen.
  • Francisca De Asis Maria Hernández Mohedo
  • Laura Curras Sanchez
  • Laura Jimenez Blanco
  • Ana Isabel Martinez Conejo
  • Maria Teresa Escudero Soler
  • Maria Luisa Rubio de la Rubia
  • Carlos Ramos Font
  • Jose Manuel Puerta Puerta
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P009 (P009)

PRECISE-HL Trial: Personalized Reduction of Chemotherapy Intensity through ctDNA Evaluation in Advanced Hodgkin Lymphoma

Introduction: Nivolumab-AVD has become a new standard for untreated advanced stage Hodgkin lymphoma in North America. The PRECISE-HL trial will assess a response-adaptive CHL treatment approach utilizing PhasED-Seq to reduce the overall chemotherapy burden for patients with early MRD-negativity when treated with nivolumab-AVD (NCT06745076). Methods: This is a multi-center phase 2, open label pilot study of six cycles of response-adapted therapy based on MRD testing by PhasED-Seq for untreated stage III or IV CHL. Patients will receive the combination of nivolumab (240 mg IV), doxorubicin (25 mg/m2 IV), vinblastine (6 mg/m2 IV) dacarbazine (375 mg/m2 IV) on days 1 and 15 of 28-day cycles. Blood samples for PhasED-Seq testing at baseline and post cycle 2 will be sent to Foresight Diagnostics for rapid processing (estimated turn-around time 10-14 days). For patients with undetectable MRD at cycle 3 day 1, the doxorubicin, vinblastine, and dacarbazine will be removed from Cycle 5 and Cycle 6 while continuing nivolumab. For patients with detectable or inconclusive MRD, treatment after interim assessment will continue with all 4 agents for 6 total cycles. Planned enrollment is 125 patients. The primary endpoint is 1-year PFS in patients with undetectable MRD after 2 cycles of treatment. Secondary endpoints include 1-year PFS in MRD positive patients after 2 cycles of treatment, 2-year PFS in the overall cohort and stratified by MRD status, and best overall response as complete or partial response (CR/PR). Exploratory endpoints include MRD assessments at other timepoints and during follow up, patient reported outcomes, and cardiac biomarkers. The primary efficacy benchmark for this trial is a 1-year progression-free survival (PFS) rate of ≥94% for interim ctDNA negative patients based on historical data from the S1826 study. Additional key eligibility criteria include age 18+ and measurable disease per Lugano criteria. Key exclusion criteria include current or prior autoimmune disease except vitiligo or thyroid disease on stable replacement doses.
  • Ryan Lynch
  • David Russler-Germain
  • Joseph Schroers-Martin
  • Alison Moskowitz
  • Reid Merryman
  • Azra Borogovac
  • Hongyan Du
  • Heather Rasmussen
  • Ranjana Advani
  • Ash A. Alizadeh
  • Philippe Armand
  • Nancy Bartlett
  • Alex Herrera
  • Sarah Rutherford
  • David Kurtz
  • Ted Gooley
  • Jenna Voutsinas
  • Ajay Gopal
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P010 (P010)

Frontline Escalation to BrECADD in Advanced Hodgkin Lymphoma: Multicenter Real-World Experience

Background: Response-adapted treatment escalation is an established strategy in advanced classical Hodgkin lymphoma for patients with inadequate early response to initial lower-intensity therapy. However, the published evidence for PET2-adapted escalation is based largely on escalation to escalated BEACOPP with The RATHL study and SWOG S0816 support escalation with 3- and 2-year progression-free survival of 67.5% and 64% respectively. BrECADD protocol has mainly been studied as an upfront intensive regimen and showed lower treatment-related morbidity than escalated BEACOPP with at least noninferior efficacy and a 4-year progression-free survival of 94.3 percent. Data on BrECADD as an escalation strategy in routine practice remain limited. Methods: We conducted a multicenter retrospective real-world analysis of adults treated with BrECADD between July 1, 2023, and October 1, 2025, data cut off was 1.12.25. Within this cohort, we identified nine patients with advanced Hodgkin lymphoma who underwent escalation to BrECADD during frontline therapy. Most patients escalated because of inadequate response to initial lower-intensity treatment. This subgroup was analyzed descriptively for treatment delivery, response, survival outcomes, and safety. Results: Nine patients with advanced Hodgkin lymphoma underwent escalation to BrECADD after other regimen: ABVD in 6 patients, AAVD in 2, and CHOP in 1. Escalation was triggered by partial response in 7 patients, toxicity in 1, and revised diagnosis in 1. The median age was 25 and stage 4 disease was reported in 4 patients. Patients received a median of 4 BrECADD cycles, with 8 of 9 completing planned treatment and 2 requiring dose reduction. All 9 patients achieved complete metabolic response after BrECADD, 7 of them after 2 cycles. After a median follow-up of 15.7 months (range, 5.1–30.7), 2 patients had relapsed, and all patients were alive at last follow-up. Grade 4 hematologic adverse events were recorded in 6 patients with only one patient with Grade 3-4 non hematologic toxicity. No ICU admission or neurologic toxicity was reported. Conclusions: In this multicenter real-world series, frontline escalation to BrECADD was feasible and induced complete metabolic response in all patients. Although 2 relapses occurred during follow-up, there were no recorded death which bring the overall survival to 100%. These findings extend the limited literature on BrECADD beyond its use as upfront
  • Tzvika Porges
  • Tsofia Levi
  • Tareq Buqai
  • Eldad J Dann
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P011 (P011)

Interim analysis of the A-AVD PET2 adapted in patients with stage IV classical Hodgkin lymphoma. The AVATAR program

Background: In the ECHELON-1 trial brentuximab-AVD (A-AVD) improved the progression-free survival (PFS) and overall survival (OS) stage IV classical Hodgkin lymphoma (cHL) compared to ABVD. This trial, alongside other real-life studies confirmed the predictive role of the 18FDG PET-CT scan after the two courses of A-AVD (PET2), with PET2 positivity (PET2+) associated with a higher risk of relapse. Recently in the COBRA trial almost 40% of the patients with a positive PET after 1 cycle of A-AVD escalated to BrECADD for 6 cycles with a 2-yr PFS of 89%. We hypothesized that escalation to BrECADD in PET2+ cases would reduce the number of patients requiring treatment intensification while improving their outcomes. Methods: Patients with stage IV cHL aged 18–60 years were treated with A-AVD for 2 cycles according to Italian regulatory agency. Patients with a negative PET2 scan (Deauville score 1–3) continued A-AVD until cycle 6, whereas those with a positive PET2 scan (DS 4–5) received 4 cycles of BrECADD. Consolidative radiotherapy (cRT) was provided in case of focal residual disease at the end of treatment (EoT). Results: Fifty patients with stage IV cHL have been enrolled since 2021, 46% were male, median age was 31 years (IQR 25-43), 62% had B symptoms, 38% an IPS >3, 20% a bulky mass and 6% were HIV positive. Regarding histology, 70% had nodular sclerosis subtype, 4% mixed cellularity, 2% lymphocyte-rich, 2% lymphocyte depletion, 22% NOS. Only 10% of cases were PET2+ (6% DS 4, 4% DS 5). Among 90% PET2 negative cases, only 2 patients had a positive EoT PET, 1 with localized diseases received cRT achieving a complete remission. Among the 5 PET2+ patients, 1 patient with localized EoT PET positivity received cRT. Only 1 patient in both subgroups relapsed, after 2 and 9 months, respectively. After a median follow-up of 24 months the 2-yr PFS and OS were 92.2% and 97.6%. Only 1 HIV+ PET2 negative patient died of infection at cycle 5. As expected, cytopenias, blood transfusion and fatigue were more common with BrECADD, while the rate of peripheral neuropathy (PN) was higher patients who received 6 cycles of A-AVD. Thus since February 2026, to reduce the incidence of PN, PET2-negative patients are receiving A-AD (i.e w/o vinblastine). Conclusions: In our ongoing program, we confirmed the low rate of PET2+ after of A-AVD and provide initial results that 4 cycles of BrECADD can successfully rescue most PET2+ patients.
  • Andrea Visentin
  • Alessandro Cellini
  • Francesco Angotzi
  • Martina De Ferrari
  • Mattia D'Antiga
  • Anna Giordano
  • Nicolo' Danesin
  • Marco Pizzi
  • Gaia Grassetto
  • Federica Vianello
  • Francesco Piazza
  • Andrea Gallamini
  • Livio Trentin
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P012 (P012)

KEYNOTE-204 final analysis: An open-label, phase 3 study of pembrolizumab (pembro) versus brentuximab vedotin (BV) in relapsed or refractory (R/R) classic Hodgkin lymphoma (cHL)

Background: At the second interim analysis of KEYNOTE-204 (NCT02684292), PFS was significantly improved with pembro vs BV in participants with R/R cHL (median PFS, 13.2 vs 8.3 months; HR, 0.65 [95% CI, 0.48-0.88]; P=0.0027 [P value threshold for significance, 0.0043]). We report results from the final analysis. Methods: Eligible participants aged ≥18 years with R/R cHL who were post−autologous stem cell transplant (auto-SCT) or ineligible for auto-SCT, had measurable disease, and an ECOG PS of 0 or 1, were randomly assigned 1:1 to pembro 200 mg or BV 1.8 mg/kg IV Q3W for 35 cycles. Participants were stratified by prior auto-SCT (yes vs no) and status after 1L therapy (primary refractory vs relapsed <12 months vs relapsed ≥12 months after 1L). Dual primary end points were PFS per IWG 2007 criteria by BICR including clinical and imaging data after auto-SCT or allogeneic SCT (allo-SCT) and OS. ORR per IWG by BICR and safety were secondary. DOR per IWG by BICR was exploratory. Results: 304 participants were randomized and 300 participants were treated (pembro, n=148; BV, n=152). At data cutoff (Jan 14, 2026), median (range) follow-up was 97.6 months (90.6-113.9) for pembro and 97.7 months (90.1-114.3) for BV. Median PFS was 13.6 months for pembro and 8.2 months for BV (HR [95% CI], 0.73 [0.55-0.99]); median OS was 106.6 months and not reached (NR; HR [95% CI], 0.93 [0.66-1.33]), respectively (Figure). ORR (95% CI) was 65.6% (57.4-73.1; 40 complete responses, 59 partial responses) for pembro and 54.2% (46.0-62.3; 37 complete responses, 46 partial responses) for BV. Median (range) DOR was 24.9 months (0.0+ to 102.6) for pembro and 13.8 months (0.0+ to 96.2+) for BV. Treatment-related AEs occurred in 75.0% of participants for pembro and 77.0% for BV (grade 3-5, 19.6% and 25.0%). One participant in the pembro arm died due to treatment-related pneumonia. Subsequent therapies included auto-SCT (23.0% pembro, 24.3% BV), allo-SCT (14.2%, 12.5%), BV (47.0%, 13.1%), anti–PD-1 (21.9%, 49.0%), and other (62.9%, 65.4%). Conclusions: PFS benefit with pembro at the interim analysis was maintained at the final analysis. OS was not statistically significantly improved with pembro vs BV. The converging OS Kaplan-Meier curves are likely due to receipt of effective subsequent therapies, including auto-SCT, allo-SCT, or anti–PD-1 agents. Results illustrate the limitations of using OS as a primary end point in cancers with rapidly changing therapeutic landscapes.
  • John Kuruvilla
  • Armando Santoro
  • Jan Walewski
  • Robin Gasiorowski
  • Nathalie Johnson
  • Vladimir Melnichenko
  • Valeria Buccheri
  • Patricia Giacon
  • Laura Maria Fogliatto
  • Iara Goncalves
  • Guilherme Perini
  • Sergey Alekseev
  • Neta Goldschmidt
  • Iryna Kriachok
  • Judyta Strzala
  • Michael Dickinson
  • Anna Lojko-Dankowska
  • Andrew McDonald
  • Muhit Ozcan
  • Razi Ghori
  • Doyun Park
  • Rushdia Yusuf
  • Pier Luigi Zinzani
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P013 (P013)

Subcutaneous Pembrolizumab (Pembro) in Relapsed or Refractory Classic Hodgkin Lymphoma (cHL) or Primary Mediastinal Large B-cell Lymphoma (PMBCL): Additional Follow-Up From a Phase 2 Study

Background: Subcutaneous pembro is approved outside the US for treatment of relapsed or refractory (R/R) cHL and PMBCL. Prior analysis of an open-label, phase 2 study (NCT06504394) evaluated pharmacokinetics (PK), efficacy, and safety of subcutaneous pembro in participants (pts) with R/R cHL or R/R PMBCL. At a median follow-up of 2.6 months, subcutaneous pembro 790 mg Q6W had a manageable safety profile and efficacy consistent with intravenous pembro. Additional follow-up are presented that includes complete cycle 1 data for all pts. Methods: Eligible pts were ≥18 years with histologically confirmed, FDG-avid cHL or PMBCL per WHO criteria, radiographically measurable disease, and ECOG PS 0 or 1. Pts with cHL or PMBCL were anti–PD-1 naive and had disease that was refractory to, did not achieve CR with, or had relapsed after prior therapy. Pts with cHL received ≥1 multiagent regimen, and those with PMBCL received ≥2 prior therapies (including ≥1 rituximab-based regimen). Pts could enroll if they were ineligible for or had relapsed after stem cell transplant. Pts received subcutaneous pembro 790 mg Q6W for ≤18 cycles (~2 years) or until disease progression or other discontinuation criteria were met. Primary objectives included PK exposure measures during cycle 1 (C1) and ORR; secondary objectives included safety and duration of response (DOR). OS and PFS were exploratory objectives. ORR, DOR, and PFS were assessed per Lugano criteria by investigator. Results: At data cutoff (January 28, 2026), 64 pts had enrolled and received ≥1 cycle of subcutaneous pembro (n=58, cHL; n=6, PMBCL). Median follow-up was 9.9 months (range, 1.4-15.0). PK exposures of subcutaneous pembro in pts with hematologic tumors were consistent with those with IV pembro (table). Overall, 57 pts with cHL and 4 with PMBCL had a baseline and postbaseline assessment. For pts with cHL ORR was 84% (95% CI, 72-93; 26 CR; 22 PR). Among those with PMBCL, the ORR was 75% (95% CI, 19-99; 1 CR and 2 PR). For pts with cHL, median DOR was 8.3 months (range, 0.0+-10.8+), median PFS was 11.0 (95% CI, 8.5-NR) and median OS was NR (95% CI, NR-NR). Among all pts, 12 (19%) had a grade 3 or 4 treatment-related AEs (TRAEs), and 3 (5%) discontinued due to a TRAE. No deaths due to TRAEs occurred. Conclusion: With ≥9 months follow-up, the PK profile was consistent with the previous report; subcutaneous pembro Q6W continues to demonstrate durable responses with no new safety concerns.
  • Elizabeth H. Phillips
  • Gabriel Barragán Ibáñez
  • Ewa Paszkiewicz-Kozik
  • Wojciech Jurczak
  • Mauricio Chandia Cabas
  • Sergio Portiño
  • Elifcan Aladag Karakulak
  • Sebastian Giebel
  • Anna Sureda
  • Tae Min Kim
  • Brenda González-García
  • Norma Gutiérrez
  • Sebastian Hidalgo
  • Kirit Ardeshna
  • Antonia Rodríguez Izquierdo
  • Bastian von Tresckow
  • Gina Song
  • Jessica Flynn
  • Katherine Ryland
  • Rushdia Yusuf
  • Muhit Ozcan
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P014 (P014)

Changes in Patient Reported Outcomes and Treatment Tolerance with a Structured Diet and Exercise Plan

Background: Diet and exercise have shown benefits in a variety of cancers but evidence in lymphoma is limited. Here we explore the impact of a structured diet and exercise intervention during treatment on patient-reported outcomes (PRO) in patients (pts) with Hodgkin lymphoma (HL). Methods: Patients with newly diagnosed lymphoma receiving six cycles of chemotherapy were enrolled on the Lifestyle Intervention of Food and Exercise for Lymphoma Survivors (LIFE-L) trial (NCT05839210) and randomized 2:1 to the intervention arm, where pts followed a Mediterranean diet and a home-based exercise regimen with weekly remote health coaching from a registered dietitian and exercise physiologist, or the control arm. Patient-Generated Subjective Global Assessment (PG-SGA) for malnutrition assessment, handgrip strength, and PRO-Common Terminology Criteria for Adverse Events (PRO-CTCAE) were completed at baseline, before cycle (C) 3 and C6, and 4 weeks post treatment. This is a secondary analysis of HL pts from LIFE-L. Descriptive statistics were used to summarize pt characteristics and generalized linear mixed-effects models evaluated changes in outcomes. Results: 32 pts with HL were enrolled between 04/26/2023-10/2/2025. Pts were white (91%), Hispanic (84%), and had advanced stage HL (75%) with equal distribution of sex (male 50%). Groups were well balanced other than age; control group (n=13) was younger than intervention group (n=19), 39.8 (SD: 14.0) vs 43.1 (SD: 16.4) yrs old respectively (p<0.001). PG-SGA was significantly different over time (p<0.001) with a trend towards significance between groups (p=0.056), with the intervention arm reporting better nutritional status at baseline. Peripheral neuropathy differed between groups, timepoints, and their interaction (all p<0.001), however, estimates were unstable with large odds ratios, suggesting model instability due to sparse data. Constipation severity varied over time (p=0.001), but not between groups (p=0.771). Fatigue frequency worsened over time (p=0.013), particularly from baseline to C3, (OR 3.41, CI 95%, 1.10-10.56), as did depression severity (p=0.036). No significant difference was observed for vomiting, anxiety, depression, cognition, insomnia or handgrip strength. Conclusion: The LIFE-L study is among the first interventional trials evaluating a structured diet and exercise program in HL. These early results from this ongoing trial are promising and should be replicated in a more robust sample size.
  • Michele Stanchina
  • Melissa Lopez-Pentecost
  • Akina Natori
  • Juan Alderuccio
  • Asaad Trabolsi
  • Alvaro Alencar
  • Emily Panzner
  • Grey Freylersythe
  • Tracy Crane
  • Craig Moskowitz
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P015 (P015)

High efficacy and acceptable toxicity of BrECADD regimen in advanced-stage classical Hodgkin lymphoma

Background: The HD21 trial conducted by the German Hodgkin Lymphoma Study Group established BrECADD, a regimen including brentuximab vedotin, etoposide, cyclophosphamide, doxorubicin, dacarbazine, and dexamethasone, as the standard first-line therapy for advanced-stage classical Hodgkin lymphoma (cHL). Our retrospective analysis provides real-world data on the efficacy and toxicity of BrECADD regimen in patients with cHL in the Czech Republic. Methods: Patient demographics and baseline characteristics were analyzed using descriptive statistics. PET/CT scans were performed before starting treatment, after completing two cycles of chemotherapy, upon the conclusion of treatment, and assessed according to the Lugano criteria. Overall survival (OS) and progression-free survival (PFS) were calculated utilizing the Kaplan-Meier method. Results: A total of 97 patients, including 58 males, who received at least one cycle of the BrECADD regimen between November 2023 and February 2026, were evaluated. The median age was 32 (range 18-66) years. Among the 97 patients, 76 (78%) were classified as being in clinical stages III or IV, while 21 (21.6%) were in stage IIB with a massive mediastinal tumor and/or extranodal disease. Additionally, 18 patients (18.5%) had an International Prognostic Score 4-7. Overall 7.2% of patients did not complete the planned number of BrECADD cycles. A complete metabolic response was observed in 63.9% of cases after two cycles and increased to 84.5% by the end of the treatment. Only four (4.1%) patients received radiotherapy. During a median follow-up of 8.2 months three patients relapsed. The estimated 1-year PFS rate was 96.5% and the 1-year OS rate was 100%. Although the incidence of grade ≥3 neutropenia was high at 65%, the occurrence of grade ≥3 infections remained relatively low at 15.8%. Toxicity resulted in treatment reductions for 25.4% of patients. Brentuximab vedotin was prematurely discontinued in two (3.1%) patients due to grade ≥3 peripheral neuropathy. Conclusion: The BrECADD regimen was well-tolerated, and our efficacy findings closely match those reported in the HD21 trial. This work was supported by the grant AZV NU22-03-00182 from the Ministry of Health of the Czech Republic and by the Cooperatio Program, research area “Oncology and Haematology”
  • Heidi Mocikova
  • Lubica Gaherova
  • Barbara Brizova
  • Katerina Steinerova
  • Jozef Michalka
  • Zdenek Kral
  • Marie Lukasova
  • Vit Prochazka
  • Alice Sykorova
  • Pavla Stepankova
  • Katarina Hradská
  • Juraj Duras
  • Blanka Vackova
  • Jan Koren
  • Tomas Kozak
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P016 (P016)

FENIX Score: A Novel PET-Derived Signature Predicting Neurotoxicity in Advanced Hodgkin Lymphoma Treated with A+AVD

Background: Brentuximab vedotin plus AVD (A+AVD) is a standard treatment for advanced-stage Hodgkin lymphoma (HL), but peripheral neuropathy (PN) remains a frequent and clinically relevant toxicity. Reliable predictors are lacking. While PET-derived parameters are established prognostic biomarkers, their role in predicting treatment-related toxicity is largely unexplored. Methods: We retrospectively analyzed 21 patients with stage IV HL treated with frontline A+AVD. Baseline PET/CT parameters included SUVmax, total metabolic tumor volume (TMTV4), and total lesion glycolysis (TLG4). The FENIX score (FDG-based Extraction of Neurotoxicity Imaging indeX) was defined as a composite PET-derived index integrating focal metabolic activity and global tumor burden, calculated as (SUVmax/TMTV4 + SUVmax/TLG4) ×100, reflecting the relative metabolic intensity of the disease. The primary endpoint was grade ≥2 PN. Continuous variables were compared using the Mann–Whitney test, while categorical variables were analyzed using Fisher’s exact test. Receiver operating characteristic (ROC) analysis was performed to assess the discriminative performance and identify an optimal cut-off. Results: Baseline PET showed heterogeneous tumor burden. Grade ≥2 PN occurred in 9/21 patients (42.9%). FENIX score was significantly higher in patients developing PN (p=0.017). ROC analysis demonstrated good discrimination (AUC 0.81). Using an optimal cut-off of 8.7, FENIX identified patients at higher risk with 77.8% sensitivity and 83.3% specificity. PN incidence was higher in patients with high FENIX score (75.0% vs 23.1%, p=0.032). Among baseline clinical variables, only hemoglobin was associated with PN, while no significant associations were observed for other baseline characteristics. Conclusion: The FENIX score, a PET-derived index integrating metabolic activity and tumor burden, predicts clinically relevant PN using baseline PET alone. The FENIX score reflects the relative metabolic intensity of the disease, integrating peak metabolic activity with both tumor mass and overall metabolic burden. These findings support the role of PET-based biomarkers in identifying patients at increased risk of neurotoxicity and guiding personalized therapeutic strategies. The association with hemoglobin should be interpreted with caution given the small sample size. Prospective validation is warranted.
  • Matteo Cristante
  • Federico Fallanca
  • Teresa Calimeri
  • Andrés José Maria Ferreri
  • Fabrizio Marino
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P017 (P017)

Frontline Use of Nivolumab with Doxorubicin, Vinblastine, and Dacarbazine inAdvanced-Stage Classical Hodgkin Lymphoma: A Real-World Analysis

Background: The combination of nivolumab with doxorubicin, vinblastine, and dacarbazine (N-AVD) represents a promising frontline therapeutic approach that has demonstrated high efficacy in the treatment of advanced-stage classical Hodgkin lymphoma (cHL). We assessed the real-world effectiveness and safety of frontline N-AVD treatment in patients with advanced-stage cHL. Methods: A retrospective analysis was conducted on 61 cHL patients in clinical stages III/IV who received N-AVD treatment between 2023 and 2026 in the Czech Republic. Treatment response was assessed using 18F-FDG PET/CT imaging based on the Lugano criteria. Results: Out of 61 patients 19 were aged < 60 and 42 were ≥ 60, with a median age of 67 years. Of the participants, 68.9% were diagnosed with stage IV disease and 75.4% presented with B symptoms. The PET-2 results showed rapid metabolic clearance in 85.7% of patients, whereas 11.9% demonstrated Deauville scores of 4 to 5. N-AVD demonstrated an overall response rate of 89.2%, with 86.5% of patients achieving a complete metabolic response at the end of treatment. After a median follow-up of 8.9 months, 5 (8.1%) patients progressed or relapsed, resulting in an estimated 1-year progression-free survival rate of 91.8%. Four patients died (two due to cardiotoxicity-related complications, one due to infection and one unknown cause) and the estimated 1-year overall survival rate was 93.4%. Grade ≥3 hematological toxicities were observed in 44.3% of cases (neutropenia 27.9%, anemia 11.5%, thrombocytopenia 4.9%). Non-hematologic toxicities including immune-related adverse events of grade ≥3 were reported in 16.4% of cases. Treatment discontinuation due to toxicity was reported in 11.5% of patients. This included two patients (3.2%) experiencing grade ≥3neurotoxicity and one patient (1.6%) with grade ≥3 ulcerative colitis. Patients aged ≥60 years had higher rates of severe hematologic toxicities, while younger patients experienced more immune-related adverse events. Treatment discontinuation rates were similar across both age groups. Conclusions: The frontline N-AVD regimen demonstrated excellent response rates in patients with advanced-stage cHL. Extended follow-up is necessary to better assess the durability of responses, long-term toxicity, and overall survival outcomes.This work was supported by the grant AZV NU22-03-00182 from the Ministry of Health of the Czech Republic and by the Cooperatio Program, research area “Oncology and Haematology”
  • Ľubica Gahérová
  • Tomáš Kozák
  • Jozef Michalka
  • Marcela Cermanová
  • Zdeněk Král
  • Blanka Vacková
  • Jan Kořen
  • Alice Sýkorová
  • Katarína Hradská
  • Kateřina Steinerová
  • Marie Lukášová
  • Heidi Móciková
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P018 (P018)

Interim PET remains clinically informative during frontline nivolumab-based therapy in advanced-stage classical Hodgkin lymphoma

Background: Interim PET is essential for response-adapted frontline treatment in classical Hodgkin lymphoma, but its interpretation may be complicated by PD-1 blockade. We evaluated whether PET2, supported by quantitative PET parameters, remains informative for treatment adaptation during nivolumab-based treatment. Methods: We conducted a prospective single-center study (NCT07209059) evaluating a PET-adapted nivolumab-based first-line strategy in advanced-stage classical Hodgkin lymphoma (AS-cHL). 44 previously untreated pts were enrolled. All pts received two induction cycles of nivolumab 40mg (N40) plus EACOPD-14. Patients achieving CMR (DS 1–3) at PET2 received N40-AVD consolidation followed by 2 cycles of N40, whereas patients with PMR (DS 4–5) continued N40-EACOPD-14 up to 6 cycles. RT was omitted in all patients. Quantitative PET analysis included changes in SUVmax (ΔSUVmax) and metabolic tumor volume (ΔMTV) and was available for 31 patients. Results: All 44 pts completed induction therapy and underwent PET2 assessment. CMR was achieved in 36/44 patients (82%), while 8/44 (18%) demonstrated PMR. No DS5 cases were observed. All PMR cases showed low-volume residual uptake confined to mediastinal lesions. One patient experienced pseudoprogression after 2 cycles of N40-AVD. Quantitative PET analysis demonstrated profound early metabolic responses. Median ΔSUVmax was −84.5% (IQR, −87.3% to −81.4%) in pts achieving PET2 CMR and −72.8% (IQR, −78.6% to −70.6%) in pts with PET2 PMR. Importantly, near-complete elimination of MTV was observed irrespective of PET2 category, with ΔMTV of 100% in 30/31 pts and 99% in the remaining patient. At data cutoff, 38 patients had completed treatment and all achieved EOT CMR. No relapses or disease progression have been observed. Me FU was 10.2 months. Conclusions: This PET-adapted nivolumab-based strategy demonstrated high early metabolic response rates and enabled chemotherapy de-escalation with radiotherapy omission in AS-cHL. Despite residual PET2 DS4 uptake, metabolic tumor burden was nearly completely eliminated, suggesting treatment-related inflammatory activity rather than substantial viable lymphoma. Quantitative PET parameters may help refine PET2 interpretation during PD-1-containing treatment regimens and improve response assessment beyond conventional Deauville scoring.
  • Anna Kravtsova
  • Daria Koroleva
  • Olga Shchetsova
  • Madina Bagova
  • Aminat Magomedova
  • Oleg Margolin
  • Ekaterina Gitelzon
  • Alexey Subbotin
  • Evgeny Zvonkov
  • Yana Mangasarova
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P019 (P019)

Real-World Treatment Options and Outcomes of Hodgkin Lymphoma in Hungary

Background: Survival outcomes in Hodgkin lymphoma (HL) have markedly improved, with 80–90% of patients now curable. A nationwide initiative was launched in Hungary to evaluate real-world treatment patterns and compare them with international results. Since January 2021, 17 of 20 hematology centers have contributed data. Aims: To assess epidemiology, treatment approaches, and survival outcomes of HL patients diagnosed between 2021–2023 in Hungary, with special focus on stage IV disease and the real‐world introduction of brentuximab vedotin (A) + AVD. Methods: Patients diagnosed and treated for HL between 01/01/2021 and 12/31/2023 were analyzed. Progression-free survival (PFS) and overall survival were evaluated by stage and treatment. A+AVD was accessible only for stage IV patients through individual reimbursement requests, typically allowing its use from cycle 3 after initial ABVD. Stage IV patients were grouped into: ABVD (n=75); ABVD → AVD with negative interim PET/CT (n=15); A+AVD from cycle 1 (n=6); ABVD → A+AVD following approval (n=12). Interim PET/CT was evaluated using the Deauville score. Results: A total of 385 HL patients were identified (204 female, 181 male). Of these, 361 had classical HL and received curative-intent therapy (187 early-stage, 149 advanced-stage). Sixteen patients received non-standard therapy due to age or comorbidities. The 2‐year PFS was 87.6% in early-stage and 79.9% in advanced-stage disease. Twenty‐seven early-stage and 32 advanced-stage patients were refractory or relapsed. In stage III, 2‐year PFS was 90.5%; in stage IV, 75.7% (p=0.024), lower than international benchmarks. In stage IV, combined ABVD/AVD groups (1+2) achieved a 2‐year PFS of 75.6%, while brentuximab-treated groups (3+4) reached 77.8%. No relapses or deaths occurred after 2 years in patients receiving any brentuximab vedotin. Group-specific 2‐year PFS was: 76% (group 1), 73.3% (group 2), 50% (group 3), and 91.7% (group 4) (p=0.04). Interim PET/CT was Deauville 4 in three patients each in groups 3 and 4. Summary/Conclusion: Real‐world PFS of stage IV HL patients in Hungary was inferior to outcomes from clinical trials. Nevertheless, adding brentuximab vedotin improved PFS even when initiated after initial ABVD cycles. Although subgroup numbers were small, the findings provide important real‐world evidence supporting the use of brentuximab vedotin in advanced HL.
  • Zsófia Miltényi
  • Fanni Borics
  • Dávid Tóthfalusi
  • Boglárka Fülöp-Dobó
  • László Imre Pinczés
  • Árpád Illés
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P020 (P020)

Efficacy and Safety of the combination of Programmed Death -1 inhibitors (PD-1i) with chemotherapy for the treatment of classical Hodgkin’s Lymphoma (cHL). A single center experience

Background: Although efficacy and toxicity of the continuous treatment of PD-1i is well documented, less is known about their combination with chemotherapy. Aim: Our aim is to provide real-word data on this topic. Methods: We report outcomes and toxicities of 11 subjects treated with Nivolumab+AVD as 1L for advanced stage cHL (AS-cHL) and 6 other salvaged with Pembrolizumab+GVD for primary refractory disease. Results: Between 2023-2026, 2 men and 9 women, median age 61y (51-70), were newly diagnosed with AS-cHL. The subtypes were nodular sclerosis (NS) in 5, mixed cellularity (MC) in 3, lymphocyte-rich (LRcHL) in 3 cases. Ann Arbor stage was III in 8, IV in 3 patients. Seven patients concluded 6 cycles, 3 interrupted due to toxicity and 1 is on treatment. iPET was performed in 9: DS2 n=5, DS3 n=2, DS1 n=1, DS4 n=1. EoT PET was performed in 8 patients: DS2 n=4, DS3 n=3, DS5 n=1. All had GCSF prophylaxis. Treatment-related toxicities were observed in 7 patients: Acute heart failure, rash, hypothyroidism, thrombocytopenia with hemorrhagic manifestations, anemia, stomatitis, cataract. Febrile neutropenia requiring hospitalization was manifested in 4 (36%) and hepatotoxicity >= grade 3 in 4 (36%) patients. Among them a woman died due to liver failure, while delayed hepatic fibrosis occurring 6 months after treatment completion was observed in another case. With a mfollow up of 27.7 months (0.9-34), all patients but 1 are alive. The mPFS is 18.93 months (5.17-31.8) with 3 (27%) patients relapsing after achieving CR and 1 dying in CR. Median OS was not reached. Between 2024 -2026, 3 men and 3 women, median age 51y. (33-69) with primary refractory cHL-NS, after treatment with BrECADD (n=2) and ABVD (n=4) were salvaged with PembroGVD. The Ann Arbor stage was II (n=1), III (n=3) and IV (n=2). One patient is on treatment and 5 completed it: Four achieved CMR and 3 underwent ASCT. A 4th patient manifested acute heart and renal failure, becoming ineligible for ASCT. The 5th subject showed resistant disease and died thereafter. One patient was intubated due to severe pulmonary toxicity and another 1 for aseptic meningitis, 2 developed hypothyroidism, 1 hepatotoxicity. With a mfollow up of 17.8 months (0.6-20.8), all patients but 1 are alive. MedianOS was not reached. Among patients who achieved CR nobody relapsed. Conclusions: Combining PD-1i with chemotherapy is efficacious, but it demonstrates significant toxicity, more than it is described in the pivotal trials.
  • Kassiani Papanastassi
  • Pavlos-Panagiotis Triantafyllou
  • Chara Giatra
  • Natassa – Eleni Loutsidi
  • Alexandros Tolias
  • Antonis Patrinos
  • Eleni Tsitziloni
  • Leonidas Kotsifas
  • Evaggelia Giannikou
  • Maria Vasilleiou
  • Christos Massaoutis
  • Phoebi Rondogianni
  • Ioannis Baltadakis
  • Maria Bouzani
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P022 (P022)

Association of Patlak-derived dynamic FDG PET parameters with Deauville response categories and kinetic heterogeneity of residual PET-positive findings in classical Hodgkin lymphoma: a prospective single-center pilot study

Background: FDG PET/CT interpreted using the Deauville score (DS) is the standard method for response assessment in classical Hodgkin lymphoma (cHL). However, visual assessment of residual uptake is limited by inflammatory changes and suboptimal specificity. Dynamic FDG PET/CT with Patlak kinetic modeling enables quantitative evaluation of tracer kinetics beyond SUV metrics. Aim: To assess the association between Patlak-derived FDG PET parameters and Deauville response categories and to explore kinetic heterogeneity among residual PET-positive lesions in cHL. Methods: In this prospective single-center pilot study, patients with cHL undergoing interim or end-of-treatment FDG PET/CT with residual uptake (Aug 2025–May 2026, University Hospital Olomouc) were included. Dynamic PET/CT was performed on a Siemens Biograph Vision 600 scanner. Patlak analysis with population-based input function was used to calculate metabolic rate of FDG (MRFDG) and distribution volume (DVFDG). One dominant mediastinal lesion per scan was analyzed. Scans were classified as PET-negative (DS 1–3) or PET-positive (DS 4–5). MRFDG and DVFDG were compared between groups; ROC analysis and intra-group variability were assessed. Results: Fourteen examinations were included; 5 were DS 1–3 and 9 DS 4–5. MRFDG was higher in PET-positive vs PET-negative scans (12.34 ± 6.72 vs 4.59 ± 2.00; p= 0,009), with a 2.7-fold difference. DVFDG was also increased (208.83 ± 81.48 vs 110.95 ± 18.99; p=0.006). MRFDG and DVFDG showed strong discrimination (AUC 0.93 and 0.91, respectively). PET-positive scans showed marked heterogeneity in MRFDG (4.73–24.21) and DVFDG (105.84–389.39) despite identical DS. Conclusions: Patlak-derived FDG PET parameters correlate with Deauville categories and reveal substantial kinetic heterogeneity among residual PET-positive cHL lesions. Dynamic PET may provide additional quantitative information beyond visual assessment. Further outcome-based validation is required.
  • Gregor Horňák
  • Veronika Hanáčková
  • Marie Lukášová
  • Jaroslav Ptáček
  • Vít Procházka
  • Milan Kamínek
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P023 (P023)

Real-World Effectiveness and Safety of the BrECADD Regimen in Advanced Hodgkin Lymphoma. A Multicenter Observational Study of the Polish Lymphoma Research Group.

Introduction: The BrECADD regimen has demonstrated high efficacy in patients with advanced Hodgkin lymphoma (HL). Aim: The aim of this observational study conducted by the Polish Lymphoma Research Group (PLRG) was to assess the efficacy and safety of the BrECADD regimen in patients with advanced HL treated in real-world clinical practice. Materials and methods: Clinical data from patients with HL treated in 12 hematology centers in Poland were retrospectively evaluated. The analysis included 61 patients: 30 women and 31 men, diagnosed with advanced-stage HL. The mean age was 33 years. According to the Ann Arbor classification, 15 patients had stage III disease and 46 had stage IV . B symptoms were present in 43 patients (70.5%), while extranodal involvement was confirmed in 45 patients (75%). Statistical analyses were performed using R software. Categorical variables were presented as n (%), while continuous variables were expressed as mean ± standard deviation due to their normal distribution. Normality of distribution was assessed using the Shapiro–Wilk test and additionally verified by skewness and kurtosis analyses. Results: The median number of administered cycles was 4. Interim PET/CT assessment after 2 cycles was performed in 53 patients and demonstrated complete remission (CR) in 40 patients (75%) and partial remission (PR) in 12 patients (22.6%). Disease progression (PD) was observed in 1 patient.PET/CT assessment after 4 cycles was available in 39 patients and confirmed CR in 34 patients (87%), while PD was observed in 2 patients (5%). Progression-free survival (PFS) in the overall analyzed cohort was 97.1% at 6 months. Grade 3–4 neutropenia occurred in 40 patients (89%), thrombocytopenia with platelet count below 20 G/L was observed in 13 patients (21%). Febrile neutropenia developed in 13 patients (21%). Dose reduction of brentuximab vedotin was required in 12 patients (19%), whereas dose reductions of other agents (cyclophosphamide and etoposide) were necessary in 19 patients (31%). Conclusion: Our preliminary real-world data confirm the high efficacy of the BrECADD regimen in patients with advanced HL, with high complete remission rates and excellent short-term PFS. Although hematologic toxicity was frequent, adverse events were manageable and consistent with the known safety profile of the regimen. These findings support the implementation of BrECADD as an effective first-line treatment option for advanced HL in Poland.
  • Justyna Rybka
  • Tomasz Wróbel
  • Anna Czyż
  • Kacper Bułdyś
  • Iwona Grygoruk-Wiśniowska
  • Monika Długosz-Danecka
  • Mateusz Sawicki
  • Katarzyna Malesa
  • Jarosław Dybko
  • Ewa Paszkiewicz-Kozik
  • Michał Kurlapski
  • Kamila Kruczkowska-Tarantowicz
  • Agnieszka Kołkowska-Leśniak
  • Ewa Lech-Marańda
  • Emilia Migryt-Rogala
  • Justyna Gil
  • Agnieszka Kopacz
  • Anna Kopińska
  • Agnieszka Janus
  • Agnieszka Giza
  • Jan Maciej Zaucha
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P024 (P024)

Anthracycline-containing regimens confer better survival in risk-matched, advanced stage older patients with classic Hodgkin lymphoma; comorbidity, not age, predicts cardiac toxicity

Introduction: Older (≥60 year old (y)) patients with classical Hodgkin lymphoma (cHL) have worse outcomes than their younger counterparts. The interplay between comorbidities, treatment choice and outcomes has been incompletely examined. Methods: This is a retrospective cohort study with contribution from 24 UK sites. Eligible ≥60y cHL patients were diagnosed from 2010-23. Baseline factors were compared using Kruskal Wallis and Fisher’s exact tests. Overall survival (OS) and event-free survival (EFS) were assessed using Kaplan-Meier survival analysis with groups compared using Cox regression. Binary endpoints were compared using logistic regression. Results: A total of 1011 eligible patients were registered to the study: 645 receiving anthracycline-containing chemotherapy (anthra), 202 multiagent chemotherapy without anthra (non-anthra), 48 single-agent, 31 radiotherapy alone and 85 with no treatment. Anthra was used more commonly and radiotherapy less commonly in the more recent era (2020-23 p=0.002 compared to pre-2020). Anthra patients had lower CIRS-G score at diagnosis (p<0.0001). The median follow up was 5.3 years. OS and EFS varied significantly by CIRS-G score at baseline, treatment groups and type of chemotherapy delivered (all p<0.0001). Upfront dose modification was more common in the non-anthra group (p=0.002), older patients (p<0.0001), prior cardiac history (p=0.016) and higher CIRS-G score (p=0.007); it did not protect against later treatment changes when groups were adjusted for age, CIRS-G and treatment group. There was increased risk of treatment-related cardiac toxicity if prior cardiac history, but only in the non-anthra group (p=0.0092). CIRSG with omission of cardiac scores was more predictive in anthra but the interaction was not significant (p=0.11). No significant difference was seen with increasing age (p=0.15). There was increased risk of infectious admission in the non-anthra group (p=0.002), higher CIRS-G score (p=0.008) and increased age at diagnosis (p=0.005). When advanced stage patients were matched for international prognostic score factors, CIRS-G and age band the non-anthra group had inferior OS (HR 1.59, p=0.021) and EFS (1.45, p=0.046) compared to anthra. Discussion: Anthracycline use is preferable in older cHL patients. A comorbidity-focused approach to treatment selection may improve outcomes whilst maintaining acceptable toxicity.
  • Aisling Barrett
  • Amy Kirkwood
  • Pam McKay
  • Wendy Osborne
  • Nimish Shah
  • Fatima Jamil
  • Ravindu De Silva
  • Joanna Fawcett
  • Nicola Crosbie
  • Jacinta Hardman
  • Sarah Idris
  • ChenXi Lee
  • Edward Truelove
  • Amjad Hmaid
  • Sunil Iyengar
  • Laura McDonald
  • Fiona Miall
  • Heather Laing
  • Georgina Talbot
  • Syed Hasan
  • Shuyang Dai
  • Anna Santarsieri
  • Sai Lon Wann
  • Maria Marzolini
  • James Paterson
  • Sarah Lawless
  • David Waddell
  • Rachel Trickey
  • Tessa Davies
  • Vivek Radhakrishnan
  • Srishma Sridhar
  • Elizabeth H. Phillips
  • Chiara Dallatorre
  • Peter Toth
  • Pierre McCarthy
  • Emily Chernucha
  • Moitreyo Pandit
  • Laura Percy
  • Jack Easton
  • Rory McCulloch
  • Julia Wolf
  • Matthew Wells
  • David Quinn
  • Andrea Kuhnl
  • Charlotte Subklewe
  • Lucy Cook
  • Oscar Atkins
  • Eve Gallop-Evans
  • Katja Williams
  • Cathy Burton
  • Graham P. Collins
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P025 (P025)

Validation of the Hodgkin lymphoma Simplified Frailty Score for Patients Receiving Modern Regimens

Background: Treatment of classic Hodgkin lymphoma (cHL) in older patients (≥ 60 years) is challenging due to frailty, comorbidities, and poor tolerance to standard therapies. Front-line regimens incorporating either brentuximab vedotin (BV) or nivolumab (nivo) demonstrated improved outcomes. A simplified frailty score combining age (≥70), Charlson Comorbidity Index (CCI (0-2 vs 3 or higher)), and Eastern Cancer Oncology Group (ECOG ≥2) predicted outcomes in older patients treated with conventional curative treatment (Lia, et al. Haematologica 2025). We assessed the utility of the simplified frailty score in patients treated with newer regimens containing either BV or nivo. Methods: We identified consecutive patients age ≥ 60 at the time of cHL diagnosis treated with curative-intent treatment consisting of BV or nivo in combination (or sequentially) with AVD chemotherapy, treated from June 2014 to February 2025. Each frailty criterion contributed one point for an index ranging from fit (0), unfit (1-2), and frail (3). The primary outcomes were progression-free survival (PFS) and overall survival (OS) analyzed using Kaplan-Meier methods and log-rank tests. Results: Among 75 patients, median age was 69 (60 - 82); 29 (39%) received nivo-based therapy and 46 (61%) BV-based (67% sequential; 33% combined). There were 31 (41%) fit patients, 43 (57%) unfit patients, and one frail patient. 5-year PFS and OS were 65% and 85%, respectively. The 5-year PFS for fit and unfit patients were 74% and 59% (p=0.10); the 5-year OS were 100% and 72% (p=0.009). Treatment with nivo-based, BV-sequential, or BV-combined therapy was associated with 5-year PFS of 80%, 54%, and 53%, respectively (p=0.16 for nivo-based vs BV-sequential, p=0.039 for nivo-based vs BV-combination). For unfit patients, PFS was significantly improved for patients treated with nivo-based therapy compared to BV-based therapy (5-year PFS 91% vs 43%, p = 0.039), however OS was not significantly different (5-year OS 89% vs 61%, p = 0.24). For fit patients, outcomes were similar regardless of treatment; 5-year PFS, OS were 74%, 100% and 78%, 100%, for patients treated with nivo-based therapy and BV-based therapy, respectively (Figure). Conclusion: These findings aid in validating the simplified frailty score in patients treated with modern therapy and suggest that nivo-based therapy is particularly beneficial for unfit elderly patients. Treatment choice is less likely to impact outcomes for fit patients.
  • Katherine Sobol
  • Efrat Luttwak
  • Tiffany Chang
  • Nivetha Ganeson
  • Pallawi Torka
  • Alison Moskowitz
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P026 (P026)

Fitness-adapted, pembrolizumab-based therapy for untreated classical Hodgkin Lymphoma (cHL) patients (Pts) 60 years of age and above: a multicenter prospective study

Background: cHL occurs in a bimodal age distribution with 20-30% of diagnoses occurring in Pts aged ≥ 60 years. Outcomes have improved in the recent era. However, treatment related toxicities are common, especially for unfit and frail pts. We designed a multicenter prospective study utilizing fitness-based assessments to assign targeted cHL therapy. Methods: Subjects had untreated cHL with an age ≥ 60 years and ECOG performance status (PS) of 0-1 or PS of 2 if decline was cHL-related. Those with Grade ≥ 2 neuropathy, known additional malignancy, and active inflammatory disease were excluded. All subjects were treated with brentuximab vedotin (BV) and pembrilizumab (Pem) for 6 weeks (Figure). Thereafter, fitness assessment, comprising activities of daily living (ADLs), instrumental ADLs, and Cumulative Illness Rating Scale-Geriatric scores were repeated. Subjects were grouped into Fit, Unfit and Frail adapted from Merli et al JCO 2021. All patients continued Pem, with additional treatment based on fitness: Fit (full dose AVD x4 cycles), Unfit (half-dose "mini" AVD x4 cycles), and Frail (BV x18 weeks). Primary objectives were to assess safety and efficacy. Target sample size was 44 participants. The study was registered on clinicaltrials.gov (NCT05404945) and supported by a research grant from Merck Sharp &Dohme LLC. Results: Enrollment occurred from 7/2022 to 12/2025 at 3 US institutions. Due to slow enrollment and a new standard therapy for fit older cHL Pts (S1826 study: Rutherford et al JCO 2025), the study closed early. Ten pts consented to the trial and 8, with a median age of 81 years (range 66-85), were treated. After BV/Pem lead-in, 3 were allocated to the frail arm, 4 were allocated to the unfit arm, and 1 was allocated to the fit arm. 75% (n=6) completed induction. All subjects responded; best response was CR in 75% (n=6) and PR in 25%(n=2). Five related SAE’s occurred in 37.5% (n=3) of subjects. No new toxicities were identified or Grade 5 events. One subject remains on treatment. Conclusions: Treatment with Bv/Pem-based therapy for newly-diagnosed older cHL Pts based on fitness assessments was feasible. This study also introduced a new “mini-AVD” regimen for unfit cHL Pts. Responses rates were robust in this small cohort; however, the study was closed prematurely. Further study is warranted for older cHL pts with therapy tailored according to fitness.
  • Craig Portell
  • Bethany Horton
  • David Brighton
  • Jakub Svoboda
  • Victor Orellana-Noia
  • Andrew M. Evens
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P027 (P027)

Cost-effectiveness analysis of N-AVD vs BrECADD in advanced-stage classic Hodgkin lymphoma

Background: Recent trials have established Nivolumab(N)-AVD and BrECADD as parallel standards in advanced-stage classic Hodgkin lymphoma (cHL). Many factors influence the choice of frontline regimen, including comorbidities, stage, toxicities, and reimbursement decisions. We compared the cost-effectiveness of the two strategies from a US payer perspective over a lifetime horizon. Methods: A 5-state Markov model was developed: progression-free after first-line therapy (PF1), salvage therapy +/- ASCT for first progression (PD1), progression-free after salvage and ASCT (PF2), second progression (PD2), and death. Patients who relapsed after N-AVD were assumed to receive Brentuximab-based salvage, while patients who relapsed after BrECADD were assumed to receive Pembrolizumab-based salvage. Costs and utilities were discounted at 3% annually. Transition probabilities were derived from digitized and extrapolated survival curves. Main outcomes were incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (INMB). Sensitivity analyses were performed to test the validity of the base case conclusions. Results: In the base case, BrECADD increased discounted quality-adjusted life years (QALYs) by 0.50 and life-years by 0.36 at an incremental cost of $39,307, yielding an ICER of $79,298/QALY and an INMB of $35,046 at a willingness-to-pay (WTP) threshold of $150,000/QALY. In probabilistic sensitivity analysis (10,000 simulations), the ratio-of-means ICER was $84,241/QALY, and the probability that BrECADD was cost-effective was 74.3% at a WTP of $150,000/QALY. In one-way sensitivity analyses, the base case conclusion was most sensitive to varying frontline regimen efficacy, frontline costs, and the time horizon. In two-way sensitivity analyses, BrECADD was no longer preferred when N-AVD 5-year PFS was increased to 91.3%, when BrECADD drug costs were increased by 125%, or when the time horizon was shortened to 26 years. In a structural sensitivity analysis assigning Pembrolizumab-based salvage after both N-AVD and BrECADD, the ICER for BrECADD rose to $176,019/QALY. Conclusion: BrECADD was cost-effective compared with N-AVD at a WTP threshold of $150,000/QALY. This finding remained consistent across most deterministic and probability sensitivity analyses.
  • Jowon Laura Kim
  • Amar H. Kelkar
  • Susan Parsons
  • Alison Moskowitz
  • Kishan Patel
  • Adrienne Nedved
  • Arushi Khurana
  • JC C. Villasboas Bisneto
  • Jonas Paludo
  • Jithma P. Abeykoon
  • Yun Kyoung Tiger
  • Paul J. Hampel
  • Yucai Wang
  • Yi Lin
  • N. Nora Bennani
  • Luis F. Porrata
  • Gita Thanarajasingam
  • Carrie A. Thompson
  • Patrick B. Johnston
  • Ivana N. Micallef
  • Thomas M. Habermann
  • Thomas E. Witzig
  • Philippe Armand
  • Stephen M. Ansell
  • Urshila Durani
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P028 (P028)

First-line BrECADD in routine clinical practice: excellent treatment deliverability and early efficacy in advanced-stage classical Hodgkin lymphoma

Background: BrECADD became the preferred first-line treatment for advanced-stage (AS) classical Hodgkin lymphoma (cHL) following HD21. However, real-world data remain limited. Aim: To evaluate efficacy, treatment deliverability, and toxicity of first-line BrECADD in routine clinical practice and compare toxicity outcomes with a historical escalated BEACOPP (escBEACOPP) cohort. Methods: We retrospectively analyzed all patients with AS cHL treated with first-line BrECADD at the University Hospital Centre Zagreb (2023–2025). Toxicity findings were compared with an escBEACOPP cohort treated between 2015 and 2025. Toxicity endpoints included grade ≥3 neutropenia, transfusion requirements, treatment modifications, peripheral neuropathy, and hospitalizations. Multivariable logistic regression adjusted for age, stage, and ECOG performance status was used to evaluate factors associated with transfusion requirements and treatment modifications. Results: Twenty-one patients received first-line BrECADD. Median age was 27 years (19–60); 86% had stage IV disease and 71% extranodal involvement. Interim PET2 was available in 19 pts, with 18/19 achieving complete metabolic remission (CMR). Most pts received 4 cycles (4 received 6 cycles). At a median follow-up of 15 months, all patients achieved CMR, with progression-free and overall survival rates of 100%. Treatment modifications occurred in 43% of patients; however, no cycle delays or treatment discontinuations were observed. Grade ≥3 neutropenia occurred in 95% of patients, hospitalization for febrile neutropenia in 33%, red blood cell transfusions in 19%, platelet transfusions in 33%, and peripheral neuropathy in 14%. Compared with escBEACOPP (n=119), BrECADD-treated patients received fewer treatment cycles (median 4 vs 6, p<0.001). Overall transfusion requirements were lower with BrECADD (48% vs 72%; p=0.039). In multivariable analysis, BrECADD remained independently associated with lower odds of transfusion requirement (OR 0.37, 95% CI 0.14–0.98; p=0.046) and superior treatment deliverability (OR 2.73, 95% CI 1.01–7.41; p=0.048). Conclusions: In routine clinical practice, first-line BrECADD demonstrated excellent efficacy and tolerability. Despite frequent hematologic toxicity, treatment completion was universal and no treatment delays occurred. Compared with escBEACOPP, BrECADD was associated with reduced transfusion requirements and better preservation of planned treatment intensity.
  • Ida Hude Dragičević
  • Klaudia Babić Čukman
  • Sandra Bašić-Kinda
  • Barbara Dreta
  • Dino Dujmović
  • Josip Batinić
  • Margareta Dobrenić
  • Lea Galunić-Bilić
  • Igor Aurer
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P029 (P029)

Ten-year follow-up of ECHELON-1: overall survival and long-term safety with Brentuximab vedotin plus AVD versus ABVD in patients with previously untreated advanced classic Hodgkin lymphoma

Background: The phase 3 ECHELON-1 study (NCT01712490) compared brentuximab vedotin plus doxorubicin, vinblastine, and dacarbazine (A+AVD) with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) in patients (pts) with previously untreated stage III/IV classic Hodgkin lymphoma (cHL). A 7-year follow-up (FU) analysis showed durable progression-free survival and overall survival (OS) benefits, and no new safety signals with A+AVD versus ABVD. We report 10-year FU data from ECHELON-1. Methods: Pts were assigned 1:1 to receive up to 6 cycles of A+AVD (n=664) or ABVD (n=670) on days 1 and 15, every 28 days. OS was investigator-assessed in the intent-to-treat population (data cut-off [DCO] December 16, 2025). Long-term safety was evaluated in all pts who received ≥1 dose of any study medication (A+AVD, n=662; ABVD, n=659) and included subsequent anti-cancer therapies, secondary malignancies, peripheral neuropathy (PN) resolution/improvement, and pregnancies. Results: At DCO, with a median FU of 120 months (95% CI 117.0–121.2), estimated 10-year OS rates were 90.3% (95% CI: 87.3–92.6) with A+AVD and 84.9% (95% CI: 81.4–87.8) with ABVD (hazard ratio 0.59 [95% CI 0.42–0.83]; P=0.002; Figure). A+AVD was associated with proportionally fewer deaths than ABVD (8% vs 13%). In the A+AVD and ABVD arms, 21% and 25% of pts had ≥1 subsequent anti-cancer therapy, respectively; chemotherapy was most common (13% A+AVD; 17% ABVD). Secondary malignancies were reported in 5% of pts (A+AVD) and 7% pts (ABVD), which included solid tumors (4% A+AVD; 4% ABVD) or hematological malignancies (2% A+AVD; 3% ABVD). Treatment-emergent PN was ongoing in 116/443 (26%) pts who originally reported PN in the A+AVD arm (15% grade 1; 8% grade 2; 3% grade 3; <1% grade 4) and in 56/286 (20%) pts in the ABVD arm (13% grade 1; 5% grade 2; 1% grade 3). PN resolved or improved in 86% of pts with A+AVD (74% resolved/12% improved) and 87% of pts with ABVD (80%/7%). Median (range) time to complete PN resolution and improvement was 36 (0–507) and 42 (8–392) weeks with A+AVD, and 17 (0–530) and 22 (2–213) weeks with ABVD, respectively. Pregnancies occurred in 94 pts (A+AVD, n=60; ABVD, n=34) and 87 partners of male pts (n=42; n=45). Live births were reported in 77 pts (A+AVD, n=51; ABVD, n=26) and 77 partners of male pts (n=37; n=40), with no stillbirths reported. Conclusion: In this 10-year FU, A+AVD demonstrated a sustained OS benefit vs ABVD in advanced cHL, with manageable long-term safety.
  • Stephen M. Ansell
  • David J. Straus
  • Joseph M. Connors
  • Wojciech Jurczak
  • Won Seog Kim
  • Andrea Gallamini
  • Marco Picardi
  • Tatyana Feldman
  • Kerry J. Savage
  • Radhakrishnan Ramchandren
  • Pier Luigi Zinzani
  • Jeremy S. Abramson
  • Graham P. Collins
  • Jonathan W. Friedberg
  • Andrew Grigg
  • Mehmet Turgut
  • Martin Hutchings
  • Ranjana Advani
  • Adriana Scheliga
  • Andrew M. Evens
  • Rizvan Bush
  • Farhad Sedarati
  • Fei Jie
  • Michelle Fanale
  • John Radford
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P030 (P030)

Outcome and Prognostic Value of PET-2 in Stage IV Classical Hodgkin Lymphoma Treated with Frontline Brentuximab Vedotin Plus AVD: A Real-World Multinational GELTAMO-GATLA Study

Background: Real-world evidence of the benefit of Bv AVD vs. ABVD in stage IV cHL remains limited, and the prognostic value of interim PET (PET-2) is not clearly defined. Aims: Evaluate metabolic complete remission (mCR) rate, 2-year EFS, OS, toxicity and the prognostic value of PET-2 in stage IV cHL pts treated with frontline Bv-AVD in routine clinical practice within a GELTAMO and GATLA collaboration. Methods: Retrospective multicentre cohort of stage IV cHL patients (≥16 years) treated with frontline Bv-AVD (2/2019–3/2025) at 30 centres in Spain and Argentina. PET-2 (after >= 2 cycles) mCR was DS1–3. EFS/OS calculated with Kaplan-Meier. EFS/OS predictors were assessed by uni/multivariable Cox models including age (<60 vs >= 60), IPS (1-3 vs 4-7), B symptoms, bulky (Bx) disease, PET-2 status, and ≥2 extranodal (EN) sites. Results: 110 pts were included. Median age was 40.4 yrs (range 27.8–53.5); 80.6% ECOG 0–1, 69.1% B symptoms and 53.6% ≥2 EN sites. Bx disease in 28.2%; 38.2% IPS ≥4. Median of Bv doses was 12. PET-2 was done in 102/110 pts (92.7%) achieving 79.2% mCR. EOT PET was done in 98/110 (89.1%), 88.8% mCR rate. Consolidative RT was delivered in 4.7% pts. At a median follow-up of 28.3 m for EFS and 34 m for OS, 2-year EFS was 81.9 % [95%CI 74.6%-89.9%] and 2-year OS was 95.9% [CI95% 92%-100%]. mCR at PET-2 was associated with improved EFS (83.0% vs. 57.4%; p= 0.002) but not OS. IPS ≥4 and >=2 EN sites involvement were associated with shorter OS (85.5% vs. 98.2%, p=0.05 and 88.6% vs. 100%, p= 0.04 respectively). In multivariable analysis, PET-2 positivity remained independently associated with shorter EFS (HR 3.52; p=0.007), without significant impact on OS. 48% pts developed neutropenia (>= G3 35%) with a median of 1 cycle; 14% >= G3 febrile neutropenia. Peripheral neuropathy developed in 34% of the pts, mostly G1-2 (27%). Conclusions: This large binational real-world study, restricted to pts with stage IV cHL, demonstrates that frontline Bv-AVD achieves favorable outcomes, with 2-year EFS and OS rates of 81.9% and 95.9%, respectively, consistent with ECHELON-1. To our knowledge, it represents the largest real-world series in stage IV pts and the first to show that PET-2 positivity independently predicts inferior EFS with Bv-AVD, although the implications for treatment adaptation require prospective validation. This collaborative GELTAMO–GATLA analysis provides a relevant benchmark for future PET-adapted strategies in this high-risk population.
  • Jose Ignacio Trucco
  • Marta Peña
  • Maria Teresa Marti
  • Laura Korin
  • Maria Rocio Figueroa Mora
  • Carmen Martinez
  • Guadalupe Antelo Perez
  • Marta Zerga
  • Maria Belen Navarro
  • Carolina Mahuad
  • Cecilia Carpio
  • Carmen Maria Alonso Prieto
  • Lorena Fiad
  • Maria Jimena Cannata-Ortiz
  • Malena Rocca
  • Nicolas Kellenher
  • Mariana Rosenhain
  • Blanca Sanchez Gonzalez
  • Luciano Salvano
  • Lucia Villalon Blanco
  • Javier Romano
  • Veronica Musso
  • Alessandra Comai
  • Fernando Warley
  • Carlos Santorum
  • Florencia Negri Aranguren
  • Maria Orlova
  • Amalia Cerutti
  • Valeria Drouet
  • Lautaro Sardu
  • Trinidad Viviani
  • Julia Valerga Couste
  • Eva Domingo-Doménech
  • Anna Sureda
  • Astrid Pavlovsky
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P031 (P031)

Multistate Modeling of Disease Trajectories for Advanced-Stage Hodgkin Lymphoma Patients Receiving PET Response-Adapted Therapy

Background: Despite recent advances in advanced-stage (AS) classical Hodgkin lymphoma (cHL), PET-adapted chemotherapy remains a first-line option where access to novel agents is limited. Many regimens begin with 2 cycles of escalated BEACOPP (escBEACOPP2) or ABVD (ABVD2), followed by interim PET (iPET)-guided treatment. There have been no direct comparisons of PET-adapted regimens initiated with escBEACOPP2 vs ABVD2. We used rigorous multistate model (MSM) methodology to assess transition specific impacts of treatment (escBEACOPP vs ABVD), baseline HL International Prognostic Index (A-HIPI) risk score, and iPET result. Methods: We pooled individual data from 4 clinical trials of newly-diagnosed stage IIB-IV cHL patients (ages 18-60 years (y)) treated with PET-adaptive escBEACOPP2 (n=363 from AHL2011) or ABVD2 (n=1917 from SWOG0816, RATHL, HD0607) regimens. The 5y MSM implemented with a Cox model had 4 states: diagnosis, sustained remission at 1y, treatment failure, and death. We assessed the impact of treatment on transitions (except binary sustained remission at 1y) that involved ≥5 pts per group, adjusting for A-HIPI for all transitions and iPET for post-remission transitions. Results: The escBEACOPP2 group was younger (age 32 (SD 11) vs 34 y (SD 11)), had fewer females (39% vs 47%), less stage IIB disease (12% vs 28%), more bulk (57% vs 25%), and higher baseline disease risk according to A-HIPI (25.1 (SD 6.3) vs 22.7 (SD 6.3)). After adjusting for A-HIPI, escBEACOPP2 was associated with lower hazard of treatment failure within 1y (aHR 0.61, 95%CI 0.40-0.93) and post-remission failure (aHR 0.39, 95%CI 0.22-0.6; see Table). Negative iPET was associated with lower hazards of post-remission failure (aHR 0.55, 95%CI 0.38–0.78) and death after first-line treatment failure (aHR 0.57, 95%CI 0.35–0.91), independent of baseline A-HIPI score and initial chemotherapy. Conclusions: iPET-adapted treatment with escBEACOPP was associated with lower rates of both early treatment failure and post-remission relapse versus ABVD, after adjustment for baseline disease risk. Negative iPET was independently associated with a lower risk of post-remission treatment failure and death following frontline treatment failure, regardless of chemotherapy regimen or A-HIPI score. MSM offers a dynamic assessment of disease trajectories by capturing transitions between remission, treatment failure and death, and it provides a comprehensive framework to inform clinical decision-making.
  • Zhu
  • Jenny
  • Cui
  • Hocine Tighiouart
  • Nicholas Counsell
  • Sara Rossetti
  • Jenica Upshaw
  • Amy Kirkwood
  • Hongli Li
  • Ranjana Advani
  • Olivier Casanovas
  • James Cerhan
  • Massimo Federico
  • Andrea Gallamini
  • Hervé Ghesquieres
  • Eliza Hawkes
  • David Hodgson
  • Martin Hutchings
  • Peter Johnson
  • Brian Link
  • Eric Mou
  • John Radford
  • Kerry J. Savage
  • Deborah Stephens
  • Pier Luigi Zinzani
  • Matthew Maurer
  • Cedric Rossi
  • Andrew M. Evens
  • Susan Parsons
  • Angie Mae Rodday
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P032 (P032)

ABVD versus a risk-stratified and a response adapted strategy– addressing the dilemma in Advanced Hodgkin Lymphoma: A Phase III Randomized Study

Background: Outcomes with ABVD in advanced-stage cHL remain suboptimal in resource-limited settings. Although escBEACOPP improves disease control, concerns regarding toxicity and resource utilization limit its use. We evaluated a risk-stratified, response-adapted (RS/RA) strategy based on International Prognostic Score (IPS) and interim PET response against standard ABVD in a phase III randomized study. Methods: Patients aged 15–60 years with newly diagnosed advanced-stage cHL were enrolled. They were randomized 1:1 to receive standard ABVD (Arm A) or a risk-stratified, response-adapted strategy (Arm B) using RATHL (IPS 0-2) and GHSG HD18 (IPS 3-7) approaches with interim PET-guided treatment modification. The primary endpoint was 3-year modified PFS, defined as progression, relapse, death, non-complete response, or initiation of subsequent anticancer therapy. Results: Between September 2022 and July 2024, 200 patients were enrolled; 2 were excluded for protocol ineligibility, and 198 patients were analysed. The median age was 27 years (range, 15–58), and 140 (70.7%) were male. Baseline characteristics included B symptoms in 154 (77.8%), ECOG performance status 0–1 in 181 (91.4%), extranodal disease in 116 (58.5%), bulky disease in 82 (41.4%), stage III/IV disease in 169 (85.3%), and high-risk patients were 53/99 in Arm A and 56/99 in Arm B. The 3-year mPFS was 79.1% (95% CI, 71.2-87.7) in Arm A and 83.0% (95% CI, 75.7-91.0) in Arm B (p=0.53). The 3-year OS was 96.8% (95% CI, 93.3–100.0) and 93.6% (95% CI, 88.2–99.3), respectively (p=0.72). After a median follow-up of 38 months (range, 1–63), 37 events were observed, including 20 in Arm A and 17 in Arm B (including 1 death due to septic shock). The median time to relapse was 9.9 months (range, 1.9–37.1). Post relapse 15/36 patients received a nivolumab based regimen as salvage and 11/36 patients received bone marrow transplantation. No new safety signals were observed. Six patients receiving escBEACOPP were switched to ABVD/AVD due to toxicity. In Arm B, 3 low-risk patients had a positive interim PET scan and were escalated to escBEACOPP, of whom 2 subsequently had progressive disease. Conclusion: Standard ABVD achieved comparable outcomes to RS/RA strategy, with no significant differences between the groups. However, the final results comparing patient reported outcomes and resource utilization will help determine the optimal frontline treatment strategy for advanced cHL.
  • Hasmukh Jain
  • Aravind Padmanabhan
  • Alok Shetty
  • Lingaraj Nayak
  • Bhausaheb Bagal
  • Jayashree Thorat
  • Thomas Eipe
  • Supriya More
  • Nisha Khatavkar
  • Prasanth Ganesan
  • Sreeraj Vasudevan
  • Jayant Goda
  • Sumeet Gujral
  • Tanuja Shet
  • Jyothi Kode
  • Archi Agrawal
  • Venkatesh Rangarajan
  • Sneha Shah
  • Neha Sharma
  • Epari Sridhar
  • Siddhartha Laskar
  • Manju Sengar
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P033 (P033)

Evaluating the outcomes of elderly Hodgkin Lymphoma patients: a focus on sequential Brentuximab-AVD

Background: Older patients with classical Hodgkin lymphoma (cHL) have inferior outcomes and limited tolerance to conventional chemotherapy, due to poor performance status (PS) and possibly due to differences in the underlying disease biology. Sequential brentuximab vedotin (BV) before and after AVD (sBV-AVD) has shown promising activity in older patients, but real-world data remain limited. Aim: To assess the outcomes of elderly cHL patients treated with sBV-AVD in a real-wold setting. Methods: A single-centre, retrospective study was conducted at our tertiary centre, enrolling consecutive cHL patients treated with sBV-AVD between Jan 2022 and Mar 2026(AM Evens, JCO 2018). Primary endpoints were overall- and cancer-specific survival (censoring non-HL deaths, CSS), as well as event-free survival (EFS), with events defined as progression, death or the start of a new therapy. Results: Fifteen patients were enrolled in the study, with 13 (86%) having stage IV disease. Median age at enrollment was 72 years (60-86), and 8 (53%) were female. Most subjects (80%) presented with B symptoms, whereas only 2 (13%) had bulky disease. Median ECOG PS at baseline was 2, with 9 (60%) individuals having a PS ≥3. After a median follow-up of 15 months (range 1-52), 2 subjects died (one from HL progression and one from a second primacy malignancy) and 2 experienced progression. Fifteen-month EFS and OS were 67% (95% CI 45-100) and 83% (95% CI 63-100), respectively, while 15-month CSS was 93% (95% CI 81-100). An improvement in PS after the 2 lead-in BV doses was documented in all but 3 patients (one who died shortly after the 1st BV infusion, and one who started BV with a PS of 0; Wilcoxon p<0.001), and median PS were 2 and 1 before and after the lead-in BV. Overall, the sequential regimen was well tolerated. Infections were the most common adverse event, with 7 total cases being reported across 5 patients, 2 of which were septic events happening during the BV lead-in. Notably, no cases of febrile neutropenia were recorded. Peripheral neuropathy was documented in 6 patients (3 G2, 3 G1), appearing in half the cases after the second lead-in BV infusion. Conclusion: sBV-AVD appeared to be effective and well tolerated in this real-world cohort of elderly cHL patients. Of note, the initial BV infusions were associated with a notable improvement in patient performance, which led to full delivery of the following AVD cycles with only mild complications.
  • Alessandro Cellini
  • Francesco Angotzi
  • Martina De Ferrari
  • Nicolo' Danesin
  • Mattia D'Antiga
  • Arianna Bevilacqua
  • Anna Giordano
  • Marco Pizzi
  • Filippo Crimi'
  • Gaia Grassetto
  • Federica Vianello
  • Francesco Piazza
  • Livio Trentin
  • Andrea Visentin
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P034 (P034)

Netupitant/palonosetron for prevention of chemotherapy-induced nausea and vomiting in Hodgkin lymphoma treated with ABVD or BV-AVD: a single-centre observational study

Background: ABVD and brentuximab vedotin-AVD (BV-AVD) represent the standard-of-care therapeutic regimens for the treatment of classical Hodgkin lymphoma (HL) and require effective prophylaxis against chemotherapy-induced nausea and vomiting (CINV). Fixed-dose oral netupitant/palonosetron (NEPA) combines an NK1 receptor antagonist and a second-generation 5-HT3 receptor antagonist, but HL-specific data remain limited. We evaluated the effectiveness of NEPA-based prophylaxis in patients receiving first-line ABVD or BV-AVD. Methods: We performed a retrospective single-centre observational study including patients with HL treated at the University Hospital of Padova between 2021 and 2024. Patients who escalated to BEACOPP or salvage therapy after interim PET were excluded to assess CINV outcomes across ABVD/BV-AVD treatment. NEPA was administered with or without dexamethasone according to physician choice. The primary endpoint was complete response (CR), defined as no emesis and no rescue antiemetic use, during the overall phase from 0–120 hours after chemotherapy. Secondary endpoints were acute CR (0–24 hours), delayed CR (24–120 hours) and complete control (CR with no more than mild nausea). Results: One hundred patients were included; 54% were female and median age was 33 years. Seventy-one patients received ABVD and 29 received BV-AVD, for a total of 1040 chemotherapy administrations evaluable for CINV. NEPA plus dexamethasone was used in 73 patients and NEPA alone in 27. Acute-phase control was high, with acute CR in 97 [95%CI 91-99] patients. The 3 subjects who did not obtain acute CR also experienced acute vomiting. Overall-phase CR was 72% (95%CI 62-80), while complete control was achieved in 61% (95%CI 51-71). Delayed nausea occurred in 34% (95%CI 25-44), was predominantly mild-to-moderate in severity, and was not accompanied by vomiting. Rescue antiemetics were required in 26 (95%CI 18-36). Delayed CINV occurred mainly during the first cycle, accounting for 25/34 (73%; 95%CI 56-87) of delayed events, with no recurrence of the symptoms being reported in all but 2 subjects. Conclusion: In this single-centre HL cohort, NEPA-based prophylaxis provided high acute-phase protection and low rates of vomiting during ABVD and BV-AVD. Delayed nausea remained the main residual unmet need. These findings support NEPA as a feasible antiemetic strategy in this setting and justify prospective evaluation of risk-adapted prophylaxis.
  • Alessandro Cellini
  • Francesco Angotzi
  • Ivan Zatta
  • Martina De Ferrari
  • Andrea Serafin
  • Arianna Bevilacqua
  • Nicolo' Danesin
  • Giovanni Leone
  • Mattia D'Antiga
  • Anna Giordano
  • Francesco Piazza
  • Francesca Temporin
  • Livio Trentin
  • Andrea Visentin
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P035 (P035)

In-Field Recurrence Patterns Following Consolidation Radiotherapy after BrECADD in Advanced-Stage Hodgkin Lymphoma: A Secondary Analysis of the Randomized Phase 3 GHSG HD21 Trial

Purpose/Objective: While the GHSG HD21 trial demonstrated superior efficacy for the BrECADD regimen over escalated BEACOPP (eBEACOPP) in advanced-stage Hodgkin lymphoma (HL), the necessity of routine consolidation radiotherapy (RT) for end-of-treatment PET (EOT-PET)-positive patients remains debated. This analysis evaluates the role of consolidation RT by assessing patterns of in-field recurrence following both chemotherapy regimens. Materials/Methods: Data from advanced-stage HL patients receiving consolidation RT in the randomized phase 3 HD21 trial were retrospectively analyzed. Following central review recommendation, EOT-PET-positive patients received 30 Gy RT. To determine the role of consolidation RT, EOT-PET scans and subsequent imaging were analyzed in relapsed patients to identify in-field recurrences. Descriptive statistics were performed on baseline and treatment characteristics. In-field recurrence rates were calculated using cumulative incidence functions. Results: EOT-PET-positivity occurred at an identical rate of 17% in both treatment arms (n=127/734 after eBEACOPP vs n= 125/739 after BrECADD). RT was administered to 112 EOT-PET-positive patients in the eBEACOPP group and 104 patients in the BrECADD group. Image analysis revealed that local treatment failure was rare in both groups: in-field relapses occurred in only 5 patients after eBEACOPP and 2 patients after BrECADD. The 60-month cumulative incidence of in-field recurrence was 4.5% (95% CI, 0.6-8.4) for eBEACOPP compared to just 2.0% (95% CI, 0.0-4.8) for BrECADD (HR, 0.43; 95% CI, 0.08–2.21). Conclusion: Consolidation RT following frontline BrECADD provides outstanding local control even for EOT-PET-positive patients. Notably, the in-field recurrence rate was numerically lower after BrECADD than after eBEACOPP (2.0% vs. 4.5%). While EOT-PET positivity rates were identical between arms, they increased compared to the GHSG HD15 trial. Collectively, these findings suggest that in the era of modern PET technology with enhanced spatial resolution and highly effective systemic therapy, a distinct subset of EOT-PET-positive patients may not profit from consolidation RT. However, this must be carefully weighed against the excellent local efficacy of RT and the risk of undertreatment. To safely de-escalate RT, future trials should integrate advanced metrics like metabolic tumor volume or minimal residual disease assessment to precisely identify those who truly derive a therapeutic benefit.
  • Johannes Rosenbrock
  • Maja Supprian
  • Michael Oertel
  • Justin Ferdinandus
  • Hishan Tharmaseelan
  • Christian Peter Jaworek
  • Simone Ferdinandus
  • Jasmin Weindler
  • Paul J. Bröckelmann
  • Hendrik Dapper
  • Carsten Kobe
  • Michael Fuchs
  • Emmanouil Fokas
  • Peter Borchmann
  • Hans Theodor Eich
  • Christian Baues
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P036 (P036)

Interim PET-Adapted De-escalation Chemotherapy Regimen for Advanced Stage Classical Hodgkin Lymphoma Using Brentuximab Vedotin, Pembrolizumab, Doxorubicin, and Dacarbazine: Phase 2 Study — Updated Follow-up

Background: Brentuximab vedotin(Bv), nivolumab, and pembrolizumab (P) have changed frontline therapy for advanced-stage classical Hodgkin lymphoma (AS cHL). GHSG HD18/HD21 showed PET-adapted strategies can reduce treatment without compromising efficacy. We evaluated BvP+AD with PET-adapted de-escalation to reduce chemotherapy exposure. Methods: Pts with newly diagnosed AS or stage II bulky (≥10 cm) cHL received 3 cycles BvP+AD (Bv 1.2 mg/kg, P 400 mg Q6W, doxorubicin/dacarbazine standard dosing). P was dosed C1D1, C2D15, C4D1, and C5D15. Pts with interim PET DS1–2, or DS3 with ≥90% TMTV reduction after cycle 3, received 3 additional cycles BvP only. Pts with DS4–5 or DS3 with <90% TMTV reduction completed 6 total cycles BvP+AD. Primary endpoint was EOT CR rate; secondary endpoints included safety, ORR, and PFS. Results: 25 pts enrolled: median age 30 (17–64), female 48% (12); stage II bulky 32% (8), stage III/IV 68% (17); non-Hispanic White 64% (16), IPS ≥3 20% (5), extranodal disease 52% (13). All pts completed interim PET: DS1 2, DS2 16, DS3 7; all DS3 pts had ≥90% TMTV reduction. All pts de-escalated to BvP only. EOT PET: DS1 5, DS2 15, DS3 2, DS4 3. EOT CR was 88% (22/25). Of 3 pts with DS4, all achieved CR by subsequent PET follow-up. At median follow-up 18.9 mo (14.2–26.4), 24/25 pts (96%) remain progression-free, with 1 progression at 13.3 mo (Figure 1). No consolidative RT was administered. AEs: Most common any-grade AEs were PSN 80% (20), nausea 80% (20), fatigue 60% (15), ALT increased 56% (14), and alopecia 56%(14). PSN was G1 in 54%(16), G2 in 16% (4) , and no G3; PSN resolved in 40% (8/20) by last follow-up. G3 AEs included ALT elevation (3), AST elevation (1), neutropenia (2), diarrhea (1), and generalized muscle weakness (1); all resolved. No neutropenic fever occurred. IMAEs included thyroid dysfunction 16%(4), G2 pneumonitis 1, and G3 diarrhea 1. Three SAEs occurred: fever, suspected pneumonitis, and UTI/fever. Two pts discontinued P for G3 LFT abnormalities; 4 had Bv dose reduction for G2 PSN. Conclusions: BvP+AD with PET-adapted de-escalation showed favorable safety and durable efficacy in frontline AS cHL. All pts met de-escalation criteria, reducing anthracycline/alkylator exposure by 50%, with no RT, 88% EOT CR, and 96% progression-free at 18.9 mo. Longer follow-up and larger cohorts are needed.
  • Hun Ju Lee
  • Gregory Ravizzini
  • Jennifer Ramos
  • Javier Retamales
  • Ayushi Chauhan
  • Luis Fayad
  • Ranjit Nair
  • Jason Westin
  • Jared Henderson
  • Christopher Flowers
  • Michael Wang
  • Luis Malpica
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P037 (P037)

PET-Adapted EACODD-14 Regimen in Early Unfavorable and Advanced Stages of Classical Hodgkin Lymphoma: Efficacy and Survival in the Multicenter HL-Russia-1 Study

Background: Optimal first-line treatment for classical Hodgkin lymphoma (cHL) requires balancing efficacy and toxicity. The intensive EACODD-14 regimen (a modification of EA(50)COPP-14 substituting procarbazine/prednisone with dacarbazine/dexamethasone) demonstrated high efficacy and manageable toxicity in single-center trials. HL-Russia-1 evaluates PET-adapted approach in a real-world multicenter setting across Russia. Aims: To assess the real-world effectiveness, PET-response dynamics, and survival outcomes of the PET-adapted EACODD-14 in patients (pts) with early stages unfavorable prognosis (ESUP) and advanced stages (AS) of cHL. Methods: HL-Russia-1 (NCT04638790) is a prospective multicenter study. ESUP received 2 cycles of EACODD-14; PET-2-negative pts proceeded to 2 cycles of AVD, while PET-positive pts received 2-4 additional cycles of EACODD-14. AS pts received 6 cycles of EACODD-14. Consolidation involved-site radiotherapy (ISRT) was indicated for bulky disease, residual masses ≥2.5 cm, or PET-positive residual lesions. Primary neutropenia prophylaxis with pegG-CSF was recommended. Survival was analyzed using the Kaplan-Meier method. Results: Between Nov 2020 and Apr 2026, 13 centers enrolled 349 pts. We analyzed 283 pts with ESUP and AS treated with EACODD-14. Baseline: Median age was 30 years (18 – 64), 59.3% male. AS 64.1%, ESUP 26.6%. Pts with ESFP received ABVD and were excluded. IPS >2 for AS: 33.1%. PET Response: PET-2 evaluable in 243 pts (85.9%); complete metabolic response (CMR, DS 1-3) in 64.7%. PET-4 and PET-6 CMR rates were 74.3% and 88.9%. Radiotherapy: RT performed in 36.3% of pts; omitted in 44.6% of ESUP and 71.5% of AS pts with CMR and residual masses <2.5 cm. Efficacy & Survival: EOT remission rate 93.5%. With a median follow-up of 9.4 months (range 1-58.2), the estimated 2-year progression-free survival (PFS) for the entire EACODD-14 cohort is 90.3% (95% CI: 84.6% - 93.9%). For ESUP, 2-year PFS is 95.0% (95% CI: 84.9% - 98.4%), and for AS, it is 88.2% (95% CI:80.6% - 92.9%). Overall survival is 100%. Treatment failures occurred in 18 pts. Conclusion: Updated HL-Russia-1 confirms that PET-adapted EACODD-14 is highly effective and feasible in a real-world multicenter setting. High early metabolic response rates allow safe radiotherapy omission in a significant proportion of pts, minimizing long-term toxicity without compromising PFS. This platform demonstrates robust outcomes across federal and regional centers.
  • Nikita Shorokhov
  • Elena Demina
  • Gayane Tumyan
  • Valeria Spirko
  • Elena Pavluchenko
  • Kamil Kaplanov
  • Alena Bobrova
  • Elena Baryakh
  • Diana Ivanova
  • Natalia Mikhailova
  • Evgeniya Borzenkova
  • Tatyana Pospelova
  • Maria Voytko
  • Olga Smirnova
  • Elsa Kankumasheva
  • Elsa Siraeva
  • Vitaliy Kanin
  • Alexandra Saidullaeva
  • Arina Adolf
  • Irina Matveeva
  • Nikita Mochkin
  • Vladimir Melnichenko
  • Vladislav Sarzhevskiy
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P038 (P038)

Frontline nivolumab-AVD in older patients with advanced classical Hodgkin lymphoma: real-word experience from a single Italian centre

Background: Older patients with advanced classical Hodgkin lymphoma (cHL) are underrepresented in clinical trials because of comorbidities and frailty. Although the phase III S1826 study demonstrated improved efficacy and tolerability of nivolumab plus AVD (N-AVD) compared with brentuximab vedotin-AVD, real-world evidence remains limited. We report updated outcomes of elderly patients treated with frontline N-AVD at our institution. Methods: We retrospectively evaluated consecutive patients aged >60 years with stage III-IV cHL treated with frontline N-AVD. Treatment consisted of nivolumab (240 mg, days 1 and 15) combined with AVD every 28 days for six cycles. Chemotherapy dose reductions were allowed at physician discretion. Responses were assessed by PET-CT. Overall response rate (ORR) included complete and partial response (CR, PR), was assessed at end-of-treatment (EOT). Progression-free survival (PFS) was defined from treatment start to progression or death from any cause. Adverse events were graded according to CTCAE ver.5.0. Results: Eleven patients were included (median age of 71 years, range 65-85); eight (73%) were male. All had stage III-IV disease. Median IPS was 3 (range 2-5), with 64% high-risk disease (IPS ≥3). AVD dose attenuation was required in five patients (four at 50% and one at 75% of standard dose), while nivolumab was administered at full dose in all cases. Interim PET showed CR in six patients (54%), PR in four (36%), and progressive disease (PD) in one patient. At EOT, ORR was 72% (CR 63%, PR 9%); three patients experienced PD. After a median follow-up of 18 months (range 5-25), estimated 18- month PFS was 53%. Most progression events occurred within the first 10 months of treatment. One patient died from PD beyond 18 months. Progressions occurred in both dose-attenuated and full-dose groups. The most frequent toxicity was neutropenia, occurring in nine patients (82%), including grade ≥ 3 in seven (64%). Infections included pneumonia (n=2) and urinary tract (n=1). Immune-related adverse events occurred in two patients (hypothyroidism and interstitial pneumonitis). Conclusions: In this real-world series of elderly patients with advanced cHL, frontline N-AVD demonstrated considerable response rates despite dose attenuation. Early progression remained common, likely reflecting the greater frailty and comorbidity burden of patients treated in routine practice compared with those enrolled in clinical trials.
  • Tanja Lazic
  • Stefano Luminari
  • Alberto Bavieri
  • Silvia Gambara
  • Maria Elena Nizzoli
  • Laura Arletti
  • Angela Ferrari
  • Fiorella Ilariucci
  • Francesco Merli
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P039 (P039)

Has Frontline Brentuximab Vedotin Plus AVD Altered the Historical Adverse Prognostic Impact of Stage IV Disease in Classical Hodgkin Lymphoma? A Dual-Center Real-World Experience

Background: Advanced-stage classical Hodgkin lymphoma (cHL) is traditionally associated with progressively worse outcomes with increasing stage, with stage IV disease showing inferior progression-free survival (PFS). Since 2021 strategies have evolved at our institutions according to national treatment authorization, while maintaining a PET-oriented approach: stage IIB–III patients were treated with ABVD-based regimens, while stage IV patients received frontline brentuximab vedotin plus AVD (BV-AVD). We investigated whether this therapeutic shift has altered the prognostic impact of stage on PFS. Methods: We retrospectively analyzed consecutive patients with newly diagnosed cHL stage IIB–IV treated across two Italian centers from September 2021 onward. All patients were managed according to a PET-oriented treatment strategy. PFS was calculated from first-line treatment initiation to progression, relapse, death, or last follow-up using Kaplan–Meier estimates. Exploratory Cox proportional hazards models were performed to identify variables associated with PFS. Results: Seventy-seven patients were included; median age at diagnosis was 37 years (IQR 27–53), and 55.8% presented with stage IV disease. B symptoms were present in 76.7%, extranodal involvement in 57.3%, and bulky disease in 49.3%. After a median follow-up of 32 months (IQR: 16-46 months), 14 PFS events were observed. Overall estimated PFS at 24 months was 79.8% (95%CI: 68.2% - 87.6%). Contrary to historical expectations, stage IV patients did not show inferior outcomes compared with stage IIB–III disease. Estimated 24-month PFS was 84.9% in stage IV and 74.0% in stage IIB–III patients (univariable Cox model, HR=0.60; 95%CI 0.21–1.72; p=0.338). Exploratory univariable Cox models identified leukocytosis ≥15×109/L (HR=4.36; 95%CI: 1.38-13.83; p=0.012) and bulky disease (HR=3.84; 95%CI: 1.06-13.97, p=0.041) as variables associated with worse PFS. Conclusions: In this dual-center real-world PET-guided cohort, stage IV cHL did not retain its historically adverse prognostic impact and showed numerically superior PFS to stage IIB–III disease. Despite the limitations of retrospective design, sample size, and stage-based treatment allocation, these findings suggest that frontline BV-AVD may mitigate the traditional prognostic disadvantage of stage IV disease. Prospective validation is needed.
  • Martha Cecilia Berliner
  • Tanja Lazic
  • Roberta Sciarra
  • Alessandro Mazzacane
  • Sofia Pedrali
  • Nicolò Rampi
  • Chiara Rusconi
  • Luca Arcaini
  • Stefano Luminari
  • Manuel Gotti
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P040 (P040)

Hyperbilirubinemia in Classical Hodgkin Lymphoma: Impact of Severity on Hepatic Recovery and Clinical Outcomes

Background: Hyperbilirubinemia, particularly severe hyperbilirubinemia, is uncommon in classical Hodgkin lymphoma (cHL) and is not incorporated into conventional prognostic scoring systems. Delivery of first-line chemotherapy is challenging because of concerns regarding altered hepatic metabolism and drug toxicity. These patients are under-represented in clinical trials, and evidence to guide management remains limited. We evaluated treatment approaches, hepatic recovery, and outcomes in patients with cHL presenting with baseline hyperbilirubinemia. Methods: We retrospectively analysed patients with newly diagnosed cHL treated between January 2010 - December 2025 with baseline hyperbilirubinemia (total bilirubin >2 mg/dL), further stratified into mild (2–5 mg/dL), moderate (5.1–10 mg/dL), and severe (>10 mg/dL) hyperbilirubinemia. Clinical outcomes included normalization of liver function and event-free survival (EFS). Results: Of 1541 patients treated during the study period, 50 (3.2%) had hyperbilirubinemia at presentation, of whom 28 (56%), 10 (20%), and 12 (24%) patients had mild, moderate, and severe hyperbilirubinemia, respectively. Corticosteroid bridging was used in 23 patients, predominantly in moderate/severe hyperbilirubinemia (p<0.001), only 3 patients achieved sufficient hepatic recovery to receive standard ABVD. Following chemotherapy, liver function normalized in 67.9% and 80% of patients with mild and moderate hyperbilirubinemia, respectively. Median time to normalization was 12 and 100 days; only one patient with severe hyperbilirubinemia achieved normalization. The 2-year EFS was 78.4%, 75.0%, and 9.5% in patients with mild, moderate, and severe hyperbilirubinemia, respectively (log-rank p<0.001). On univariable analysis, severe hyperbilirubinemia (HR 8.4, p<0.001), non-cholestatic liver injury (HR 2.7, p=0.037) and persistent liver dysfunction (HR 23.4, p<0.001) were associated with inferior EFS. On multivariable analysis, only persistent liver dysfunction remained independently associated with inferior EFS (HR 30.5, 95% CI 4.6–204.8; p<0.001). Conclusions: Severe hyperbilirubinemia identifies an ultra-high-risk subgroup of patients with cHL characterized by poor hepatic recovery and markedly inferior EFS. Persistent liver dysfunction following treatment initiation was the strongest predictor of adverse outcome. Prospective studies evaluating alternative therapeutic strategies for this rare and vulnerable population.
  • Yash Patel
  • Kavitha Lakshmi
  • Anu Korula
  • Vikram Mathews
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P041 (P041)

INTERIM AND END-OF-TREATMENT (EOT) PET/CT ASSESSMENT AFTER NIVOLUMAB, DOXORUBICIN, VINBLASTINE, AND DACARBAZINE (N-AVD) IN ADVANCED-STAGE CLASSICAL HODGKIN LYMPHOMA (CHL): A SINGLE-CENTER EXPERIENCE

Background: Based on the randomized SWOG S1826 trial, N-AVD demonstrated superior disease control compared with BV-AVD in stage III/IV classical Hodgkin lymphoma. We adopted N-AVD as first-line therapy for advanced cHL starting in July 2023. Although PET/CT is a cornerstone of response assessment in cHL, checkpoint inhibitors may increase false-positive (FP) findings. We evaluated our institutional experience with PET/CT after first-line N-AVD. Methods:We retrospectively analyzed patients with cHL treated with first-line N-AVD. Interim PET (iPET) after 2 cycles and end-of-treatment (EoT) PET/CT were assessed according to the Deauville Score (DS), with DS4-5 considered positive. Results: Median age was 29 years (range 16–79), 13% were ≥60 years, 51% were male, 44% had B symptoms, 63% had nodular sclerosis, and 64% had stage IV disease. Four patients (10%) had positive iPET, all DS4; three converted to negative EoT scans, suggesting FP iPET findings, whereas one developed progressive disease confirmed by subsequent PET/CT (DS5) having received BrECADD after N-AVDx3. Among 36 iPET-negative patients, 7/36 (19%) had positive PET/CT (5 with DS4, 2 with DS5). Three DS4 cases became negative on repeat imaging after three months, while two DS4 and two DS5 cases represented true treatment failure confirmed by serial imaging and/or biopsy. Salvage treatment included BrESHAP followed by autologous stem-cell transplantation in two patients and radiotherapy for localized disease in one patient. One DS5 case was ultimately diagnosed as metachronous diffuse large B-cell lymphoma necessitating chemotherapy initiation. An additional patient relapsed within 12 months despite negative iPET and EoT PET/CT. Overall 6/40 patients have experienced treatment failure so far (15%). With a median follow-up of 20.7 months, estimated 2-year progression-free survival was 82%. Conclusions: N-AVD demonstrated high efficacy with a low rate of iPET positivity and no interim DS5 scans. Interestingly, most treatment failures occurred despite negative iPET, whereas several EoT-positive scans proved false positive, highlighting the limitations of PET/CT interpretation after checkpoint inhibitor-based therapy. Therefore, PET/CT results should be evaluated within the broader clinical context, and isolated metabolic findings should not automatically prompt treatment modification without careful consideration.
  • Piperidou Alexia
  • Athanasios Liaskas
  • Anastasia Kopsaftopoulou
  • Maria Dimitrakoudi
  • Eliana Konstantinou
  • Marina Belia
  • Maria Arapaki
  • Rodanthi Fioretzaki
  • Aikaterini Kolotsiou
  • Alexandros Machairas
  • Georgia Poultsaki
  • Chryzovalantou Chatzidimitriou
  • John Asimakopoulos
  • Angeliki Georgopoulou
  • Calliope Zerzi
  • Panayiotis Tsaftaridis
  • Fotios Panitsas
  • Aikaterini Benekou
  • Panayiota Petsa
  • Helen Plata
  • Aikaterini Bitsani
  • Maria Dimou
  • Marina Siakantaris
  • Maria Angelopoulou
  • Theodoros Vassilakopoulos
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P042 (P042)

Association of quantitative FDG-PET parameters and serum TARC with outcome in advanced classic Hodgkin lymphoma: A biomarker analysis of the EORTC-1537-COBRA trial

Background: In classic Hodgkin lymphoma (cHL), FDG-PET is used for staging and response assessment using Deauville Score (DS). However, the positive predictive value of an interim PET (iPET) DS 4 is restricted. Quantitative PET parameters such as metabolic tumour volume (MTV), provide objective measures of tumour burden. Serum Thymus and Activation-Regulated Chemokine (sTARC), highly expressed by Hodgkin Reed-Sternberg cells, has emerged as a biomarker for disease monitoring. We evaluated the association between quantitative PET parameters, sTARC, and outcome in the EORTC-1537-COBRA trial. Methods: The trial enrolled advanced stage cHL patients. Baseline and early interim FDG-PET-scans were centrally reviewed and scored using DS. After one cycle of A‐AVD, patients with a positive iPET (DS 4-5) were escalated to intensified treatment. Quantified PET parameters were derived by semiautomatic segmentation. TARC was measured in serum by ELISA at multiple timepoints. Elevated sTARC was predefined as >1000 pg/ml. Associations were assessed using Pearson correlation and Kaplan Meier estimates were performed to analyse correlation with modified progression-free survival (mPFS), the primary endpoint. Results: At baseline, 95% of evaluable patients showed elevated sTARC levels, resulting in 127 patients included in this analysis. sTARC declined rapidly after one cycle of A-AVD, with only 24% showing elevated sTARC at interim assessment. In contrast, 42% of patients remained iPET-positive according to DS. Using a SUV4.0 threshold, residual MTV was detected in 7% of patients (table 1). Residual MTV did not identify a subgroup of total patients with a significantly worse mPFS. Elevated sTARC correlated with adverse mPFS. Available follow-up data indicate that sTARC remained normalized in 99 of 111 (89%) patients without a mPFS event. Sequential follow-up data will be presented at the conference. Conclusion: Despite a substantial proportion of patients remaining iPET-positive based on DS, residual measurable MTV was uncommon after one cycle of A-AVD. No significant association with worse outcome was found, probably due to treatment intensification in iPET-positive patients. Available data indicate that sTARC remained normalized in most patients without a mPFS event during follow-up and sTARC levels were associated with outcome. These findings suggest that sTARC complements PET and support further investigation of sTARC-guided disease monitoring in cHL.
  • Sophie Teesink
  • Lydia Visser
  • Laure Musekera
  • Anna Sureda
  • Susana Carvalho
  • Andrey Vranovsky
  • Annika Loft
  • Anne Arens
  • Sanne Tonino
  • Ward Sents
  • Cédric Mallien
  • Berthe Aleman
  • Walter Noordzij
  • Catherine Fortpied
  • Martin Hutchings
  • Arjan Diepstra
  • Wouter Plattel
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P043 (P043)

LUNG FUNCTION ASSESSMENT BY DIFFUSING CAPACITY OF THE LUNGS FOR CARBON MONOXIDE (DLCO) MEASUREMENT IN PATIENTS WITH CLASSICAL HODGKIN LYMPHOMA RECEIVING FIRST-LINE TREATMENT WITH NIVOLUMAB-AVD

Background: Nivolumab-AVD (NAVD) has shown outstanding efficacy in patients with advanced-stage classical Hodgkin Lymphoma (cHL), establishing a new standard of care. Pneumonitis is a well-recognized complication of bleomycin in patients previously treated with ABVD. Similarly,treatment with immune checkpoint inhibitors, can also lead to pneumonitis through an immune-mediated mechanism, raising concerns about potential pulmonary impairment during therapy. Methods: The study included patients with stage III and IV cHL treated with NAVD as a first-line therapy. Single-breath Diffusing Capacity of the Lungs for Carbon Monoxide corrected for Hemoglobin (DLCOc-SB) measurements were performed at predefined time points: prior to treatment initiation, after four cycles of NAVD, and at treatment completion. Clinical evaluation and symptom assessment were constantly performed during treatment and afterwards to correlate functional changes with clinical findings. Results: Among 40 patients who had completed treatment with NAVD up to the time of the present analysis, 19 had baseline and interim DLCOc-SB assessments and 10/19 also had at least 1 post- treatment assessment. Media age was 28 years (range 16–79), with 11% aged ≥60 years. The median value of DLCOc-SB at baseline was 83.8% of the predicted value [ (IQR) 79.5-95.7%; range 55.8-120.8%], while after four cycles of NAVD it was 80% (IQR 74.4-89.2%; range 56.3-117.2%). In fact 16/19 patients had a reduction in DLCOc-SB by a median of 4.5% (range 0.5-10.12%) and 3 had an increase of 0.3-3.7%. The difference was statistically significant (p<0.001 ). In the 10 patients with available post-treatment assessment the median DLCOc-SB was 82.9% (IQR 65.2-93.6%; range 49.3-106.3%) versus 83.3% (IQR 71.7-96.6%; range 55.8-120.8%) at baseline (p=0.33) and 78.9% (IQR 67.7-91.2%; range 56.3-117.2%) at the interim assessment (p=0.96). Comparing the baseline and post-treatment evaluation, 7/10 patients had a reduction in SLCOc-SB by a median of 5.1% (range 0.1-30.2%) and 3 had an increase of 6.8-8.8%. Comparing the interim and post-treatment evaluation, 5/10 patients had a reduction in DLCOc-SB by a median of 10.0% (range 0.6-27.6%) and 5/10 had an increase of 1.4-12.4% (median 9.8%). None of the patients developed clinical symptoms of pneumonitis and only 1/19 had a reduction in SLCOc-SB by >20%. Conclusion: NAVD has a favorable pulmonary safety profile.
  • Athanasios Liaskas
  • Alexia Piperidou
  • Georgia Poultsaki
  • Maria Dimitrakoudi
  • Anastasia Kopsaftopoulou
  • Rodanthi Fioretzaki
  • Alexandros Machairas
  • Marina Belia
  • Maria Arapaki
  • Eliana Konstantinou
  • Giannis Assimakopoulos
  • Panayiotis Tsaftaridis
  • Fotios Panitsas
  • Aikaterini Bitsani
  • Maria Dimou
  • Marina Siakantaris
  • Maria Angelopoulou
  • Theodoros Vassilakopoulos
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P044 (P044)

HIV-associated Hodgkin lymphoma: real-world treatment outcomes and infectious complications – a multicentre study by the Polish Lymphoma Research Group

Background: HIV-associated Hodgkin lymphoma (HL) is uncommon and remains clinically challenging despite the availability of antiretroviral therapy (ART). Contemporary cohorts suggest favourable outcomes with standard HL treatment and effective HIV care, but real-world data from Central and Eastern Europe are limited. Methods: We retrospectively analysed 12 adults with HIV-associated HL treated in 10 Polish haematological centres between 2007 and 2026, representing 12.2% of the Polish Lymphoma Research Group HIV-positive lymphoma cohort (12/98). Results: All patients were male; median age was 39.5 years. HIV and HL were diagnosed concurrently in 1 patient; 11/12 had known HIV infection and were receiving ART before HL diagnosis. CD4 count and HIV RNA at HL diagnosis were available in 6/12; median CD4 count was 296 cells/μL. Advanced disease (Lugano III–IV) was present in 11/12 and bone marrow involvement in 3/12. Importantly, 6/12 patients had clinically significant infectious complications before HL treatment, including CMV reactivation, oesophageal candidiasis, Pneumocystis jirovecii pneumonia and pulmonary tuberculosis. First-line treatment consisted of ABVD in 11/12 patients and BV-AVD in 1/12. Infections and/or severe neutropenia complicated treatment, leading to dose reduction in 1 patient, prolonged intervals in 3 and hospitalisation in 3. Complete remission (CR) was achieved in 9/12; 4 of these patients relapsed, while 3/12 had primary refractory disease. Overall, 7/12 required second-line therapy and 1 underwent high-dose chemotherapy followed by autologous stem cell transplantation. Median time to relapse was 17.7 months. Additional events illustrated diagnostic and immune-related complexity: syphilis mimicked PET-positive nodal relapse in one patient in CR on the end of treatment, while immune thrombocytopenia developed after first-line therapy in another patient and preceded subsequent HL relapse. During a median follow-up of 41 months, 4/12 patients died (33.3%), mainly due to lymphoma progression, including hemophagocytic lymphohistiocytosis and CSN relapse. Conclusions: Despite favourable outcomes reported in ART-era cohorts, this real-world series shows that HIV-associated HL may still follow a clinically challenging course. Infectious and immune-related events may complicate PET-based assessment and follow-up. These findings underscore the need for clinical vigilance, HIV/immunological assessment and standardised infection prophylaxis.
  • Agnieszka Giza
  • Magdalena Zapala
  • Joanna Drozd-Sokolowska
  • Magdalena Witkowska
  • Jan Maciej Zaucha
  • Malgorzata Sobczyk-Kruszelnicka
  • Anastazja Szlauer-Stefanska
  • Anna Kopinska
  • Magdalena Zawartko
  • Magdalena Witak- Jedra
  • Kamil Wisniewski
  • Kamil Wdowiak
  • Jarosław Grzyb
  • Anna Parfieniuk-Kowerda
  • Natalia Leonczuk
  • Alicja Wandalowicz
  • Monika Joks
  • Justyna Rybka
  • Judyta Strzala
  • Agnieszka Szeremet
  • Aleksandra Szymczak
  • Marcin Czarnecki
  • Marta Głuchowska
  • Jarosław Dybko
  • Dagmara Zimowska-Curylo
  • Ewa Lech-Maranda
  • Tomasz Sacha
  • Milosz Parczewski
  • Monika Bociaga-Jasik
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P045 (P045)

Frontline BV-AVD in Classical Hodgkin Lymphoma: A Multicenter Real-World Comparison with the ABVD Regimen

Background: For decades, the ABVD regimen remained the global gold standard for advanced-stage classical Hodgkin lymphoma (cHL).In the ECHELON-1 trial, brentuximab vedotin (BV) combined with AVD (BV + AVD) showed higher progression-free survival (PFS) and overall survival (OS) rates in patients with advanced stage compared to the standard ABVD regimen. We evaluated the clinical outcomes of a multicenter cohort treated with first-line BV-AVD and compared them against the long-term historical outcomes of patients treated with the ABVD regimen. Methods: This multicenter, retrospective cohort study enrolled adult patients with newly diagnosed cHL across 20 centers in Turkey receiving first-line BV+AVD, with ABVD-treated patients as the internal control cohort from Ege University and external validation cohort of advanced-stage from different center.Survival outcomes were estimated using the Kaplan-Meier method and compared with the log-rank test, with Cox regression tests used for multivariate analyses. Results: A total of 275 patients were analyzed: 123 in the BV-AVD group (median age 46, range 18-83) and 152 in the ABVD group (median age 39, range 18-81). The BV-AVD cohort exhibited a significantly higher risk profile, with a greater prevalence of advanced-stage disease (90% vs. 68%; p<0.001), B symptoms (59% vs. 44.7%; p=0.019), and bone marrow involvement (24% vs. 12%; p=0.006). Median follow-up was 1.4 years for BV-AVD and 4.9 years for ABVD. In the overall cohort, the 2-year PFS and OS rates were higher in the BV-AVD group, though the difference did not reach statistical significance (PFS: 83.5% vs. 78.4%, p=0.7; OS: 96.7% vs. 89.1%, p=0.1). However, in a subgroup analysis of advanced-stage patients, while 2-year PFS remained comparable (81.8% vs. 66.7%; p=0.08), the 2-year OS was significantly superior in the BV-AVD arm (95.6% vs. 81.8%; HR: 3.97, 95% CI: 1.3-12.1, p=0.015). Regarding safety, neuropathy and grade 3-4 hematological toxicities were more frequent in the BV-AVD group. Consequently, the utilization of G-CSF was significantly higher in the BV-AVD cohort (77.2% vs. 41.1%; p<0.001). Conclusion: Our data suggests that BV-AVD is a robust and effective frontline regimen for advanced-stage HL in a real-world setting. By successfully managing a higher-risk patient population and providing a superior survival advantage in advanced stages, BV-AVD justifies its position as the new standard of care, provided that hematological toxicities are managed.
  • Fatma Keklik Karadag
  • Merve Yuksel
  • Umut Yılmaz
  • Meral Ulukoylu Menguc
  • Denis Çetin
  • Ajda Gunes
  • Batuhan Bulan
  • Taner Tan
  • Sureyya Yigitkaya
  • Hacer Berna Afacan Ozturk
  • Ezel Elgün
  • Deniz Gören
  • Ulviyya Hasanzade
  • Hale Bulbul Dilmen
  • Utku Iltar
  • Merve Ecem Erdogan Yon
  • Guldane Cengiz Seval
  • Ozan Salim
  • Orhan Kemal Yücel
  • Ekin Kircali
  • Zafer Serenli Yeğen
  • Haşim Atakan Erol
  • Ayse Uysal
  • Burak Deveci
  • Omur Kayıkcı
  • Zehra Narli Özdemir
  • Esin Oğuz Kozan
  • Mehmet Baysal
  • Ayse Hilal Eroğlu Küçükdiler
  • Zuhal Demirci
  • Irfan Yavasoglu
  • Pelin Aytan
  • Deniz Ozmen Ibis
  • Murat Ozbalak
  • Fahir Ozkalemkas
  • Ahmet Kursad Gunes
  • Ömür Gökmen Sevindik
  • Gulsum Ozet
  • Zafer Gulbas
  • Olga Meltem Akay
  • Muhlis Cem Ar
  • Ahmet Emre Eskazan
  • Elif Birtas Atesoglu
  • Burhan Ferhanoglu
  • Guray Saydam
  • Muhit Ozcan
  • Ozgur Mehtap
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T001 (T001)

CHOP/miniCHOP And Tislelizumab in EldeRly patients with classical Hodgkin Lymphoma (cHL). A report of the phase II CATER-HL trial (HD12) from the Australasian Lymphoma and Leukaemia Group (ALLG)

abstract talk Abstract Talk in Advanced Stages (Sunday, 04.10. 17:00)

Anti-PD-1 therapy with Adriamycin, vinblastine, dacarbazine (AVD) is effective in older patients (pts) with cHL with limited data in those ≥70 years. CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) is active in older cHL pts but has not been combined with anti-PD-1. Methods: CATER-HL (ALLG-HD12) is a single arm phase II study of anti-PD-1 agent, tislelizumab (T), with CHOP or miniCHOP in older (≥61 years) pts with untreated cHL. Eligible pts were stage 2 unfavourable to stage 4, with no anthracycline/immunotherapy contraindications. T monotherapy (200mg q3W) was given for 3 cycles, followed by T in combination with CHOP (or miniCHOP if aged >80 or frail) q3W for 4-6 cycles (T-CHOP[mini]). Radiotherapy (RT) or 4 extra doses of T was allowed for those with residual PET-CT avidity or if stage 2 (RT). Primary end points were complete remission (CR) and deliverability of T monotherapy (no grade 3/4 toxicity and no symptomatic progressive disease [PD]). Secondary end points were post-therapy overall response (ORR)/CR, PFS, OS and quality of life (QOL). Results: 35 pts from 11 Australian sites were enrolled from May 2023-2025. Baseline characteristics: median age 74 years (range 63-90), ≥70 years 69%, male 66%, ECOG 0-1 86%, European ethnicity 77%, advanced stage 89%, EBER-ish positive 46%, median Charlson’s comorbidity score 4 (range 3–12). After T monotherapy the CR rate was 17% (ORR 69%); deliverability was 86%. 5 pts ceased T monotherapy prematurely: 2 from immune related adverse event (IRAE) of grade 4 hepatitis and 3 for other reasons. 30 pts commenced T-CHOP[mini] (CHOP:70%, miniCHOP:30%). After 2 cycles of T-CHOP[mini] the ORR was 87% (CR 50%). At the end of T-CHOP[mini], ORR was 87% (CR 67%). Median follow up is 562 days (range 24–902). Estimated 2- year PFS/OS is 77%/94% (figure 1) and 81%/100% for the 30 pts who commenced T-CHOP(mini). Grade 3/4 treatment emergent AEs affected 51% of pts: infection 17%, hepatitis 11%, fever 9% peripheral neuropathy 6%, confusion 6%. IRAEs affected 37% pts: thyroid dysfunction 14%, hepatitis 14%, raised creatinine kinase 3%, pancreatitis 3%, pruritis 3%. 2 pts died from PD, there was no treatment related mortality. QOL scores improved by 10% after T monotherapy, and 7% post therapy. Conclusion: T monotherapy is deliverable and demonstrated early metabolic response. Sequential treatment with T-CHOP[mini] is well tolerated with promising PFS and OS in this predominantly over 70 year old cohort.
  • Tara Cochrane
  • Sze Ting Lee
  • Robin Gasiorowski
  • Shane A Gangatharan
  • Fernando Roncolato
  • William EP Renwick
  • Jock Simpson
  • Amanda Johnston
  • Uwe Hahn
  • Philip Wong
  • Masa Lasica
  • Ann Solterbeck
  • Robert Traficante
  • Sally Mapp
  • Bianca Devitt
  • Dhvani Pandya
  • Julia Carlson
  • Tracey Gerber
  • Mark Hertzberg
  • Eliza Hawkes
  • Colm Keane
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T002 (T002)

Simplified Geriatric Assessment (sGA) in Older Patients With Classical Hodgkin Lymphoma (cHL): The Prospective ELDHL Project of the Fondazione Italiana Linfomi (FIL)

abstract talk Abstract Talk in Advanced Stages (Sunday, 04.10. 17:00)

Background: Older patients (pts) with cHL generally have a poor prognosis, due to both inferior disease control and increased treatment(tx)-related toxicity. Recently, novel first-line txs have improved pts outcomes through enhanced efficacy. In this context, accurate stratification of functional status is crucial to identify pts who may benefit from standard versus alternative txs. The FIL sGA is based on chronological age and on determination of Activities of Daily Living (ADL), Instrumental ADL and Cumulative Illness Rating Scale for Geriatrics (CIRS-G). It is an easy-to-use tool that has proven to effectively stratify pts in the setting of DLBCL Pupose: To prospectively validate the use of sGA at diagnosis for older pts with cHL Methods: We conducted the prospective ELDHL study including pts aged >64 years with cHL who underwent FIL-sGA before tx. Tx choice was left to the physician’s discretion. The endpoints were Overall Survival (OS) and Progression Free Survival (PFS) with the aim of developing a potential new prognostic model Results: A total of 311 consecutive pts were analyzed (median age 74 years, range 65-91; 56% males). At baseline, 68% had advanced stage disease, 39% B symptoms, 34% extranodal sites, 10% bulky disease. According to sGA, pts were classified as fit (58%), unfit (27%) and frail (15%). Most pts received ABVD-like tx (95% of fit, 81% of unfit, and 50% of frail pts, respectively). In the whole cohort, Overall Response Rate (ORR) was 70.2%, with a Complete Response Rate (CRR) of 61.7%. At a median follow up of 39 months, 5-year PFS was 52% (95% CI, 44 to 58%), and 5-year OS 63% (95% CI, 55 to 71%). Outcomes significantly differed across sGA categories: ORR was 76%, 67% and 50% (p=0.010), CRR 66%, 61% and 41% (p=0.021), 5-year OS 75%, 54%, and 25% (p<0.001), and 5-year PFS 59%, 51% and 18% (p<0.001), in fit, unfit, and frail pts, respectively. After adjusting for Ann Arbor stage, in advanced stage cHL pts sGA stratification maintained its prognostic power in terms of both 5-year OS (70%, 47% and 11%; p< 0.001) and 5-year PFS (52%, 51% and 12%; p<0.001), in fit, unfit and frail pts, respectively Conclusion: In older pts with cHL, the definition of fitness status by sGA allowed to stratify pts into three distinct categories (fit, unfit, and frail) associated with significantly different survival outcomes. The prognostic role of sGA was independent from other risk factors and particularly relevant for pts with advanced stage disease
  • Vittorio Ruggero Zilioli
  • Francesco Merli
  • Alessandra Tucci
  • Stefano Luminari
  • Giuseppe Colloca
  • Cristina Muzi
  • Benedetta Puccini
  • Chiara Pagani
  • Candida Vitale
  • Francesca Gaia Rossi
  • Erika Meli
  • Anna Guidetti
  • Simone Maifredi
  • Dario Marino
  • Alberto Fabbri
  • Nilla Maschio
  • Manuel Gotti
  • Andrea Bernardelli
  • Salvatrice Mancuso
  • Anna Mele
  • Guido Gini
  • Ilaria Del Giudice
  • Sara Bigliardi
  • Elisabetta Scarpa
  • Barbara Botto
  • Gloria Margiotta-Casaluci
  • Andrea Maria Soccodato
  • Monica Tani
  • Arcangelo Liso
  • Michał Kurlapski
  • Leonardo Flenghi
  • Anna Merli
  • Antonello Sica
  • Francesca Ricci
  • Francesca Perutelli
  • Roberta Battistini
  • Andrés José Maria Ferreri
  • Daniele Laszlo
  • Francesco Gaudio
  • Manuela Zanni
  • Emanuele Cencini
  • Valentina Tabanelli
  • Luca Guerra
  • Claudio Agostinelli
  • Luigi Marcheselli
  • Caterina Mammi
  • Michele Spina
  • Annalisa Arcari
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T003 (T003)

Durable Remissions and Late Immune-Related Toxicities After Frontline Pembrolizumab + AVD in Classic Hodgkin Lymphoma

abstract talk Abstract Talk in Advanced Stages (Sunday, 04.10. 17:00)

Introduction: We previously reported efficacy of frontline pembrolizumab + AVD in CHL (Lynch et al, Blood 2023; ASH 2024). With emergence of highly effective frontline regimens that omit checkpoint inhibitors, better characterization of immune-related adverse events (irAEs), including management required, is needed. Methods: We analyzed additional long-term follow-up of patients with previously untreated CHL treated with pembrolizumab plus concurrent AVD, as previously described (NCT03331341). In addition to survival outcomes, we analyzed treatment-emergent irAEs during and after study therapy. Results: At median follow-up of 4.8 years, 5-year progression-free survival (PFS) and overall survival (OS) were 98% (95% CI 94%-100%) and 100% (95% CI 100%-100%), respectively. Five-year PFS was 100% (95% CI 100%-100%) in early-stage and 97% (95% CI 92%-100%) in advanced-stage disease. Forty-one patients (82%) experienced at least 1 irAE during APVD, most commonly ALT elevation (29, 58%), rash (19, 38%), AST elevation (16, 32%), and hypothyroidism (4, 8%). Six patients (12%) required oral corticosteroids for an irAE during treatment. One patient with Guillain-Barré syndrome required IVIG and prolonged hospitalization. Ten patients (20%) experienced a new irAE at least 30 days after the last pembrolizumab dose and completion of study therapy. These emerged at median 67 days (range, 33-858). Two grade 4 late irAEs were observed (pneumonitis and adrenal insufficiency), both requiring prolonged hospitalization. Other late irAEs included hypothyroidism (5, 10%) and single cases of anterior uveitis, arthritis, AST elevation, colitis, hyperthyroidism, psoriasis, and rash. All irAEs during or after treatment resolved except adrenal insufficiency (1, 2%) and hypothyroidism (7, 14%), requiring indefinite corticosteroid and levothyroxine replacement, respectively. Conclusion: APVD was highly active in untreated CHL, with durable remissions in nearly all treated patients. irAEs, including grade ≥3 events, occurred during and after study therapy. Although most were reversible, there were late irAEs including grade 4 events as well as endocrinopathies that will require lifelong supplemention. Discussion of risks and benefits relative to other effective frontline regimens is important when selecting therapy for untreated CHL.
  • Ryan Lynch
  • Thomas Kuczmarski
  • Chaitra Ujjani
  • Christina Poh
  • Edus Warren
  • Stephen Smith
  • Mazyar Shadman
  • Brian Till
  • Vikram Raghunathan
  • Yolanda Tseng
  • Hongyan Du
  • Heather Rasmussen
  • Jenna Voutsinas
  • Ajay Gopal

Biology and pathology

Selected for Oral Presentation

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    T048 (T048) A Reproducible Mutation- versus Copy-Number-Enriched Genomic Axis Underlies Molecular Subtypes of Classic Hodgkin Lymphoma

    • Cara Paulina Lange
    • Michael Yu Li
    • Andrea Garofalo
    • Tanja Zamrik
    • Christian Reinhardt
    • Bastian von Tresckow
    • Mohammad Esfahani
    • Ash A. Alizadeh
    • Christian Steidl
    • Tomohiro Aoki
    • Stefan K. Alig
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    T046 (T046) Functional characterization of STAT6 mutations as oncogenic drivers in classical Hodgkin lymphoma (cHL)

    • Luisa Tasselli
    • Rafael L. B. Coan
    • Valentina Pensato
    • Francois Le Dily
    • Barbara G. Müller-Coan
    • Valentina Pettirossi
    • Enrique Blanco
    • Alessandro Cupola
    • Laura Pasqualucci
    • Luciano Di Croce
    • Enrico Tiacci
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    T047 (T047) Award winning Artificial intelligence predicts EBV status and reveals prognostic morphology phenotypes in advanced-stage classic Hodgkin lymphoma

    • Hishan Tharmaseelan
    • Daniel Winderl
    • Steffen Gretser
    • Julia Richter
    • Justin Ferdinandus
    • Peter Borchmann
    • Michael Altenbuchinger
    • Wolfram Klapper

Posters

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    P049 (P049) Detection of traces of EBNA2 in the Microenvironment of Pediatric Classical Hodgkin Lymphoma Reveals Its Immunomodulatory Role

    • Tamara Mangiaterra
    • Karen Lindl
    • Oscar Jimenez
    • Elena De Matteo
    • Paola Chabay
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    P050 (P050) VARIANT HISTOLOGY IN PEDIATRIC NLPBL: ADVERSE FEATURES MITIGATED BY R-CHOP, INCLUDING FEASIBLE EARLY-STAGE DE-ESCALATION

    • Nesreen Ali
    • Emad Moussa
    • Eman Khorshed
    • Mohamed Zaghloul
    • Amr Elnashar
    • Amr Abdalla
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    P051 (P051) Genetic tumor cell heterogeneity and genomic instability in classic Hodgkin lymphoma

    • Sophie Klotz
    • Bettina Budeus
    • Frederik Schramm
    • Lilian K. Beeck
    • Marc A. Weniger
    • Paul J. Bröckelmann
    • Ralf Küppers
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    P052 (P052) Emerging role of SAMHD1 in anti-tumor immune responses and sensitivity to chemotherapy in classical Hodgkin lymphoma

    • Dora Trogrlic
    • Eleni Psaroudaki
    • Georgios Mermelekas
    • Ying Yang
    • Erofili Bougka
    • Christian Nordentoft
    • Nikolas Herold
    • Andreas Lundqvist
    • Elias Drakos
    • Georgios Rassidakis
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    P053 (P053) Development of CD30 CAR T-cells co-expressing an anti-PDL1.CD28 chimeric switch receptor for the treatment of r/r cHL

    • Mikalai Katsin
    • Dmitri Dormeshkin
    • Alexandr Migas
    • Hanna Klych
    • Alexander Meleshko
    • Konoplya Natalya
    • Tatsiana Doroshenko
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    P054 (P054) Elucidation of transcriptomic tumor cell heterogeneity and microenvironment in classic Hodgkin lymphoma

    • Frederik Schramm
    • Sophie Klotz
    • Bettina Budeus
    • Lilian K. Beeck
    • Marc A. Weniger
    • Paul J. Bröckelmann
    • Ralf Küppers
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    P055 (P055) RHOA Mutation Analysis Identifies Potential nTFHL Among Cases With Classic Hodgkin Lymphoma Morphology

    • Rio Yamada
    • Midori Filiz Nishimura
    • Asami Nishikori
    • Yoshito Nishimura
    • Ritsuro Suzuki
    • Yasuharu Sato
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    P056 (P056) Predictive significance of immunohistochemistry in patients with Hodgkin's lymphoma on the size of the tumor mass and IPS score

    • Snežana Sretenović
    • Danijela Jovanovic
    • Predrag Djurdjevic
    • Nikola Mirkovic
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    P057 (P057) Baseline PET Radiomics for Risk Stratification in Classic Hodgkin Lymphoma

    • Andrew Heider
    • Ajay Subramanian
    • Veit Sandfort
    • Natalie Park
    • Lei Xing
    • Richard Hoppe
    • Ash A. Alizadeh
    • Joseph Schroers-Martin
    • Ranjana Advani
    • Michael Binkley
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    P058 (P058) The TIGIT/CD155 Immune Checkpoint Axis in Classical Hodgkin Lymphoma: Clinical and Prognostic Implications

    • Ombretta Annibali
    • Teresa Marafioti
    • Valeria Tomarchio
    • Adheesh Ghosh
    • Lara Antonelli
    • Muntasser Alsharabati
    • Salvatore Iachino
    • Harriet Hunter
    • Giulia Santoro
    • Sugerdana Padmasri
    • Antonella Bianchi
    • Simona Spreafico
    • Anna Crescenzi
    • Luigi Rigacci
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    P060 (P060) Clinical relevance of serum TARC levels below 1000 pg/ml in Hodgkin lymphoma: a hidden biomarker?

    • Fanni Borics
    • Boglárka Dobó
    • Anita Gulyás
    • Dávid Tóthfalusi
    • László Imre Pinczés
    • Árpád Illés
    • Zsófia Miltényi
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    P061 (P061) Familial Presentation of Classical Hodgkin Lymphoma in First-Degree Relatives

    • Boglárka Dobó
    • Dávid Tóthfalusi
    • Fanni Borics
    • László Imre Pinczés
    • Árpád Illés
    • Zsófia Miltényi
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    P062 (P062) Correlating 18FDG-PET/CT- and CT-derived Biomarkers to Neutrophil Extracellular Traps in Classical Hodgkin Lymphoma

    • Emma Pettersson
    • Alexander Korenyushkin
    • Ashish Chauhan
    • Sambit Tarai
    • Jeremia Collin
    • Rose-Marie Amini
    • Daniel Molin
    • Anna-Karin Olsson
    • Håkan Ahlström
    • Joel Kullberg
    • Gunilla Enblad
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    P063 (P063) Genetic Clustering Reveals Biologic Similarities Across subgroups of Hodgkin Lymphoma, Primary Mediastinal Large B-Cell Lymphoma and Large B-Cell Lymphoma patients

    • Jon Felix Rischewski
    • Franziska Briest
    • Julia Mattlener
    • Daniel Noerenberg
    • Julia Katharina Schleifenbaum
    • Jessica Schneider
    • Sophie Heidenreich
    • Jan-Michel Heger
    • Frederik Damm
    • Sven Borchmann
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    P064 (P064) Time-of-Day Immunotherapy Administration and Outcomes in Classic Hodgkin Lymphoma

    • Joseph Schroers-Martin
    • Anthony Yu
    • Austin Yeung
    • Chandley Silin
    • May Powell
    • Michael Binkley
    • Richard Hoppe
    • Ranjana Advani
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    P065 (P065) Redefining Hodgkin lymphoma pathogenesis: the central and indispensable role of CD 4 T cells

    • Arjan Diepstra
    • Yajie Lei
    • Sophie Teesink
    • Wouter Plattel
    • Lydia Visser
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    P066 (P066) The Role of CD59 in Mediating T Cell Rosette Formation in Classic Hodgkin Lymphoma

    • Yajie Lei
    • Rodrigo Martinez Alcala
    • Annika Seitz
    • Lydia Visser
    • Arjan Diepstra
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    P067 (P067) Fragmentomics analysis to enhance ctDNA based risk stratification in Hodgkin Lymphoma

    • Jessica Schneider
    • Julia Mattlener
    • Sophie Heidenreich
    • Julia Katharina Schleifenbaum
    • Max Freihammer
    • Daniel Schütte
    • Peter Borchmann
    • Phillip Gödel
    • Hyatt Balke-Want
    • Christian Reinhardt
    • Bastian von Tresckow
    • Roland Schwarz
    • Jan-Michel Heger
    • Sven Borchmann
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    P068 (P068) Plasma Proteomic Profiling of Classical Hodgkin Lymphoma

    • Ragnhild Risebro
    • Jeremia Collin
    • Johan Mattsson Ulfstedt
    • Emma Pettersson
    • Mats Hellström
    • Ingrid Glimelius
    • Mattias Berglund
    • Gunilla Enblad
    • Eva Freyhult
    • Daniel Molin
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    P069 (P069) Analysis of circulating tumor DNA shows Epstein-Barr virus associated differences of mutagenic processes in classical Hodgkin lymphoma.

    • Kristyna Kupcova
    • Lubica Gaherova
    • Adriana Velasova
    • Maria Maco
    • Iva Hamova
    • Petr Nehasil
    • Petra Zemankova
    • Pavla Stepankova
    • Alexandra Kredatusova
    • Jana Markova
    • Blanka Vackova
    • Jan Koren
    • Alice Sykorova
    • Vit Prochazka
    • Tomas Kozak
    • Heidi Mocikova
    • Ondrej Havranek
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    P070 (P070) Kinetics of PD-1 Blockade on Circulating CD8+ve T Cells After Exposure to low-dose Nivolumab

    • Anu Korula
    • Phaneendra Datari
    • Arunkumar Arunachalam
    • Vikram Mathews
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P049 (P049)

Detection of traces of EBNA2 in the Microenvironment of Pediatric Classical Hodgkin Lymphoma Reveals Its Immunomodulatory Role

The detection of Epstein–Barr virus (EBV) traces using ultrasensitive techniques in B-cell lymphomas previously classified as EBV-negative by conventional methods suggests a broader role for the virus in lymphomagenesis. Its contribution in classical Hodgkin lymphoma (cHL) remains unexplored. This study aimed to characterize viral transcripts expression by sensitive methods. A total of 48 pediatric cHL cases were analyzed. EBV status was evaluated with the conventional approach: EBER in situ hybridization (ISH). LMP1 and EBNA2 transcripts were assessed using highly sensitive dual ISH combined with CD30 immunohistochemistry (IHC) to distinguish tumor cells from cells of the tumor microenvironment (TME). IHC evaluated protein expression for LMP1, CD4, CD8, CD56, CD68, CD163, PD-1, PD-L1 (TME and tumor cells), IL-10, FOXP3, Granzyme B (GrB), TGF-β, and T-bet. Event-free survival was analyzed using the Kaplan-Meier method. Among the 32 EBERS+ cases, 32 expressed LMP1 transcripts in both tumor cells (LMP1t+) and the TME (LMP1m+), none expressed EBNA2 transcripts in tumor cells (EBNA2t-), and 23 expressed EBNA2 transcripts in the microenvironment (EBNA2m+). In the 16 EBERs-, 10 cases displayed LMP1t+ cells, 11 cases LMP1m+ and 6 EBNA2m+. Remarkably, EBNA2m were exclusively observed in the TME. 5 cases did not express any of the analyzed transcripts. PD-L1 expression in the TME was significantly higher in cases expressing EBNA2 transcripts compared to those without EBNA2 expression (p=0.0373, Mann–Whitney test). Similarly, GrB expression was also significantly increased in EBNA2m+ cases (p=0.0012, Mann–Whitney test) (Figure 1). The count of IL10+ cells in the groups defined by EBNA2 transcript expression showed a trend (p=0.0768, Mann–Whitney test). Only cases expressing traces of LMP1 in both tumor cells and the TME exhibited a predominant M1 profile (CD68+cells/CD163+ cells > 1.5) (p=0.0339, p=0.0096, Fisher ́s exact test). No significant differences in event-free survival were observed according to viral transcript expression (p>0.05). EBNA2 expression in the TME, even in EBV- cases, might be associated with immune checkpoint regulation and cytotoxic responses, highlighting a previously underrecognized role of EBV and its viral traces in shaping the cHL microenvironment. Additionally, LMP1 expression in tumor cells and the TME could contribute to the M1-polarized profile previously described in pediatric EBV- associated cHL.
  • Tamara Mangiaterra
  • Karen Lindl
  • Oscar Jimenez
  • Elena De Matteo
  • Paola Chabay
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P050 (P050)

VARIANT HISTOLOGY IN PEDIATRIC NLPBL: ADVERSE FEATURES MITIGATED BY R-CHOP, INCLUDING FEASIBLE EARLY-STAGE DE-ESCALATION

Background: Nodular lymphocyte-predominant B-cell lymphoma (NLPBL) is an uncommon subtype of pediatric Hodgkin-lymphoma comprising typical-histology (patterns A-B) and variant-histology (patterns C-F). Variant patterns have been linked to higher-risk features and increased relapse, but the optimal pediatric treatment approach, particularly the safety of de-escalation in early-stage disease, remains uncertain. Methods: We retrospectively reviewed pediatric patients diagnosed with NLPBL at Children’s Cancer Hospital Egypt. Histology was classified as typical or variant, with variant subtypes recorded as patterns C-F. Survival outcomes were analyzed according to frontline treatment, with focused evaluation of early-stage patients managed with observation after complete resection (stage IA) or reduced-cycle R-CHOP for unresected stage I-II disease. Results: Among 87 patients, variant histology was identified in 41 (47.1%). Variant histology was associated with less favorable presentation, including advanced stage (p=0.06), B symptoms (p=0.05), and extranodal disease, particularly bone marrow and bone involvement (p=0.01). Progression/relapse was more frequent in variant than typical histology (39.0% vs 15.2%, p=0.009), and variant subtypes C and D were associated with inferior event-free survival (EFS; p=0.05). Among patients with variant histology, 5-year EFS was 94.4% with R-CHOP versus 33.3% with ABVD. In the updated early-stage analysis, 7/12 completely resected stage IA patients managed with observation had variant histology, with relapse patterns comparable to typical histology. Among unresected stage I-II patients treated with 3-4 cycles of R-CHOP, variant histology was present in 20/39 (51.3%), with only 2 relapses. Within the R-CHOP-treated cohort, variant-histology did not significantly affect 5-year EFS, including in early-stage patients treated with fewer cycles. Conclusion: Variant-histology identifies a biologically and clinically higher-risk subgroup of pediatric NLPBL. However, this adverse impact appears to be mitigated by R-CHOP, with excellent outcomes even in patients with variant histology. Our findings further suggest that risk-adapted de-escalation may be feasible in early-stage disease, including observation after complete resection and reduced-cycle R-CHOP for unresected stage I-II disease, without an apparent loss of efficacy. These findings support prospective multicenter validation of histology-guided, response-adapted strategies.
  • Nesreen Ali
  • Emad Moussa
  • Eman Khorshed
  • Mohamed Zaghloul
  • Amr Elnashar
  • Amr Abdalla
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P051 (P051)

Genetic tumor cell heterogeneity and genomic instability in classic Hodgkin lymphoma

Classic Hodgkin lymphoma (cHL) is one of the most prevalent types of lymphomas in the Western world and one of the most frequent cancers in young adults. Hodgkin and Reed-Sternberg (HRS) lymphoma cells are highly heterogeneous and typically show multiple chromosomal abnormalities. The rarity of HRS cells has hampered their analysis over the last decades, but understanding the tumor cell heterogeneity is essential to reveal mechanisms of therapy resistance. Therefore, we developed an advanced workflow to perform whole-exome sequencing (WES) of single HRS cells to reveal signs of intraclonal tumor evolution and the underlying mutagenic processes. Frozen cHL lymph node suspensions were processed using an antibody-based staining method, and single HRS cells were transferred to a 96-well plate using a fluorescence-activated cell sorter. We used a single-cell whole-genome amplification kit to barcode the DNA prior to the whole-exome capturing. Bulk non-tumor cells were simultaneously collected to later on distinguish germline from somatic mutations. The single-cell WES workflow was tested with a mixture of cells from two HL cell lines. By comparing cell line-specific mutations, the index-sorted cells could be explicitly assigned to its particular cell line, showing the robustness of this pipeline in identifying distinct mutations in subsets of cells. We further validated the method using a primary cHL case, which had previously been characterized in a bulk WGS study. Most of the identified exonic mutations from the bulk analysis were also identified in at least a subset of single cells, and subsequent genealogical analysis revealed first insights into the mutational development of this HL case. Six additional HL cases are currently being processed. A detailed characterization of mutation patterns at the single-cell level may provide profound insights into the genetic complexity and heterogeneity of the unique HRS cancer cells. This characterization is expected to reveal novel insights into lymphoma progression and the underlying mutagenic processes and is a pivotal step towards our long-term objective of elucidating the mechanisms of genetic instability in HRS cells, to identify markers of treatment resistance and develop new diagnostic and therapeutic approaches.
  • Sophie Klotz
  • Bettina Budeus
  • Frederik Schramm
  • Lilian K. Beeck
  • Marc A. Weniger
  • Paul J. Bröckelmann
  • Ralf Küppers
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P052 (P052)

Emerging role of SAMHD1 in anti-tumor immune responses and sensitivity to chemotherapy in classical Hodgkin lymphoma

Background: The tumor microenvironment (TME) plays a pivotal role in the pathogenesis of classical Hodgkin lymphoma (cHL). SAMHD1, a dNTP hydrolase, is involved in anti-tumor immune responses through DNA damage mechanisms and cGAS-STING pathway. SAMHD1 expression in the neoplastic Hodgkin and Reed-Sternberg cells (HRS) is an independent adverse prognostic factor in cHL, however, the mechanisms underlying its clinical significance are unknown. In this study the biologic impact of SAMHD1 on anti-tumor immune responses and sensitivity to chemotherapy in cHL was investigated. Methods: The in vitro system included 6 cHL cell lines, in 3 of which (L1236, L428, L540) SAMHD1-deficient clones (KO) were generated using CRISPR-Cas9 gene editing. In addition, the effects of plasmid-mediated forced expression of SAMHD1 were analyzed in 2 cHL cell lines with low (L428) or undetectable (MDAV) endogenous SAMHD1. The cHL cell lines were treated with a STING agonist, STING inhibitor (C-176), or doxorubicin. Protein expression and activation were analyzed by Western blot. Immune responses were evaluated using RT-qPCR for gene expression of critical immunomodulators, and targeted proteomics with Olink Target 48 Cytokine panel on culture supernates. Results: SAMHD1-KO and -WT cHL cells showed differential gene expression of critical modulators of antitumor immune responses. The effects of SAMHD1 deficiency were associated with changes in cGAS-STING pathway activation, including phosphorylation of TBK1, IRF3 and IRF7. SAMHD1 deficiency resulted in decreased secretion of IL6, CSF2, TNF, CCL2/7. STING stimulation led to significantly increased IFNβ gene expression by HRS cells in SAMHD1-WT but not in SAMHD1-KO cHL cell lines. STING inhibition also resulted in differential changes in immunomodulatory cytokines. Forced expression of SAMHD1 led to upregulation of CXCL10 and IFNβ gene expression in cultured HRS cells. These effects were linked to lower levels of CXCL9, IL10, TNF, IL17a and CXCL8 in MDA-V cells following SAMHD1 forced expression as shown by proteomic profiling. SAMHD1-WT and -KO cHL cells differentially responded to doxorubicin treatment with changes in apoptosis-regulating proteins. Conclusions: SAMHD1 expression seems to modulate the anti-tumor immune responses partially through the cGAS-STING pathway in cHL. SAMHD1 expression also affects the response to doxorubicin treatment in vitro.
  • Dora Trogrlic
  • Eleni Psaroudaki
  • Georgios Mermelekas
  • Ying Yang
  • Erofili Bougka
  • Christian Nordentoft
  • Nikolas Herold
  • Andreas Lundqvist
  • Elias Drakos
  • Georgios Rassidakis
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P053 (P053)

Development of CD30 CAR T-cells co-expressing an anti-PDL1.CD28 chimeric switch receptor for the treatment of r/r cHL

Introduction: CD30 is a validated therapeutic target in Hodgkin lymphoma (HL), particularly in relapsed and refractory cases. Chimeric antigen receptor (CAR) T-cell immunotherapy targeting CD30 demonstrates promising clinical activity. However, inhibitory signals mediated by the PD-1/PD-L1 pathway may limit the durability of response. In this study, we investigated the impact of co-expressing a chimeric switch receptor (CSR) targeting PD-L1 on the proliferative and cytotoxic activity of second-generation CD30-CAR T-cells. Materials and Methods: To compare the in vitro proliferative and functional activity of four second-generation CD30-CAR T-cell constructs (4-1BBz), including a variant with an anti-PD-L1 CSR (KN035.CD28), during repeated restimulation of CD30+ HL tumor cell lines. The following CAR constructs were evaluated: hHRS3.S-BBz.EGFRt — short hinge region (IgG4), hHRS3 scFv; SGN30.S-BBz.EGFRt — an analogous construct with SGN30 scFv (the antigen-binding fragment is identical to brentuximab vedotin); hHRS3.L-BBz.EGFRt — long hinge region (CH2-CH3) with two point mutations L235E, N297Q, and an alpha-tag for CAR detection and selection using an anti-alpha-tag nanobody; hHRS3.S-BBz.KN035-CD28 — a CAR with a CSR that binds PD-L1 and utilizes CD28 signaling. T-cells from healthy donors were activated via CD3/CD28 and transduced with the corresponding lentiviruses. Expansion was performed over 15 days in the presence of IL-7, IL-15, and IL-21. To evaluate the durability of response, a rechallenge model was applied: CD30+ tumor cells HDLM-2 (CD30+/PD-L1+) and KM-H2 (CD30+/PD-L1-) were added every 3–4 days for a total of 5 rounds. Analysis included the quantification of CAR T-cells, tumor burden evaluation, and the calculation of AUC (area under the curve) for both proliferation and cytotoxicity. Results: Among the evaluated constructs, CAR.CSR T-cells (hHRS3.S-BBz.KN035-CD28) induced the most pronounced expansion on HDLM-2, demonstrating a 17-fold increase by day 21. The remaining constructs reached peak expansion (5–10 fold) by day 10, followed by a subsequent decline. Under conditions of stimulation with the PD-L1-negative line (KM-H2), differences in activity between CAR.CSR and baseline CARs were less pronounced. Conclusions: CD30-CAR T-cells co-expressing the CSR KN035.CD28 demonstrated a sustained proliferative advantage and enhanced control of PD-L1+ tumor cells in vitro.
  • Mikalai Katsin
  • Dmitri Dormeshkin
  • Alexandr Migas
  • Hanna Klych
  • Alexander Meleshko
  • Konoplya Natalya
  • Tatsiana Doroshenko
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P054 (P054)

Elucidation of transcriptomic tumor cell heterogeneity and microenvironment in classic Hodgkin lymphoma

Classic Hodgkin lymphoma (cHL) is a B-cell–derived lymphoma that is unique among lymphoid malignancies due to its complex tumor microenvironment, which is dominated by dysregulated immune cells, and the presence of rare Hodgkin and Reed–Sternberg (HRS) tumor cells that comprise approximately 1% of the total tumor mass. Despite major therapeutic advances, detailed molecular characterization of HRS cells remains technically challenging, limiting our understanding of cHL pathobiology. To address this, we developed a workflow combining FACS index sorting of HRS cells with single-cell RNA sequencing. In parallel, we perform single-cell profiling of matched tumor microenvironment samples, enabling integrated analysis of whole transcriptomes, surface protein expression, and T-cell and B-cell receptor repertoires. This approach allows us to dissect inter- and intratumoral heterogeneity in cHL at single-cell resolution across both malignant and non-malignant compartments. Ultimately, our work aims to identify key molecular programs and interaction patterns in HRS cells and their microenvironment that contribute to therapy resistance and relapse, providing a foundation for improved treatment strategies and prognostic assessment in Hodgkin lymphoma.
  • Frederik Schramm
  • Sophie Klotz
  • Bettina Budeus
  • Lilian K. Beeck
  • Marc A. Weniger
  • Paul J. Bröckelmann
  • Ralf Küppers
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P055 (P055)

RHOA Mutation Analysis Identifies Potential nTFHL Among Cases With Classic Hodgkin Lymphoma Morphology

Background: Nodal T-follicular helper cell lymphoma (nTFHL) may contain Hodgkin/Reed–Sternberg (HRS)-like cells and mimic classic Hodgkin lymphoma (CHL), but it is usually distinguishable from CHL by other histopathological features. We recently encountered a treatment-refractory case with highly convincing CHL morphology and immunophenotype, in which detection of the RHOA G17V mutation and shared T-cell receptor rearrangements in the lymph node and bone marrow redirected the diagnosis to nTFHL (Figure). This prompted us to investigate whether a subset of cases diagnosed as CHL based on morphology may represent “nTFHL with CHL features”. Methods: We retrospectively analyzed 153 cases initially diagnosed as CHL based on excisional lymph node specimens in our consultation files (86 mixed-cellularity type and 67 nodular sclerosis type). RHOA G17V mutation was assessed using the PNA-LNA PCR clamp method, a highly sensitive assay suitable for low–tumor content samples. Clinicopathological features, histological findings, immunophenotype, EBV status, T-cell receptor gene rearrangement, treatment response, and clinical outcomes were compared according to RHOA mutation status. Results: RHOA mutations were identified in 20/153 cases (13.1%), and all RHOA-mutated cases were detected exclusively among advanced-stage cases (p<0.001). Compared with advanced-stage RHOA-wild-type cases, RHOA-mutated cases showed distinctive background features, including increased interfollicular vascularity and EBV-positive small- to medium-sized lymphoid cells (both p<0.001). In the matched cohort, RHOA-mutated cases showed a poorer response to CHL-directed therapy and significantly shorter progression-free survival (p<0.01), with a trend toward inferior overall survival(p=0.08). Conclusions: RHOA G17V mutations were detected in a substantial proportion of advanced-stage cases with CHL morphology, and these cases showed clinicopathological features suggestive of nTFHL. They may be better conceptualized as “nTFHL with CHL features” rather than conventional CHL. Given that morphology and immunophenotype alone make differentiation extremely challenging, RHOA mutation analysis should be considered in advanced-stage or treatment-refractory cases with CHL morphology, as its detection may have important diagnostic and therapeutic implications.
  • Rio Yamada
  • Midori Filiz Nishimura
  • Asami Nishikori
  • Yoshito Nishimura
  • Ritsuro Suzuki
  • Yasuharu Sato
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P056 (P056)

Predictive significance of immunohistochemistry in patients with Hodgkin's lymphoma on the size of the tumor mass and IPS score

Introduction: Hodgkin's lymphoma (HL) is a rare neoplasm of the lymphatic system, it is one of the most common cancers in the young adult population. Methodology: Retrospective analysis of 58 patients treated by M. Hodgkin from December 31. 2018. until 31.12.2023. and monitored until December 31. 2025. Including the newly diagnosed HL and excluding relapsing disease. The diagnosis was established by pathohistological analysis of the biopsied lymph gland, immunohistochemistry was performed with the original (DAKO, Gloustrup, Danmark). For the level of expression, the limit value for positivity > 30% . Bulky disease, the size of the tumor mass is greater than 70 mm. Statistical analysis SPS 23.0, significance p< 0.05. The aim of the work: To examine the predictability of the immunohistochemistry record on the size of the tumor mass and the correlation with the IPS score. Results: Analysis of the association of immunohistochemistry markers with the presence of bulky disease revealed a statistically significant association for CD30 (χ2=4.603; p=0.032), PAX5 (χ2=4.261; p=0.039) and CD3 (χ2=5.695; p=0.017). The marker CD5 showed borderline statistical significance (χ2=3.521; p=0.061), but without sufficient statistical confirmation, while the other markers CD20, MUM1, CD15, KI67, BCL2 and BCL6 did not show a statistically significant association with the bulky disease (p>0.05) at the time of diagnosis. Analysis of the relationship between immunohistochemistry markers and the diameter of the tumor mass revealed a statistically significant for CD5 (χ2=5.839; p=0.016) and CD15 (χ2=4.766; p=0.029). In patients with CD5-, the maximum diameter of the tumor mass was 37 mm, and in CD5+ it was 98 mm. An inverse association was observed for CD15, with CD15- the maximum diameter was 98 mm, and CD15+ was 43.5 mm. The other markers have no statistically significant association with the diameter of the tumor mass (p>0.05). Analysis of the relationship between immunohistochemistry markers and the IPS score a statistically significant association was observed only for CD3 (χ2=4.016; p=0.045). All patients with positive CD3 expression had a low IPS score (100%). Other markers did not show association with IPS score (p>0.05). Conclusion: Immunohistochemistry markers in the studied show selective significance. CD30, PAX5 and CD3 showed a correlation with the size of the tumor mass and they can be a predictor of tumor burden. Only CD 3 shows a correlation with IPS score.
  • Snežana Sretenović
  • Danijela Jovanovic
  • Predrag Djurdjevic
  • Nikola Mirkovic
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P057 (P057)

Baseline PET Radiomics for Risk Stratification in Classic Hodgkin Lymphoma

Purpose: To identify distinct subgroups of patients with classic Hodgkin lymphoma (cHL) using unsupervised clustering of PET/CT-derived radiomic features, and to evaluate their prognostic associations with freedom from progression (FFP). Methods: Baseline 18FDG PET/CT images were processed using an automated segmentation and PyRadiomics-based pipeline, extracting 1,316 features. Each feature was log transformed, z-score standardized, with a redundancy reduction correlation coefficient filter applied. Principal component analysis and a Gaussian mixture model (GMM) were used to assign radiomic clusters. Freedom from progression (FFP) was measured using Kaplan–Meier. A multivariable Firth-penalized Cox regression model was constructed using cluster membership after adjustments for age, stage, and sex. Results: We identified 197 patients with cHL diagnosed at Stanford University between 2015-2024, with median age of 32 (range=6-79), 64.5% with early vs 35.5% with advanced stage, median IPS of 2, and median follow-up of 3.98 years. The GMM model partitioned into three radiomic clusters: RC1 (n=104; 53%), RC2 (n=53; 27%), and RC3 (n=40; 20%). RC1 was defined by heterogeneous texture and low tumor volumes, RC2 by homogenous texture and low tumor volumes, and RC3 by heterogeneous texture and high tumor volumes. The 4-year FFP was 68.2%, 82.2%, and 48.4% for RC1, RC2, and RC3, respectively (P=0.015). In a multivariable Cox model adjusted for age, stage, and sex, both RC1 (HR 1.96, 95% CI 1.01–4.13, p = 0.046) and RC3 (HR 2.82, 95% CI 1.32–6.37, p = 0.007) had higher risk of a PFS event relative to RC2. Posterior probabilities from the GMM clustering provided each patient with a continuous probability of belonging to each radiomic cluster. In time-dependent survival analyses and receiver-operator curves, a clinical-radiomic risk model incorporating these GMM posterior probabilities and 5-fold cross-validation trials (500 iterations) yielded high area under curve performance (AUC=0.68 at 4 years), which outperformed total metabolic tumor volume alone (AUC=0.61). Conclusion: Unsupervised clustering of PET/CT-derived radiomic features can reproducibly identify three prognostically distinct cHL subgroups. These clusters capture significant FFP differences of these subgroups that remain independent of established clinical covariates including age, stage, and sex, suggesting that radiomic phenotyping may provide independent and complementary prognostic value.
  • Andrew Heider
  • Ajay Subramanian
  • Veit Sandfort
  • Natalie Park
  • Lei Xing
  • Richard Hoppe
  • Ash A. Alizadeh
  • Joseph Schroers-Martin
  • Ranjana Advani
  • Michael Binkley
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P058 (P058)

The TIGIT/CD155 Immune Checkpoint Axis in Classical Hodgkin Lymphoma: Clinical and Prognostic Implications

Background: TIGIT (T-cell immunoreceptor with Ig and ITIM domains) is an inhibitory immune checkpoint receptor involved in tumor immune escape and T-cell exhaustion. Its main ligand, CD155, can be expressed by tumor cells and may contribute to suppression of the anti-tumor immune response through activation of the TIGIT/CD155 axis. In classical Hodgkin lymphoma (cHL), the biological and prognostic significance of this pathway remains poorly defined. We retrospectively evaluated TIGIT expression by immunohistochemistry and its association with clinical characteristics, survival outcomes, and CD155 expression on Reed–Sternberg cells. Methods: Eighty-six patients with cHL were retrospectively analyzed. TIGIT expression was assessed on diagnostic biopsy specimens by immunohistochemistry and dichotomized as negative (score 0) or positive (scores 1–3). Clinical data regarding treatment response and outcome were available for 66 patients, who constituted the cohort for clinicopathological and outcome analyses. Patients were additionally stratified according to age (<40 vs ≥40 years). Overall survival (OS) was defined as the time from diagnosis to death from any cause or last follow-up, while event-free survival (EFS) was defined as the time from diagnosis to relapse, progression, or death. Survival curves were estimated using the Kaplan–Meier method and compared using the log-rank test. Due to incomplete information regarding the timing of relapse or progression, survival analyses were evaluable in 62 patients. In a subset of 10 patients, CD155 expression on Reed–Sternberg cells was also evaluated. Results: Among the 86 patients evaluated for TIGIT expression, 42 (48%) were TIGIT-positive and 44 (52%) were TIGIT-negative. Among the 66 patients with available clinical follow-up data, 35 (53%) were TIGIT-positive and 31 (47%) were TIGIT-negative. Survival analysis was evaluable in 62 patients. With a median follow-up of 5.97 years, 7 deaths and 19 EFS events were observed. TIGIT expression was not significantly associated with stage, bulky disease, relapse, progression, or death. Likewise, no significant differences were observed in OS (log-rank p = 0.419) or EFS (log-rank p = 0.292) according to TIGIT status. Patients aged ≥40 years accounted for 42 of the 66 cases, whereas 24 were younger than 40 years. TIGIT positivity was more frequently observed in older patients (61.9% vs 37.5%, p = 0.075), who also showed a higher prevalence of advanced-stage disease (61.9%
  • Ombretta Annibali
  • Teresa Marafioti
  • Valeria Tomarchio
  • Adheesh Ghosh
  • Lara Antonelli
  • Muntasser Alsharabati
  • Salvatore Iachino
  • Harriet Hunter
  • Giulia Santoro
  • Sugerdana Padmasri
  • Antonella Bianchi
  • Simona Spreafico
  • Anna Crescenzi
  • Luigi Rigacci
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P060 (P060)

Clinical relevance of serum TARC levels below 1000 pg/ml in Hodgkin lymphoma: a hidden biomarker?

Background: Serum TARC (Thymus and Activation-Regulated Chemokine) is a specific biomarker for classical Hodgkin lymphoma (cHL), used to monitor tumor volume, clinical course and treatment response. Most clinical studies exclude patients with serum TARC levels below 1000 pg/mL at diagnosis. We aimed to analyse the clinical, histopathological and prognostic characteristics of this specific subgroup and compare them to cases with high (>1000 pg/mL) baseline serum TARC concentrations. Methods: This retrospective study included 182 cHL patients diagnosed at our institute between 2010 and 2025 who had documented staging serum TARC results. The patterns of clinical stages, EORTC risk categories, and histological subtypes was analysed using Chi-square test. Overall survival (OS) and progression-free survival (PFS) were analysed using the Kaplan-Meier method, both in the total cohort and in subgroups categorized by age. Results: Low TARC levels (<1000 pg/mL) were detected in 39 patients (21.4%), while 143 patients (78.6%) presented with high levels. The baseline TARC concentrations ranged from 34 to 476,000 pg/mL (median: 27,900 pg/mL). Highly significant correlations were observed between TARC distribution and clinical stages (p<0,001), with low TARC being prominent in stage I and high TARC dominating in further (II-IV) stages. A significant correlation was also observed with EORTC risk categories (p=0.0139), where the early favourable subgroup showed the highest prevalence of low TARC levels (43.4%). The distribution of histological subtypes significantly differed (p<0.0001): the lymphocyte-rich subtype was predominant in the subgroup with low TARC levels, while a predominance of nodular sclerosis was observed at high serum levels. In the total cohort, no significant differences were found in OS or PFS (p=0.75 and p=0.547). However, when analysed by age, patients under 60 years with low baseline TARC levels showed a significantly improved PFS compared to the high TARC group (p=0.048). Conversely, no prognostic value was observed in patients over 60 years (p=0.939). Conclusion: Our findings confirm that the diagnostic value of serum TARC remains relevant below 1000 pg/mL, as it reflects tumor burden, risk stratification, and unique histopathological features. For patients under 60 years of age, low TARC levels at diagnosis can be an indicator of favourable prognosis. Therefore, integrating this commonly excluded subgroup into future studies is highly recommended.
  • Fanni Borics
  • Boglárka Dobó
  • Anita Gulyás
  • Dávid Tóthfalusi
  • László Imre Pinczés
  • Árpád Illés
  • Zsófia Miltényi
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P061 (P061)

Familial Presentation of Classical Hodgkin Lymphoma in First-Degree Relatives

Introduction: Hodgkin lymphoma (HL) is generally considered sporadic malignant lymphoproliferative disease, although familial aggregation has also been described. Several studies have demonstrated an elevated risk among first-degree relatives, suggesting a possible hereditary predisposition. Genetic susceptibility and shared environmental factors may both contribute to disease development. Case presentation: A 38-year-old woman with a history of psoriasis was diagnosed with lymphocyte rich cHL in 2012. She received six cycles of ABVD followed by 36 Gy IFRT to the neck and mediastinum. Due to refractory disease, salvage DHAP chemotherapy and autologous stem cell transplantation (APSCT) were performed, resulting in complete metabolic remission (CMR) lasting more than 10 years. In 2024, she developed bilateral axillary lymphadenopathy and B symptoms. Histolopathology confirmed diffuse larege B-cell lymphoma (DLBCL). After 6 cycles of R-CHOP21 and consolidative ISRT, CMR was achived. Shortly after the the patient presented symmetrical lower-extremity paresis and secondary CNS involvment was confirmed by PET/CT, brain MRI and malignant B-cells was also identified in the cerebrospinal fliud. After R-MPV and IT therapy, imaging studies showed CMR. Urgent APSCT was performed. Unfortunately the patient died from multi organ failure due to an agressive fungal infection. Her daughter was diagnosed at the age of 20 after an incidental radiological finding following a household accident. Histology confirmed cHL nodular sclerosis subtype. Based on staging PET/CT, she was classified having advanced-stage (IV/BE) disease. Treatment was started with A+AVD and after 2 cycles the interim PET/CT showed CMR, than we followed with Nivolumab+AVD. Her teatment is ongoing and she is in good clinical condition. Results: The occurrence of classical HL in a mother–daughter pair represents a rare example of familial aggregation. Despite differences in histological subtype and clinical course, the diagnosis of cHL in two first-degree relatives is notable given the predominantly sporadic nature of the disease. This observation is unlikely to be purely coincidental. Conclusion: Although familial HL has been described, the development of subsequent DLBCL in one affected family member is particularly unusual and may indicate a broader inherited risk of lymphoid malignancies. Further genetic and molecular studies are needed to better understand the mechanisms underlying familial clustering.
  • Boglárka Dobó
  • Dávid Tóthfalusi
  • Fanni Borics
  • László Imre Pinczés
  • Árpád Illés
  • Zsófia Miltényi
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P062 (P062)

Correlating 18FDG-PET/CT- and CT-derived Biomarkers to Neutrophil Extracellular Traps in Classical Hodgkin Lymphoma

Introduction: Accumulation of neutrophil extracellular traps (NETs), neutrophil-derived networks of decondensed chromatin and granule proteins, is associated to worse prognosis in many cancer types. To investigate their role in malignant lymphoma, we measured NETs in plasma in patients with classical Hodgkin lymphoma (cHL) and high-grade B-cell lymphomas (HGBCL) and found that NETs were associated with inflammation and worse patient outcome in univariate survival analyses. Here, the biology of NETs and inflammation in cHL was further explored using tumour and body composition data derived from 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18FDG-PET/CT) and CT scans. Methods: NETs were measured in plasma taken at diagnosis in 113 cHL and 222 HGBCL patients from the Swedish U-CAN biobank with an ELISA targeting citrullinated histone complexes. Clinical data and routine blood counts at diagnosis were available for all included patients. Semi-automated tumour lesion segmentations of lesions with standardized uptake value (SUV) ≥ 4 were generated in 87 cHL baseline 18FDG-PET/CT scans, in order to extract data on total metabolic tumour volume (TMTV), maximum distance between tumour lesions (Dmax), maximum SUV (SUVmax) and lesion count. Furthermore, Body and Organ Analysis (BOA) was used on the corresponding CT scans to generate data on muscle mass and total (TAT) and visceral (VAT) adipose tissue volume. Results: TMTV, Dmax and lesion count correlated positively to the plasma NET levels. Higher TMTV and SUVmax were associated with worse progression-free survival, with similar although non-significant trends for overall survival. Dmax and lesion count did not significantly correlate to patient outcome. No associations were observed between plasma NET levels and muscle mass, TAT or VAT. Other inflammatory blood counts investigated in the study also showed correlations to the 18FDG-PET/CT imaging biomarkers, but not to the muscle mass, TAT or VAT of the patients. Conclusions: In cHL, NETs showed an association with 18FDG-PET/CT imaging biomarkers representing increased tumour burden and dissemination, but not with CT-based body composition parameters. These findings indicate that increased NET levels may reflect biological processes linked to tumour burden and tumour-induced inflammation, rather than chronic inflammation and alterations in the metabolic status of the patients. Additional patients will be included in the study.
  • Emma Pettersson
  • Alexander Korenyushkin
  • Ashish Chauhan
  • Sambit Tarai
  • Jeremia Collin
  • Rose-Marie Amini
  • Daniel Molin
  • Anna-Karin Olsson
  • Håkan Ahlström
  • Joel Kullberg
  • Gunilla Enblad
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P063 (P063)

Genetic Clustering Reveals Biologic Similarities Across subgroups of Hodgkin Lymphoma, Primary Mediastinal Large B-Cell Lymphoma and Large B-Cell Lymphoma patients

Background: Primary mediastinal large B-cell lymphoma (PMBL) occupies a unique position in the spectrum of aggressive B-cell lymphomas, sharing molecular and clinical features with both Hodgkin lymphoma (HL) and diffuse large B-cell lymphoma (DLBCL) (Rosenwald et al., 2003; Savage et al., 2003; Savage, 2022; Duns et al., 2021). Here we use a data-driven approach integrating all three entities in a unified analytical framework to understand genetic similarities between subgroups of all three diseases. Methods: Genetic alterations (SNPs, small InDels, CNVs) were assessed by circulating tumor DNA sequencing of HL patients at baseline and relapsed/refractory DLBCL patients. Genetic alterations of PMBL patients were analyzed by tissue DNA sequencing. Non-negative Matrix Factorization (NMF) clustering was used as the primary analytical framework. Results: NMF clustering suggests that genetically coherent subgroups can be formed that are independent of disease entity. One cluster is defined by high weights for genes involved in JAK/STAT signaling and immune evasion, most prominently SOCS1, STAT6, B2M, TNFAIP3, NFKBIE, GNA13, ITPKB, CIITA, CD58, CD83, XPO1, and histone linker genes (HIST1H1B/C/E), and is strongly enriched for PMBL and HL cases. This signature aligns with constitutive NF-κB and JAK/STAT activation, impaired MHC class I antigen presentation, and a pronounced immune privilege phenotype shared by PMBL and HL (Mottok et al., 2019). A second cluster is characterized by TP53, EZH2, FAT4, CREBBP, DDX3X, EP300, MYC, P2RY8, DTX1, and CD79A/B, a mutation-driven landscape more consistent with GCB-type DLBCL biology (Alizadeh et al., 2000; Li et al., 2018) although including some samples of all three disease entities. Conclusion: Unsupervised genomic clustering across PMBL, HL, and DLBCL reveals biologically coherent subgroups transcending established diagnostic boundaries.
  • Jon Felix Rischewski
  • Franziska Briest
  • Julia Mattlener
  • Daniel Noerenberg
  • Julia Katharina Schleifenbaum
  • Jessica Schneider
  • Sophie Heidenreich
  • Jan-Michel Heger
  • Frederik Damm
  • Sven Borchmann
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P064 (P064)

Time-of-Day Immunotherapy Administration and Outcomes in Classic Hodgkin Lymphoma

Introduction: Evidence in solid tumors suggests an association between earlier time of day administration of checkpoint inhibitor immunotherapy (TODA, CPI) and improved clinical outcomes, potentially driven by circadian immune variation. We hypothesized that a chronologic effect might be seen in classic Hodgkin lymphoma (cHL), where CPI are utilized in the frontline (1L) and relapsed/refractory (R/R) settings. Methods: We included adult cHL patients who received CPI regimens at our institution with available infusion times and 1+ year of follow-up. N=5 were excluded due to CPI discontinuation after first infusion due to immune-related adverse event. We categorized patients as early or late TODA if the majority of infusions occurred before or after the cohort median infusion time, and also evaluated common literature TODA thresholds of 13:00, 14:00, 16:00. Progression-free survival (PFS) was assessed via log-rank test, cross-group outcomes via Fisher’s exact, and median infusion times via Wilcoxon rank-sum. Results: Eighty patients were treated from 2016-2025 in the 1L (n=23) or R/R (n=57) settings, receiving total 568 infusions (median 4/pt) on clinical trial protocols (n=47) or per standard of care (n=33). Median age was 38 years (range 18 to >90), 48.8% female, and median follow-up was 29 months. 25% of patients had progression after CPI (n=20). Most events occurred in R/R patients (n=16) or 1L anthracycline-ineligible patients receiving BV-nivolumab (n=3), and more frequently with age >60 years (p=0.02). The median infusion TODA was 14:48 (IQR 13:12-16:17). PFS was similar for patients with early versus late TODA, defined by either cohort median (Fig 1A) or literature thresholds. No significant difference was seen in median infusion TODA for patients with or without subsequent progression (Fig 1B) or complete radiographic response (Fig 1C). Progression was rare after CPI/chemotherapy for both 1L patients (1/18, 5.6%) and R/R patients who underwent ASCT (1/14, 7.1%). Conclusions: In contrast to data in solid tumors, no clear chronologic effect on outcomes was observed in this single institution retrospective study. Given favorable outcomes in Hodgkin lymphoma as compared to solid tumors, particularly with combination CPI-chemotherapy, further investigation could focus on large multicenter cohorts in the R/R setting where event rates are higher.
  • Joseph Schroers-Martin
  • Anthony Yu
  • Austin Yeung
  • Chandley Silin
  • May Powell
  • Michael Binkley
  • Richard Hoppe
  • Ranjana Advani
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P065 (P065)

Redefining Hodgkin lymphoma pathogenesis: the central and indispensable role of CD 4 T cells

Background: Classic Hodgkin lymphoma (cHL) remains a biological paradox. A key conceptual puzzle is how the malignant Hodgkin Reed–Sternberg (HRS) cells manage to survive and thrive within a massive tumor microenvironment (TME) dominated by immune cells. Although mechanisms of immune evasion have been extensively explored, the active supportive functions of the TME are less widely recognized. CD4 T cells are particularly intriguing in this context, as they are consistently abundant and form intimate, often rosette‐like contacts with HRS cells. Here, we propose a unifying pathogenetic framework that links these interactions to the origin, evolution, and diagnostic hallmarks of cHL. Methods: We developed an integrative conceptual framework centered on the interaction between CD4 T cells and HRS cells, based on evidence from in vitro coculture systems, gene expression analyses, immunohistochemistry and established immunology principles. Results: Our framework highlights that HRS cells produce exceptionally high levels of the chemokine TARC (CCL17), which begins to rise already years before diagnosis and selectively recruits Th2 and regulatory T cells (see figure). The recruited CD4 T cells establish immunological synapses with HRS cells through HLA class II and CD58 mediated interactions. However, the T cells do not become fully activated and the HRS cells deliberately orchestrate a chronic state of intermediate T-cell activation, marked by low-level expression of immune checkpoint molecules and the transcription factor TOX2. Remarkably, this phenotype resembles early commitment toward the T follicular helper (Tfh) lineage which can explain strong support of HRS cells at diagnosis. It also links the cHL immune landscape to the germinal center (GC) niche from which HRS cells arise. Within this niche, GC B cells depend on strong Tfh cell derived survival signals to escape from apoptosis. Disruption of this tightly controlled system may enable the accumulation of genetic aberrations and facilitate the earliest steps of lymphoma development within GCs. Conclusions: We propose that the core biology of cHL is built on functional units composed of malignant B cells and cooperating CD4 T cells. Within this unit, GC B cells acquire the capacity to recruit and modulate CD4 T cells through TARC production and controlled chronic activation, thereby securing Tfh-like support signals that promote their survival, growth and malignant transformation.
  • Arjan Diepstra
  • Yajie Lei
  • Sophie Teesink
  • Wouter Plattel
  • Lydia Visser
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P066 (P066)

The Role of CD59 in Mediating T Cell Rosette Formation in Classic Hodgkin Lymphoma

The tumor cells in classic Hodgkin lymphoma(HL) are surrounded by CD4+ T-cell rosettes that provide support and form a physical shield against anti-tumor immune responses. To study the mechanisms behind rosette formation, we previously developed an in vitro co-culture model and found that CD2-CD58 interactions increase rosetting and activation of CD4+ T cells. In the current study, we explore the role of CD59, an alternative CD2 ligand, in rosetting. In 45/62 diagnostic cases, tumor cells showed increased expression of CD59. HL cell lines L428(CD58+/CD59+), L1236(CD58+/CD59-) and KMH2(CD58-/CD59+) and peripheral blood mononuclear cells (PBMCs) from healthy donors were co-cultured. After 30 minutes, L428 showed the highest percentage of rosette formation, followed by L1236 and KMH2, respectively. Accordingly, the production of IL-2 after 24 hours, as a marker of T cell activation, showed the same pattern. CD59 knockout in L428 reduced the rosette formation, strongly indicating that CD59 expression is involved. During rosette formation, CD58 firstly redistributed along the HRS cell membrane towards the T cell interaction site, and CD59 followed CD58 to the same sites within 30 minutes. Proximity ligation assays showed that the CD58-CD59 interaction was only present at the interface between tumor cells and T cells. There were more CD2-CD58 signals in L428 than in L1236, while CD2-CD59 signals were present in L428 and missing in KMH2. In conclusion, CD59 expression is upregulated by tumor cells and helps to enhance the interaction between CD58 and CD2 during the formation of rosettes in HL.
  • Yajie Lei
  • Rodrigo Martinez Alcala
  • Annika Seitz
  • Lydia Visser
  • Arjan Diepstra
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P067 (P067)

Fragmentomics analysis to enhance ctDNA based risk stratification in Hodgkin Lymphoma

Background: Current clinical challenges in Hodgkin lymphoma (HL) include long-term treatment-related toxicities and relapsed/refractory disease. Up to now, risk stratification tools mainly rely on clinical characteristics and lack sensitivity. Recent studies, including ours, demonstrated that circulating tumor (ct)DNA sequencing offers the potential to overcome this limitation. Aims: We aim to increase the sensitivity to distinguish tumor (ctDNA) from non-tumor derived cell-free (cf)DNA and thus refine detection of minimal residual disease (MRD) (Sobesky, Med, 2021; Heger, J Clin Oncol, 2024; Heger, Blood, 2026) by incorporating fragmentomics analysis. Methods: We developed a software tool to extract advanced fragmentomics data at the read level and incorporate mutational information. The tool was applied to 154 plasma samples from 71 patients with previously untreated HL (sampled from the HD21 trial) and 10 healthy controls. Results: We found significant differences in cell-free DNA fragment length distribution between pre-treatment HL samples and healthy controls (mean 180 vs. 200bp, Mann-Whitney U test, p<0.01). Interestingly, fragment length increased with more treatment applied, ultimately approximating healthy controls (healthy control=200bp; pre-treatment=180bp; mid-treatment=185bp; end-of-treatment=187bp). Not only is this shift noticeable for the mean fragment length but it is also independently present for the peak corresponding to mono-nucelosmal length as well as the second peak (corresponding to di-nucleomal length) when comparing HL samples (Fig 1 (A), pre-treatment (blue; BL), mid-treatment (yellow;2CX), and end-of-treatment (grey; EOT)) to healthy controls (red; ctrl). We found that shorter mean fragment length (<182bp) in pre-treatment HL samples was associated with shorter progression free survival (PFS) (Logrank P-value <0.01). Further results will be presented at the meeting. Conclusion: Fragmentomics analysis in our HL cohort showed shorter mean pre-treatment fragment length compared to healthy controls, with shorter mean length associated with inferior PFS. These findings suggest a potential use of fragment size and other fragmentomic features for dynamic risk stratification in patients with HL.
  • Jessica Schneider
  • Julia Mattlener
  • Sophie Heidenreich
  • Julia Katharina Schleifenbaum
  • Max Freihammer
  • Daniel Schütte
  • Peter Borchmann
  • Phillip Gödel
  • Hyatt Balke-Want
  • Christian Reinhardt
  • Bastian von Tresckow
  • Roland Schwarz
  • Jan-Michel Heger
  • Sven Borchmann
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P068 (P068)

Plasma Proteomic Profiling of Classical Hodgkin Lymphoma

Background: The proteomic landscape of classical Hodgkin lymphoma (cHL) remains incompletely explored. Plasma proteomics may provide insight into disease biology, diagnosis, and prognosis. Using Olink protein panels, we performed large-scale analysis of protein expression in plasma from cHL patients and healthy controls (HC). Additionally, cHL is often accompanied by systemic inflammation, including elevated erythrocyte sedimentation rate (ESR) and B-symptoms, though not all patients present with these features. Inflammatory response does not uniformly correlate with tumor stage, with discordant cases occurring in both directions. Hence, the inflammatory proteomic profile in cHL was also investigated. Aims: This study aims to characterize the plasma proteomic profile of cHL in comparison with HC and identify protein patterns associated with the presence or absence of an inflammatory response. Methods: The plasma proteome (1443 proteins) from 115 cHL patients and 122 HC was compared using age- and sex-adjusted linear regression with multiple testing correction. Inflammatory (n=77) and non-inflammatory (n=38) subtypes were defined by elevated ESR. Inflammatory group differences were assessed using estimated marginal means and partial least squares discriminant analysis. Selected findings will be validated by ELISA. Results: The results revealed 675 significantly differentially expressed proteins in cHL plasma. Beyond established markers such as TARC, PD1, PDL1, and CD30, we identified VWF and ATP5IF1 as markedly elevated across the cohort, while the suggested tumor suppressor protein CRTAC1 was reduced compared to HC. The inflammatory subtype was characterized by increased expression of many immune mediators, among them proteins associated with an antibacterial response, including LBP, CD14, DEFA1_DEFA1B, and PLA2G2A. In contrast, the non-inflammatory subtype showed higher expression of immune suppressive proteins VTCN1, CD83, FASLG, and PLA2G7. ELISA results will be ready before the conference. Conclusions: Large-scale proteomic analysis revealed pronounced alterations in the plasma proteome of cHL compared to HC. This study confirms known cHL markers, while also identifying novel findings. Furthermore, the two inflammatory states show distinct differences in plasma proteome expression. The inflammatory subtype is characterized by elevation of antibacterial-associated proteins, while the non-inflammatory subtype displays a more immunosuppressive profile.
  • Ragnhild Risebro
  • Jeremia Collin
  • Johan Mattsson Ulfstedt
  • Emma Pettersson
  • Mats Hellström
  • Ingrid Glimelius
  • Mattias Berglund
  • Gunilla Enblad
  • Eva Freyhult
  • Daniel Molin
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P069 (P069)

Analysis of circulating tumor DNA shows Epstein-Barr virus associated differences of mutagenic processes in classical Hodgkin lymphoma.

Background: About 30% of classical Hodgkin lymphomas (cHL) are associated with EBV (Epstein-Barr virus) infection. However, it is not fully understood how EBV positivity affects genetic profile of cHL and associated characteristics of circulating tumor DNA (ctDNA). Methods: We prospectively analyzed pre-treatment plasma samples of 140 patients with cHL using Cancer Personalized Profiling by deep Sequencing (CAPP-Seq) and Clinical Lymphoma Exploration and Research Sequencing (CLEARS) panel (521 genes). COSMIC (Catalogue of Somatic Mutations in Cancer) mutational signatures were detected by SigProfiler. EBV status was determined by immunohistochemistry (LMP1), ISH (EBER), or qPCR (peripheral EBV DNA). Results: Among 140 analyzed cHL patients, the median age at diagnosis was 39 years (range 19 – 77); the most frequent histological subtype was nodular sclerosis (64.7%; mixed cellularity - 28.7%; lymphocyte rich - 6.6%); most patients had advanced GHSG (German Hodgkin Study Group) clinical stage (70.1%; intermediate stage - 16.7%, early stage - 12.7%); 24% of patients were EBV positive. Advanced GSHG stage was associated with higher levels of pre-treatment ctDNA in comparison to patients with intermediate/early stages (18.4 vs. 8.1 ng/mL, respectively; P < 0.001). EBV positivity was associated with lower tumor mutational burden (median TMB 6.07 vs. 10.0 mut/Mb; P = 0.03) and a trend towards higher ctDNA concentration (mean 2.3 vs. 1.7 ng/mL; P = 0.13). Importantly, EBV+ tumors were largely missing alterations in several critical genes most frequently (20% of cases) altered in EBV- cases, namely in TNFAIP3 and NFKBIE (negative regulators of NFκB signaling) and in ITPKB (a negative regulator of PI3K/AKT signaling). Other cHL driver genes were altered in EBV+ and EBV- cHL tumors at similar frequencies (e.g., SOCS1, HLA-B, GNA13, or KMT2C). Based on identified mutagenic processes, EBV- cHL tumors showed higher contribution of activation induced cytidine deaminase (AID) and had evidence of mismatch repair deficiency (MMRD, which was missing in EBV+ tumors). Conclusion: EBV positivity and related expression of viral proteins (e.g. LMP1) seems to trigger similar cellular signaling as alterations of several key driver genes in EBV- cHL. Consequently, EBV+ tumors need lower number of additional mutations and EBV- cHL is associated with other mutagenic processes, as are AID activity and MMRD. Supported by NU22-03-00182, DRO-FNOl_00098892, DRO-VFN00064165, LX22NPO5102.
  • Kristyna Kupcova
  • Lubica Gaherova
  • Adriana Velasova
  • Maria Maco
  • Iva Hamova
  • Petr Nehasil
  • Petra Zemankova
  • Pavla Stepankova
  • Alexandra Kredatusova
  • Jana Markova
  • Blanka Vackova
  • Jan Koren
  • Alice Sykorova
  • Vit Prochazka
  • Tomas Kozak
  • Heidi Mocikova
  • Ondrej Havranek
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P070 (P070)

Kinetics of PD-1 Blockade on Circulating CD8+ve T Cells After Exposure to low-dose Nivolumab

Introduction: Low-dose (40 mg) nivolumab results in near-complete saturation of PD-1 receptors on circulating T cells, suggesting that current dosing schedules may exceed the biological requirements for effective target engagement in classical Hodgkin lymphoma (cHL). Here we evaluate the durability of PD-1 receptor occupancy (RO) following treatment cessation in patients enrolled in an ongoing trial of low-dose nivolumab in advanced-stage cHL. Methods: Peripheral blood samples were collected at baseline, immediately following nivolumab infusion, and at 2-week intervals following the final nivolumab dose up to 12 weeks. PD-1 RO on circulating T cells was assessed using a standardized flow cytometry-based assay. Results: Between August 2024 and January 2026, 44 patients were enrolled onto the nivolumab arm, of whom 34 completed all four planned doses and had at least one follow-up sample available for analysis. At baseline, the PD-1 expression on circulating CD8+ T cells was 44.2% (range 10.5–85.8%). One hour after nivolumab infusion, median PD-1 RO was 99.7% (IQR 97.3–99.95%). Five patients (18.5%) demonstrated <90% RO including one patient with occupancy of only 44.3%. Following the final nivolumab dose, RO remained high at week 2, with a median occupancy of 99.8% (IQR 97.3–99.9%); however, 4/34 patients (11.8%) demonstrated RO <90%. At 12 weeks following the final infusion, median RO remained 99.9% (IQR 95.5–99.9%), with 4/28 evaluable patients (14.3%) demonstrating occupancy <90%. Thus, near-complete PD-1 RO was maintained in most patients for up to 12 weeks following the last dose of nivolumab. Among 29 patients who completed 6 cycles of therapy, one had progressive disease at end-of-treatment and three relapsed within one year. No clear association was observed between RO and remission status. Three of four patients with subsequent progression or relapse maintained near-complete RO throughout the 12 week period of testing, while several patients with occupancy <90% remained in remission. Conclusions: PD-1 RO remained near-complete for up to 12 weeks post-nivolumab, indicating prolonged target engagement after low-dose nivolumab. Current 2-weekly dosing intervals may therefore exceed the biological requirements for sustained target engagement. The lack of an apparent association between RO persistence and clinical outcome suggests that receptor saturation alone may be an insufficient biomarker of therapeutic efficacy.
  • Anu Korula
  • Phaneendra Datari
  • Arunkumar Arunachalam
  • Vikram Mathews
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T048 (T048)

A Reproducible Mutation- versus Copy-Number-Enriched Genomic Axis Underlies Molecular Subtypes of Classic Hodgkin Lymphoma

abstract talk Abstract Talk in Translating ctDNA into clinical routine (Sunday, 04.10. 10:45)

Background: Several independent groups have recently proposed genomic subtype classifications of classic Hodgkin lymphoma (cHL), either by ctDNA profiling or analysis of microdissected tumor tissue: two subtypes by Alig et al. (Nature 2023, H1/H2), four by Aoki et al. (Cancer Discov 2026, CST/CN913/STB/CN2P), three by Heger et al. (JCO 2024), and two by Pirosa et al. (Blood 2025, C1/C2). Whether these independently derived systems capture the same biology or identify orthogonal structure remains unknown. Methods: We applied the BC Cancer (Aoki) subtype classifier to 293 cHL patients from the Stanford ctDNA targeted sequencing cohort (Alig et al., Nature 2023). Subtype concordance was assessed by cross-tabulation, cluster enrichments by Fisher's exact test, and prognostic associations by log-rank test. Co-association analysis of cluster-defining features by observed vs expected (O/E) frequencies was performed across all 4 classification systems. Results: The BC Cancer classifier resolved the H1/H2 axis into four subtypes distributed as CST (39%), STB (23%), CN913 (15%), CN2P (5%), and unclassified (18%), with CST and STB (mutation-dominated) mapping predominantly within H1 (87% and 80% H1, respectively) and CN913 and CN2P (copy number aberration [CNA]-dominated) within H2 (73% and 63% H2; p<0.00001). CN913 was enriched for older age (median 59 vs 29 years for CST/STB; p=0.002) and EBV positivity (60% vs 15% for CST/STB; p<0.00001). PFS differed significantly across subtypes (p=0.046), with inferior outcomes in CN913/CN2P vs CST/STB. Co-association analysis of cluster-defining features showed strong within-cluster co-enrichment (log2 O/E CST=0.60, CN913=0.49, STB=0.31, CN2P=-0.03), with mutual exclusivity largely restricted to features crossing the mutation- versus CNA-dominant axis. Co-association analyses using defining features from the Heger and Pirosa classifications also each independently reproduced the same CNA- versus mutation-dominated pattern. Conclusion: A binary mutation- versus CNA-dominant axis represents the primary organizing feature of cHL tumor genome biology and appears highly reproducible across independent studies supporting at least two molecular subtypes. More granular models may provide additional resolution within this framework, with their additional clinical impact an area of active investigation. Harmonization efforts across studies are warranted to define a consensus classification for prospective clinical application.
  • Cara Paulina Lange
  • Michael Yu Li
  • Andrea Garofalo
  • Tanja Zamrik
  • Christian Reinhardt
  • Bastian von Tresckow
  • Mohammad Esfahani
  • Ash A. Alizadeh
  • Christian Steidl
  • Tomohiro Aoki
  • Stefan K. Alig
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T046 (T046)

Functional characterization of STAT6 mutations as oncogenic drivers in classical Hodgkin lymphoma (cHL)

abstract talk Abstract Talk in Biology & Pathology (Sunday, 04.10. 12:15)

Background: cHL is largely curable but a subset of patients still dies of this lymphoma, underscoring the need to better define its drivers for enabling targeted therapies. Mutations in the DNA-binding domain of the STAT6 transcription factor occur in 30% of cHL cases (Tiacci et al. Blood 2018), yet how they contribute to cHL pathogenesis is unclear. Methods: We studied the most frequent STAT6 mutations (N417Y, D419G/H/N, and double mutants, Fig. A) in cHL cell lines expressing endogenous or exogenous wild-type (WT) or mutant STAT6 through an integrated multi-omics approach combining chromatin binding (ChIP-seq), chromatin accessibility and regulatory profiling (ATAC-seq; Cut&Run for H3K27ac), 3D genome organization (Hi-C-seq), and transcriptomic analyses (RNA-seq). Results: Compared to WT, each STAT6 mutant showed stronger and expanded genomic occupancy, at least in part through neomorphic binding to non-canonical (“alternative”) STAT6 DNA motifs (Fig. B), leading to increased chromatin accessibility, activation of regulatory elements including super-enhancers (SEs), and increased long-range chromatin interactions at multiple loci. These alterations established aberrant transcriptional programs (Fig. C) promoting proliferation, metabolic adaptation, immune evasion (including upregulation of PD-L1/PD-L2) and lineage plasticity, while repressing interferon signaling and tumor suppressors. Notably, mutant STAT6 newly generated a SE overlapping the locus of the myeloid receptor tyrosine kinase CSF1R, leading to expression of a novel truncated isoform lacking the ligand-binding domain but retaining the kinase domain, consistent with potential constitutive activity. Indeed, viability of STAT6-mutant cHL cells was impaired by the clinical-grade CSF1R-specific inhibitor pimicotinib (Fig. D). Consistently, knock-out of endogenous mutant STAT6 induced cHL cell apoptosis, which was rescued only by exogenous mutant (but not WT) STAT6 (Fig. E), indicating oncogenic addiction to mutant-specific programs. Finally, a young patient with STAT6-mutant cHL not responding to 9 prior therapies (including nivolumab) achieved a rapid and marked clinical response to treatment with the JAK/STAT inhibitor ruxolitinib combined with nivolumab. Conclusions: We functionally dissected the role of STAT6 mutations in cHL pathogenesis and provided a mechanistic rationale for therapeutic strategies targeting the JAK/STAT axis and key downstream effectors like CSF1R.
  • Luisa Tasselli
  • Rafael L. B. Coan
  • Valentina Pensato
  • Francois Le Dily
  • Barbara G. Müller-Coan
  • Valentina Pettirossi
  • Enrique Blanco
  • Alessandro Cupola
  • Laura Pasqualucci
  • Luciano Di Croce
  • Enrico Tiacci
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T047 (T047)

Artificial intelligence predicts EBV status and reveals prognostic morphology phenotypes in advanced-stage classic Hodgkin lymphoma

abstract talk Abstract Talk in Biology & Pathology (Sunday, 04.10. 12:15)

Award winning Karl Musshoff Prize: Best Preclinical Abstract

Background: Epstein–Barr virus (EBV) status and morphologic heterogeneity characterize the histopathologic phenotype of classic Hodgkin lymphoma (cHL). We asked whether artificial intelligence (AI) models trained on self-supervised histology foundation-models can (i) predict EBV status without testing for the virus and (ii) define clinically meaningful clusters from routine stains. Methods: We analyzed 935 advanced stage cHL cases from the German Hodgkin Study Group HD21 trial. Embeddings were generated from H&E, CD30 and CD20 staining Whole-slide imaging (WSI) using the general pathology foundation model PathOrchestra. Unsupervised clustering with k-means was applied on mean patch embedding per case and tested against EBV status and interim PET positivity (PET-2) by Fishers exact test, and 3-year progression-free survival (PFS) differences using log-rank test. In addition, a supervised EBV prediction was trained using attention-based multiple instance learning per stain and extractor. All metrics are 5-fold cross-validated. Results: Supervised prediction for detection of EBV status worked best using H&E (5-fold out-of-fold [OOF] held-out cross-validation prediction AUC for all staining combined: 0.74; CD20: 0.70; CD30: 0.71; H&E: 0.77). Unsupervised clustering revealed distinct phenotypes (k = 2 for H&E/CD30, k = 3 for CD20). The CD30 phenotype clusters were associated with EBV (19% Cluster 0 (C0) vs. 11% C1; p=0.01). CD20 phenotypes associated with interim PET (C0: 30%, C1: 25%, C2: 35%; p = 0.01). After the combination of similarly prognostic clusters a prognostic difference could be demonstrated (3-yr PFS C0&C2: 95.0% [95% CI: 93.0–96.4] vs. C1: 91.3% [95% CI: 87.2–94.1]; p=0.02). Conclusion: AI analysis of conventional histology slides reveal clinical phenotypes and show feasibility of detecting molecular features of Hodgkin-Reed-Sternberg-cells like EBV without directly testing for this feature. These findings will be validated in an additional cohort that will be presented at the meeting.
  • Hishan Tharmaseelan
  • Daniel Winderl
  • Steffen Gretser
  • Julia Richter
  • Justin Ferdinandus
  • Peter Borchmann
  • Michael Altenbuchinger
  • Wolfram Klapper

Children and adolescents

Selected for Oral Presentation

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    T071 (T071) The Genomic Landscape of Pediatric High-Risk Hodgkin Lymphoma: A Liquid Biopsy Study of COG AHOD1331

    • Shuyu Shi
    • Lianna J. Marks
    • Hrishikesh K. Srinagesh
    • Lena Osswald
    • Stefan K. Alig
    • Ragini Adams
    • Maya Strohband
    • Xiaoman Kang
    • Mari N Olsen
    • Chih Long Liu
    • Lindsay A. Renfro
    • Lisa Giulino-Roth
    • Kara M. Kelly
    • Tyler J. Bradshaw
    • Maximilian Diehn
    • Steve Yoon-Ho Cho
    • Sharon M Castellino
    • Ash A. Alizadeh
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    T072 (T072) Body-Size Normalisation of Metabolic Tumour Volume in Paediatric Hodgkin Lymphoma: Does MTV/BSA Improve Prognostic Stratification and Reclassify Smaller Children?

    • Claire Gowdy
    • Caron Strahlendorf
    • Andrea C. Lo
    • Yvonne Mbithi
    • Carlos Uribe
    • Arman Rahmim
    • Fereshteh Yousefirizi

Posters

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    P073 (P073) Outcomes of Pediatric Hodgkin Lymphoma Patients treated with ABVD Regimen. A retrospective Cohort Study

    • Hany Abdel Rahman
    • Emad Moussa
    • Mohamed Sedky
    • Nesreen Ali
    • Walaa El Sayed
    • Maram Farouk
    • Sally Talaat
    • Hanaa Rashad
    • Eman Khorshed
    • Mohamed Saad Zaghloul
    • Esraa Roshdy
    • Madeha El Wakeel
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    P074 (P074) Outcomes of Second-Line EuroNet Salvage Regimens in Pediatric Patients with Relapsed and Primary Refractory Hodgkin Lymphoma

    • Emad Moussa
    • sara Badawy
    • Asmaa Hamouda
    • Asmaa Attia
    • sally Talaat
    • Hany Abdelrahman
    • Nesreen Ali
    • Mohamed Sedqy
    • Nashwa Ezz El Din
    • Walaa El Sayed
    • Maram Farouk
    • Mona Fakhry
    • Ebtihal Shoukry
    • yassin Taher
    • Amr El Nashaar
    • Mohamed Saad Zaghloul
    • Eman Naguib
    • Esraa Roushdy
    • Madeha El Wakeel
    • Reham Abdelaziz
    • Alaa El Haddad
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    P075 (P075) Response Adapted Therapy of Pediatric Classic Hodgkin Lymphoma According to Modified EURO-NET Protocol-Single Center Experience

    • Hany Abdel Rahman
    • Nesreen Ali
    • Mona Fakhry
    • Maram Farouk
    • Ebtihal Shoukry
    • Nashwa Mahmoud
    • Asmaa Attia
    • Walaa El Sayed
    • Mohamed Sedky
    • Yassin Taher
    • Riham Abdel Aziz
    • Asmaa Hamoda
    • Sally Talaat
    • Eman Khorshed
    • Mohamed Saad Zaghloul
    • Esraa Roushdy
    • Madeha El Wakeel
    • Sarah Badawy
    • Mohamed Kamal
    • Emad Moussa
    • Alaa El Haddad
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    P076 (P076) ATAXIA TELANGIECTASIA ASSOCIATED PEDIATRIC HODGKIN LYMPHOMA: HIGH RESPONSE RATES BUT SUBSTANTIAL NON RELAPSE MORTALITY

    • Nesreen Ali
    • Hany Abdelrahman
    • Emad Moussa
    • Nesreen Radwan
    • Eman Khorshed
    • Sara Badawy
    • Walaa Elsayed
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    P077 (P077) Real-World Outcomes of IGEV Salvage Therapy in Relapsed or Refractory Pediatric Hodgkin Lymphoma: Challenges from a Resource-Limited Setting

    • Walaa Elsayed
    • Maram Salama
    • Hany Abdelrahman
    • Emad Moussa
    • Yousef Medany
    • Mohamed Saad Zaghloul
    • Madeha El Wakeel
    • Eman Khorshed
    • Esraa Roshdy
    • Nesreen Ali
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    P078 (P078) Baseline and Delta PET/CT Radiomics for Prognostic Stratification in Paediatric Hodgkin Lymphoma

    • Claire Gowdy
    • Caron Strahlendorf
    • Andrea C. Lo
    • Yvonne Mbithi
    • Carlos Uribe
    • Arman Rahmim
    • Fereshteh Yousefirizi
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    P079 (P079) Survival benefit of brentuximab vedotin in classical Hodgkin lymphoma: a multicenter real-world study

    • Wenhui Zhang
    • Yuanyuan Wang
    • Shaoxuan Hu
    • Ming Jiang
    • Shujuan Wen
    • Weiping Liu
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    P080 (P080) Feasibility of tumor microenvironment analysis in pediatric and adolescent classical Hodgkin lymphoma by automated cyclic immunofluorescence staining

    • Mira Albracht
    • Fatih Yalcin
    • Julia Richter
    • Sarah Reinke
    • Matthias Braun
    • Marius Rohde
    • Alexander Claviez
    • Britta Maecker-Kolhoff
    • Birgit Burkhardt
    • Arndt Borkhardt
    • Tobias Feuchtinger
    • Anja Tröger
    • Martin Ebinger
    • Gabriele Escherich
    • Dominik Schneider
    • Jan-Henning Klusmann
    • Anne Thorwarth
    • Dieter Körholz
    • Christine Mauz-Körholz
    • Wolfram Klapper
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    P081 (P081) Allogeneic stem cell transplantation for multiply recurrent EBV-driven classic Hodgkin lymphoma arising in the setting of suspected activated PI3-kinase delta syndrome (APDS) associated with a novel variant: a case report spanning 13 years

    • Joseph deBettencourt
    • Rebecca Hale
    • Jaclyn Schienda
    • Amy Keating
    • Marian Harris
    • Leslie Lehmann
    • Angela Feraco
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P073 (P073)

Outcomes of Pediatric Hodgkin Lymphoma Patients treated with ABVD Regimen. A retrospective Cohort Study

Background: Hodgkin lymphoma (HL) a highly curable malignancy has a peak incidence in adolescent and young adults. Chemotherapy regimen ABVD and involved field radiotherapy (IFRT) is the gold-standard treatment for early and advanced stages of HL in adults. Aim of the study To analyze data of patients who received first line chemotherapy ABVD and IFRT at the Children Cancer Hospital Egypt 57357 (CCHE) over 12 years period. Methodology: A retrospective analysis including all patients, < 18 years, diagnosed and treated as classic HL during the period from 2007-2019. Patients were stratified as low (stage IA/IB/IIA with ESR<30 and without bulky disease), intermediate (stage IEA/IEB/IIA/IIIA with ESR ≥ 30 or with bully disease), and high risk (stage IIBE/IIIAE/IIIB/IV) disease. Chemotherapy consisted of 4 cycles for low, and 6 for intermediate and high risk patients, followed by IFRT total dose 1,980 Gy. The median follow up period was 105 months (range 6- 217 months). Results: This study included 1378 patients. Their median age was 9.3 years. The majority (70%) were from 5-15 years. There was a strong male predominance accounting for 72%. The most common pathologic subtype was nodular sclerosis (54%), followed by mixed cellularity (38%). Stage 2A was he most common (31%). Low risk patients were the most common (46%), followed by high risk (31%). Two hundred thirteen patients (15.4 %) had relapse (187, 13.5%) or refractory (26, 0.18%) disease. Following salvage chemotherapy, 123 (8.9%) patients received a hematopoietic stem cell transplant (HSCT), mainly (98%) autologous. The 5 years overall survival (OS) for the entire cohort was 95.3% (95% CI 94.2%-96.4%), while the 5 years progression free survival (PFS) probability was 86.7% (95% CI 84.9% -88.5%). The 5 years PFS for low risk group was 94.2%, compared to 86.8% for intermediate risk and 75.6% for high risk patients (P<0.001). Second malignant neoplasm (SMN) was detected in 31 patients (0.22) mainly cancer thyroid (58%). One hundred patients (7.2%) died, mainly from disease progression including 28 post HSCT and 6 post SMN. Summary and conclusion: ABVD regimen at our institution has an excellent outcome. late effects of therapy, include an elevated risk for SMN, cardio toxicity, pulmonary toxicity, and endocrine dysfunction. Recently, new treatment strategies have been developed to balance the intensity of therapy needed to maintain disease-free survival while simultaneously preserving overall survival.
  • Hany Abdel Rahman
  • Emad Moussa
  • Mohamed Sedky
  • Nesreen Ali
  • Walaa El Sayed
  • Maram Farouk
  • Sally Talaat
  • Hanaa Rashad
  • Eman Khorshed
  • Mohamed Saad Zaghloul
  • Esraa Roshdy
  • Madeha El Wakeel
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P074 (P074)

Outcomes of Second-Line EuroNet Salvage Regimens in Pediatric Patients with Relapsed and Primary Refractory Hodgkin Lymphoma

Background: Since EuroNet-PHL-C1 protocols are standard but real-world data on salvage outcomes in resource-limited settings are scanty. The majority of patients with Hodgkin's lymphoma (HL) are cured with first-line therapy; however, approximately 15% – 25% of patients relapse or become refractory. The importance of chemosensitivity, stage at relapse, time to relapse, and the type of response after salvage chemotherapy and before HDT/ASCT in predicting outcome has been stated in several studies. Aim: We aim in this study to evaluate the response rates and survival outcomes (PFS/OS) of pediatric patients treated with EuroNet-PHL salvage regimens, and to test the efficacy of IGEV and IEP/ABVD regimens in a large cohort of pediatric Hodgkin lymphoma patients. Methodology: A retrospective review was conducted on 79 cases of patients between 2019 and 2023 having a relapsed or primary refractory cHL treated at the Children Cancer Hospital of Egypt. Patients were given the EuroNet-PHL recommended salvage regimens such as IGEV or IEP/ABVD regimens. PET-CT using Lugano 2014 criteria, assessed the response after two cycles of chemotherapy. Result: The 3-year OS was 73.4%. However, PFS at 3 years was merely 26.5% for the whole cohort. For High-Risk patients, the 3-year PFS was 11.4% (95% CI: 5.0-25.9%), for Standard-Risk patients 3-year PFS was 45.3% (95% CI: 26.5-77.5%) while for Low-Risk 3-year PFS was 74.3% (95% CI: 51.7-100%).(p < 0.0001). Surprisingly, all the 6 patients who were low-risk and received radiation therapy relapsed later and underwent ASCT. Conclusion: The survival outcomes in our cohort were much lower than in international trials, most probably due to non-availability of new agents as PDL1 inhibitors, and delays in stem cell transplantation.
  • Emad Moussa
  • sara Badawy
  • Asmaa Hamouda
  • Asmaa Attia
  • sally Talaat
  • Hany Abdelrahman
  • Nesreen Ali
  • Mohamed Sedqy
  • Nashwa Ezz El Din
  • Walaa El Sayed
  • Maram Farouk
  • Mona Fakhry
  • Ebtihal Shoukry
  • yassin Taher
  • Amr El Nashaar
  • Mohamed Saad Zaghloul
  • Eman Naguib
  • Esraa Roushdy
  • Madeha El Wakeel
  • Reham Abdelaziz
  • Alaa El Haddad
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P075 (P075)

Response Adapted Therapy of Pediatric Classic Hodgkin Lymphoma According to Modified EURO-NET Protocol-Single Center Experience

Background: Hodgkin lymphoma (HL) represents about 5–7% of all malignancies in children, with a 5-year probability of overall survival (pOS) exceeding 90%. Radiotherapy containing regimen bear an increasing risk for late effects particularly secondary malignancies and cardiovascular disease. The omission of radiotherapy in patients with an adequate 18FDG-PET CT metabolic response after two intensive induction chemotherapy cycles has become the current treatment approach in the EuroNet-PHL consortium. Aim: To report the results of HL patients treated according to the EuroNet protocol at the Children Cancer Hospital Egypt (CCHE 57357). Methodology: This retrospective study included all patients diagnosed with classic HL, and treated as per EuroNet protocol during the period from 2/2019 till end of 12/2023. Patients demographic data (age, sex), disease characteristics; histologic subtypes, initial ESR, stage, B symptoms, treatment groups (TG), response to induction chemotherapy either adequate or inadequate according to interim 18FDG-PET CT, radiotherapy dose and duration, outcomes including overall (OS), event free (EFS) survival were collected and analyzed. Results: Seven hundred and nineteen patients were included in the study. The most common age group was from 5-15 years (68.8%). There was a clear male predominance (69.1%). Nodular sclerosis was the most common pathologic subtype (60.3%). Stage II-A was the most commonly seen (24.3%). TG 3 according to EuroNet risk stratification was predominant (40.0%). Seventy percent of the patients had an adequate metabolic and radiologic response, while 26.2% received upfront radiotherapy. Relapse rate was 13.4% and progression on chemotherapy was seen in 0.28%. The 5-year OS was 96.1 % (95 % CI: 93.7% - 98.5%), while the EFS was 82.7 % (95 % CI: 78.4% - 85.8%). For patients with adequate response, the 5- year EFS was 86.9 % (95 % CI: 83.2% - 90.6%), compared to 73.2 % (95 % CI: 64.2% - 82.2%) for those with inadequate response. Conclusion: EuroNet risk adapted response adapted protocol for pediatric classic HL seems a good strategy. The rationale is to reserve radiotherapy, with its potential serious late effects to patients with high risk disease. In addition to interim 18FDG-PET CT results, serum disease response biomarkers (CD163, TARK, ctDNA) may be able in the future to refine risk stratification, with the potential of adding targeted and/or immunotherapy as upfront treatment for high risk patients.
  • Hany Abdel Rahman
  • Nesreen Ali
  • Mona Fakhry
  • Maram Farouk
  • Ebtihal Shoukry
  • Nashwa Mahmoud
  • Asmaa Attia
  • Walaa El Sayed
  • Mohamed Sedky
  • Yassin Taher
  • Riham Abdel Aziz
  • Asmaa Hamoda
  • Sally Talaat
  • Eman Khorshed
  • Mohamed Saad Zaghloul
  • Esraa Roushdy
  • Madeha El Wakeel
  • Sarah Badawy
  • Mohamed Kamal
  • Emad Moussa
  • Alaa El Haddad
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P076 (P076)

ATAXIA TELANGIECTASIA ASSOCIATED PEDIATRIC HODGKIN LYMPHOMA: HIGH RESPONSE RATES BUT SUBSTANTIAL NON RELAPSE MORTALITY

Background: Ataxia-telangiectasia (AT) is a rare inherited disorder characterized by immunodeficiency, defective DNA damage response, chromosomal instability, and marked radiosensitivity, predisposing affected children to lymphoma while increasing treatment-related toxicity. Evidence guiding optimal management of Hodgkin lymphoma (HL) in children with AT remains limited. Methods: We retrospectively reviewed children with AT diagnosed with HL at Children’s Cancer Hospital Egypt between July 2007 and July 2024. Data included clinical presentation, disease characteristics, frontline treatment, dose modifications, number of cycles, interim response, and survival. Results: Fourteen patients were identified; median age at diagnosis was 9 years (range, 6-17), and 11/14 were male. Advanced presentation was frequent, with stage IV disease in 7/14 (50.0%) and B symptoms in 6/14 (42.9%). Risk stratification showed 7/14 high-risk, 5/14 intermediate-risk, and 2/14 low-risk disease. Histology was predominantly classical HL, with mixed cellularity in 8/14 (57.1%) and nodular sclerosis in 5/14 (35.7%); 1 case showed features intermediate between diffuse large B-cell lymphoma and classical HL. Frontline treatment was heterogeneous and toxicity-adapted: 4/14 patients received AVPC with 50% dose reduction, 3/14 AVPC with 25% reduction, 1/14 full-dose AVPC, and 4/14 ABVD. One additional patient received 2 cycles of dose-reduced ABVD without doxorubicin, then shifted to dose-reduced COPDAC. The patient with intermediate features received rituximab alone because of very poor general condition. Eleven patients achieved complete metabolic response after 2 cycles, 1 had progressive disease, and 2 died before response evaluation. Despite the high early response rate, all patients ultimately died, predominantly from non-relapse causes, mainly chest infection, respiratory failure, and septic shock. Median survival was 6 months. Conclusion: AT-associated pediatric HL appears highly chemosensitive, but outcomes are dominated by extreme non-relapse mortality, mainly related to infectious, pulmonary, and treatment-related complications. These findings underscore the need for AT-adapted strategies that preserve efficacy while minimizing toxicity, with intensive prophylaxis, pulmonary support, and immune optimization.
  • Nesreen Ali
  • Hany Abdelrahman
  • Emad Moussa
  • Nesreen Radwan
  • Eman Khorshed
  • Sara Badawy
  • Walaa Elsayed
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P077 (P077)

Real-World Outcomes of IGEV Salvage Therapy in Relapsed or Refractory Pediatric Hodgkin Lymphoma: Challenges from a Resource-Limited Setting

Background: Outcomes for relapsed or refractory (R/R) pediatric classical Hodgkin lymphoma (HL) remain suboptimal in low- and middle-income countries (LMICs), where access to timely autologous stem cell transplantation (ASCT), immune checkpoint inhibitors, and targeted therapies is often restricted, limiting salvage treatment options. While the ifosfamide, gemcitabine, vinorelbine, and prednisone (IGEV) regimen is recommended as first-line salvage therapy, real-world data from resource-constrained settings remain scarce. We evaluated the efficacy, toxicity, and stem cell mobilization potential of IGEV, with a focus on treatment delays and their impact on outcomes. Methods: We conducted a retrospective study of children and adolescents (≤18 years) with R/R classical HL treated with IGEV at Children's Cancer Hospital Egypt between August 2021 and December 2022. The response was assessed using FDG PET-CT per EuroNet criteria. Outcomes included overall response rate (ORR), toxicity, stem cell mobilization, event-free survival (EFS), and overall survival (OS). Results: Forty patients were included (median age 12 years); 37.5% had primary refractory disease, 22.5% early relapse, and 40% late relapse. After two cycles of IGEV, ORR was 70% (CR 42.5%, PR 27.5%). Treatment was well tolerated, with grade 3–4 febrile neutropenia in 22.5% and no treatment-related mortality. Among responders, a substantial proportion experienced disease progression while awaiting stem cell collection or ASCT, with a median time to progression of 5.5 months during delays. Only 7 patients proceeded directly to ASCT after successful CD34+ mobilization. At 2 years, OS was 86% while EFS was 33.7%. Inferior EFS was significantly associated with positive interim PET-CT and with primary refractory or early relapsed disease. Conclusions: IGEV demonstrates meaningful efficacy and acceptable toxicity as salvage therapy for pediatric R/R HL in LMIC settings. However, survival outcomes are substantially compromised by delays in ASCT, with progression occurring in a significant proportion of responding patients during the waiting period. These findings highlight a critical gap between response and consolidation in resource-limited settings and underscore the urgent need to improve transplant access and expand availability of novel targeted therapies for high-risk patients. Key words: Hodgkin lymphoma; Pediatric; Relapsed/refractory; IGEV; Low- and middle-income countries
  • Walaa Elsayed
  • Maram Salama
  • Hany Abdelrahman
  • Emad Moussa
  • Yousef Medany
  • Mohamed Saad Zaghloul
  • Madeha El Wakeel
  • Eman Khorshed
  • Esraa Roshdy
  • Nesreen Ali
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P078 (P078)

Baseline and Delta PET/CT Radiomics for Prognostic Stratification in Paediatric Hodgkin Lymphoma

Background: Reliable prognostic biomarkers are needed to improve risk stratification and treatment adaptation in paediatric Hodgkin lymphoma (HL). While conventional PET metrics such as SUVmax and total metabolic tumor volume (TMTV) are clinically established, the added value of longitudinal radiomic heterogeneity features remains incompletely understood. This study investigated the prognostic significance of baseline and delta PET/CT radiomic features for progression-free survival (PFS) in paediatric HL. Methods: A retrospective cohort of 61 paediatric HL patients undergoing FDG PET/CT imaging was analyzed. Clinical, PET, CT, and radiomic features were extracted from baseline and paired longitudinal scans. Baseline metrics included SUVmax, TMTV, total lesion glycolysis (TLG), DMaxBulk, entropy-based texture features, and neighborhood gray-tone difference matrix (NGTDM) features. Longitudinal delta features were computed between sequential scans. Cox proportional hazards analysis, Kaplan–Meier survival analysis (log-rank test), ROC analysis, and subgroup analyses for early- and advanced-stage disease were performed. Optimal prognostic cutoffs were determined using the Youden index. Results: On univariate analysis (UVA), baseline TMTV and DMaxBulk demonstrated significant associations with PFS (p=0.016 and p=0.001, respectively), whereas baseline SUVmax was not predictive (p=0.757). CT NGTDM Complexity showed strong prognostic value (p=0.001), while baseline PET and CT entropy demonstrated borderline significance. ROC analysis with Youden-index optimization identified prognostic cutoffs for MTV, DMaxBulk, TLG, SUVmax, body surface area, and chest ratio, with corresponding Kaplan–Meier stratification analyses confirming significant survival separation for selected biomarkers. On univariate analysis, longitudinal analysis revealed that delta TMTV remained significantly associated with outcome (p=0.016), whereas changes in SUVmax were not predictive (p=0.631). Delta PET NGTDM Strength demonstrated significant prognostic value (p=0.001), supporting the importance of temporal heterogeneity assessment. Subgroup analyses showed that standard early response assessment retained prognostic significance in early-stage patients (p=0.025), while several radiomic biomarkers demonstrated stronger predictive performance in advanced-stage disease. Multivariable modeling suggests incremental prognostic value when combining radiomic biomarkers, clinical variables, and treatment-
  • Claire Gowdy
  • Caron Strahlendorf
  • Andrea C. Lo
  • Yvonne Mbithi
  • Carlos Uribe
  • Arman Rahmim
  • Fereshteh Yousefirizi
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P079 (P079)

Survival benefit of brentuximab vedotin in classical Hodgkin lymphoma: a multicenter real-world study

Background: Classical Hodgkin lymphoma (cHL) is highly curable, yet a meaningful proportion of patients still relapse after frontline chemotherapy, making deeper and more durable first-line responses a key goal. Adding the CD30-directed antibody–drug conjugate brentuximab vedotin (BV) to AVD(Doxorubicin、Vinblastine、Dacarbazine) has increasingly used in clinical practice due to improved survival outcome. However, pivotal comparative evidence derives largely from selected, advanced-stage trial populations, whereas real-world, multicenter data across the full spectrum of disease stages are needed to confirm the benefit of BV+AVD over ABVD(Doxorubicin、Bleomycin、Vinblastine、Dacarbazine) and to inform first-line regimen selection. Applying rigorous propensity-score matching to balance baseline risk, we directly compared first-line BV+AVD with ABVD in a real-world cohort. Methods: Patients with cHL receiving first-line BV+AVD or ABVD were retrospectively analyzed. Response rates were compared by Fisher's exact test. PFS and OS were estimated by Kaplan–Meier curve. To reduce confounding, 1:1 propensity-score matching was used to analyze the survival benefit of different treatment regimens. Results: A total of 356 patients were enrolled, of whom 84 received the BV+AVD regimen and 272 received ABVD regimen. Compared with the ABVD regimen, the BV+AVD regimen achieved higher ORR (96.4% vs 83.8%; P=0.002) and CRR (92.9% vs 66.2%; P<0.001). The 2-year PFS was 86.3% in the whole cohort. The 2-year PFS were 93.6% (95% CI 87.6–100) for BV+AVD versus 78.7% (69.6–89.0) and 74.2% (64.0–86.0) for ABVD (log-rank P=0.015). BV+AVD was associated with significantly improved PFS (HR 0.28, 95% CI 0.09–0.88; P=0.029). After matching, the BV+AVD regimen significantly improved PFS (2-year PFS 93.6% vs 78.7% and 74.2%; log-rank P=0.015; HR 0.28, 95% CI 0.09–0.88). Conclusion: In this multicenter real-world matched analysis, the BV+AVD regimen provided superior PFS and response rates, supporting it as an effective frontline option in routine practice and extending comparative evidence beyond selected trial populations. Longer follow-up is warranted to assess overall survival.
  • Wenhui Zhang
  • Yuanyuan Wang
  • Shaoxuan Hu
  • Ming Jiang
  • Shujuan Wen
  • Weiping Liu
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P080 (P080)

Feasibility of tumor microenvironment analysis in pediatric and adolescent classical Hodgkin lymphoma by automated cyclic immunofluorescence staining

Background: The tumor microenvironment (TME) plays a central role in classical Hodgkin lymphoma (cHL) biology. While the TME has been extensively studied in adult cHL, spatial and single-cell data of pediatric and adolescent patients remain limited. In this study, we implemented cyclic immunofluorescence to characterize the cellular composition of the TME in pediatric and adolescent cHL. Methods: Diagnostic biopsy material from pediatric and adolescent patients treated within the EuroNet-PHL-C1 trial was analyzed (Mauz-Körholz et al., 2023). Early response after two cycles of OEPA was defined as adequate response (AR) with partial morphological remission or greater and PET negativity and inadequate response (IR) when criteria for AR were not met (Mauz-Körholz et al., 2023). Overall, n=39 specimens were assembled in a tissue microarray (TMA). Multiplex phenotyping was performed on TMAs using the MACSimaTM imaging platform and a 28-antibody panel (including CD30, CD3, CD4, CD8a, CD20, CD11c, CD163, CD68, CD56, CD66b, CD45RA, CD45RO, LAG3, TIM3, PD1, PDL1, HLA-DR, HLA-ABC). Single-cell segmentation and phenotyping were performed using StarDist and Nimbus, followed by downstream quantification in QuPath. Results: By standard protocols of multiplex immunophenotyping, Hodgkin-Reed-Sternberg cells (HRSCs) were insufficiently detected and frequently oversegmented (one HRSC erroneously considered as multiple cells due to multinuclearity). We established and optimized a workflow allowing us to reliably identify and localize HRSCs as a prerequisite for spatial analysis in cHL. Moreover, we developed an analysis pipeline that allows us to assign phenotypes to the densely packed cells of the cHL microenvironment, including reliable macrophage detection. Overall, our assay assigned a phenotype to 78.5% of all cells in the tissue. As expected, HRSCs comprised a minority of cells (1.1%) and CD4+ T-cells (44.7%) dominated the TME. The content of B-cells was variable, and NK-cells were rarely detected. M1 macrophages were more abundant than M2 macrophages. Conclusion: We demonstrate feasibility of multiplex immunophenotyping of the TME in cHL using the MACSimaTM imaging platform. We managed to overcome limitations in detecting HRSCs and implemented a data analysis pipeline for the TME of cHL. Data acquisition is currently ongoing and a correlation of TME features and treatment response (AR vs. IR) will be presented at the meeting.
  • Mira Albracht
  • Fatih Yalcin
  • Julia Richter
  • Sarah Reinke
  • Matthias Braun
  • Marius Rohde
  • Alexander Claviez
  • Britta Maecker-Kolhoff
  • Birgit Burkhardt
  • Arndt Borkhardt
  • Tobias Feuchtinger
  • Anja Tröger
  • Martin Ebinger
  • Gabriele Escherich
  • Dominik Schneider
  • Jan-Henning Klusmann
  • Anne Thorwarth
  • Dieter Körholz
  • Christine Mauz-Körholz
  • Wolfram Klapper
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P081 (P081)

Allogeneic stem cell transplantation for multiply recurrent EBV-driven classic Hodgkin lymphoma arising in the setting of suspected activated PI3-kinase delta syndrome (APDS) associated with a novel variant: a case report spanning 13 years

Initial Presentation: Original diagnosis at age 8 was stage IIB EBV+ nodular sclerosis classic Hodgkin lymphoma (cHL). The male patient was treated with escalated BEACOPDac and involved field radiotherapy. First Recurrence: EBV+ cHL re-emerged at age 15. The patient was treated with single agent pembrolizumab every 3 weeks with frank disease progression. Upon arrival to our center, the patient had stage IVB disease and sepsis-like episodes concerning for secondary hemophagocytic lymphohistiocytosis (HLH). Disseminated dermatophyte infection remitted only with systemic terbinafine. Investigating host immunity: Testing for primary immunodeficiency revealed a heterozygous variant of uncertain significance in PIK3CD (c.1013G>A; p.Arg338Gln; CADD score 26.6), concerning for a pathologic variant. Treatment approach: Autologous (auto) versus allogeneic (allo) stem cell transplant were considered. Given that Activated PI3K Delta Syndrome (APDS) was suspected but not definitively diagnosed, potential morbidity of allo, and poor HLA matches in the United States bone marrow repository, auto was recommended. At age 16, after achieving a complete metabolic response to brentuximab vedotin (BV) and bendamustine treatment, the patient had auto with BEAM conditioning. Post-auto course: Approximately 60 days after auto, the patient presented with florid disseminated EBV and secondary HLH (massive splenomegaly, refractory thrombocytopenia, unremitting fever) requiring rituximab and high-dose intravenous immunoglobulin to quell. Received post-auto consolidation with BV per the AETHERA trial. Abnormal marrow signal was detected ~7 months after auto and confirmed by biopsy. Measurable nodal disease emerged shortly thereafter. Clinical trials were considered but the patient was ineligible due to progressive cytopenias. Treated with BV and nivolumab followed by BV and bendamustine per AHOD1721 to provide a >12-week interval between final dose of anti-PD1 checkpoint inhibition and intake for allo. Allo and subsequent course: Allo performed at age 19 with busulfan and fludarabine conditioning and post-allo cyclophosphamide. To ensure an EBV-exposed donor, a cryopreserved 9/10 HLA-matched peripheral blood stem cell product was used. Course complicated by significant colitis and prolonged hospitalization. Today, the patient appears free of cHL 21 months after allo SCT with excellent performance status. Immune evaluation may benefit the youngest with cHL, particularly upon relapse.
  • Joseph deBettencourt
  • Rebecca Hale
  • Jaclyn Schienda
  • Amy Keating
  • Marian Harris
  • Leslie Lehmann
  • Angela Feraco
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T071 (T071)

The Genomic Landscape of Pediatric High-Risk Hodgkin Lymphoma: A Liquid Biopsy Study of COG AHOD1331

abstract talk Abstract Talk in HL in Children and Adolescents (Sunday, 04.10. 08:00)

Background: Pediatric classic Hodgkin lymphoma (cHL) has excellent survival, yet risk stratification relies on baseline clinical and imaging features that incompletely capture disease biology. We hypothesized that circulating tumor DNA (ctDNA) level and derived genomic subtypes, defined at baseline before therapy, are associated with disease burden, and could inform risk. Methods: We studied patients ≥2-<22 years with newly diagnosed high-risk cHL enrolled in COG study AHOD1331 with available blood specimens. Baseline plasma was profiled using CAPP-Seq to detect tumor-derived somatic mutations and quantify ctDNA levels. Baseline ctDNA was dichotomized into high vs low levels using a previously defined threshold (2.5log10 hGE/mL) and classified into genomic subtypes (H1 and H2) using an established algorithm (Alig et al, Nature 2024). Univariate associations between genomic subtype, somatic mutation features, and clinical characteristics including age, stage, and centrally reviewed PET-derived total metabolic tumor volume [TMTV] were evaluated. Results: 323 patients (55%) from the eligible trial cohort had evaluable samples, with median age of 15.7 years (range 3.4-22), 54% male, and stage distribution representative of the overall trial (20.1% bulky IIB, 21.4% IIIB, 28.8% IVA, 29.7% IVB; p=0.86). All patients (100%) had detectable ctDNA at baseline, varying across a broad range (4-23622 hGE/mL, median 129 hGE/mL). Higher pretreatment ctDNA levels were significantly associated with higher TMTV (P<0.001, Fig. 1A), bulky disease (P=0.018, Fig. 1B), large mediastinal adenopathy (LMA; P<0.05, Fig. 1C), B-symptoms (P=0.017, Fig. 1D), and erythrocyte sedimentation rate (ESR; P<0.05, Fig. 1E). Children had significant enrichment of H1 subtype (68.1% in AHOD1331) when compared to adults older than 60 (37.2% in Rossi et al ICML2025, p<0.001, Fig. 1F). H1 tumors harbored significantly higher somatic SNV/Indel counts than H2 counterparts (p<0.001, Fig. 1H). Key genetic alterations had expected recurrence frequencies (Fig. 1G). Conclusion: In the largest genomic study of pediatric cHL to date, we establish the universal detection of baseline ctDNA and enrichment of H1 subtype. We confirm significant associations with key clinical indicators of tumor burden, including baseline TMTV, known to be significantly associated with EFS in this trial. Ongoing analyses of ctDNA at interim and end of therapy are being used to develop a dynamic radiogenomic risk prediction model.
  • Shuyu Shi
  • Lianna J. Marks
  • Hrishikesh K. Srinagesh
  • Lena Osswald
  • Stefan K. Alig
  • Ragini Adams
  • Maya Strohband
  • Xiaoman Kang
  • Mari N Olsen
  • Chih Long Liu
  • Lindsay A. Renfro
  • Lisa Giulino-Roth
  • Kara M. Kelly
  • Tyler J. Bradshaw
  • Maximilian Diehn
  • Steve Yoon-Ho Cho
  • Sharon M Castellino
  • Ash A. Alizadeh
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T072 (T072)

Body-Size Normalisation of Metabolic Tumour Volume in Paediatric Hodgkin Lymphoma: Does MTV/BSA Improve Prognostic Stratification and Reclassify Smaller Children?

abstract talk Abstract Talk in HL in Children and Adolescents (Sunday, 04.10. 08:00)

Background: In paediatric Hodgkin lymphoma (HL), total metabolic tumour volume (MTV) is an established prognostic biomarker, yet published cut-offs apply a single absolute threshold regardless of body size. A 400 mL tumour represents greater relative burden in a 7-year-old (BSA 1.0 m2) than a 17-year-old (BSA 2.0 m2). We investigated whether normalising MTV by body surface area (MTV/BSA) improves prognostic performance and reclassifies smaller children into higher risk groups. Methods: Sixty-one paediatric HL patients (BC Children’s Hospital, 2014–2023; median age 15.6 y, range 7.2–19.5) were included. MTV and TLG were extracted from baseline FDG-PET/CT using an IBSI-compliant pipeline. BSA was available in 55/61 patients. Normalised metrics (MTV/BSA, TLG/BSA) were compared with raw values using ROC analysis, Youden-index cut-offs, Cox regression (HR per 1 SD), and Kaplan–Meier analysis. Reclassification analysis identified patients changing risk categories when MTV/BSA replaced raw MTV. Endpoint: PFS (13/61 events [21%]; median follow-up 4.7 years). Results: BSA correlated weakly but significantly with raw MTV (Spearman r = 0.33; p = 0.026). Despite this, MTV/BSA did not improve prognostic performance (AUC 0.673 vs 0.710; HR 1.31; p = 0.301; see Table 1). TLG was the strongest predictor (AUC 0.746; HR 1.75; p = 0.014) and was not improved by normalisation (TLG/BSA: AUC 0.710; p = 0.081). BSA alone showed moderate prognostic value (AUC 0.707; p = 0.164); progressors had higher median BSA than non-progressors (1.89 vs 1.73 m2). Reclassification analysis (n = 45) showed 3/45 patients (7%) changed risk group as derived statistically: 1 upstaged (MTV 405 mL, BSA 1.30 m2, age 16.6 y; no progression) and 2 downstaged (BSA ≥2.44 m2; no progression). No progressing patient was reclassified. Conclusion: In this adolescent-predominant cohort (age 7–19 y), BSA normalisation of MTV did not improve prognostic discrimination and produced clinically minimal reclassification (3/45 patients; no progressor reclassified). Raw TLG outperformed all normalised metrics. These findings suggest that for the typical paediatric HL age range, absolute volumetric burden is an adequate prognostic surrogate without body-size correction. However, a reclassification signal was observed in one patient with small habitus (BSA 1.30 m2), supporting prospective evaluation in young children (≤ 10 years) with wider BSA variation.
  • Claire Gowdy
  • Caron Strahlendorf
  • Andrea C. Lo
  • Yvonne Mbithi
  • Carlos Uribe
  • Arman Rahmim
  • Fereshteh Yousefirizi

Early stages

Selected for Oral Presentation

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    T082 (T082) Radiation-free initial treatment of early-stage favorable classic Hodgkin Lymphoma (RAFTING) trial: three-year follow-up

    • Andrea Gallamini
    • Kateryna Filonenko
    • Marco Picardi
    • Stephane Chauvie
    • Andrea Riccardo Filippi
    • Maria Cristina Pirosa
    • Luca Guerra
    • Federico Fallanca
    • Marta Bednarek
    • Michał Kurlapski
    • Eva Domingo-Doménech
    • Andrea Visentin
    • Caterina Patti
    • Ramón Garcia Sanz
    • Javier Nunez
    • Javier Lopez
    • Agnieszka Giza
    • Adam Wyszomirski
    • Alessandro Rambaldi
    • Davide Rossi
    • Anna Sureda
    • Jan Maciej Zaucha
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    T083 (T083) Integrating E-HIPI and Interim PET to Refine Risk Stratification in Early-Stage Classic Hodgkin Lymphoma

    • Alessandro Cellini
    • Martina De Ferrari
    • Giovanni Manfredi Assanto
    • Alessandra Romano
    • Gabriella Santuccio
    • Candida Vitale
    • Maria Chiara Montalbano
    • Francesco Angotzi
    • Andrea Serafin
    • Nicolo' Danesin
    • Arianna Bevilacqua
    • Mattia D'Antiga
    • Giovanni Leone
    • Marta Coscia
    • Francesco Di Raimondo
    • Ilaria Del Giudice
    • Francesco Piazza
    • Livio Trentin
    • Andrea Visentin

Posters

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    P084 (P084) Role of consolidative radiotherapy in preventing relapses and subsequently salvage ASCT in early-stage classic Hodgkin lymphoma

    • Reyad Dada
    • John Apostolidis
    • Refaei Belal Ibrahim
    • Asma Ahmed Salem
    • Mostafa Ibrahim Mahmoud
    • Hafiz Asif Iqbal
    • Tarik Boubakra
    • Hamza Ghatasheh
    • Khalid Halahleh
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    P085 (P085) Definition of a risk collective for high cardiac radiation doses - A post-hoc analysis of the HD17 study by the German Hodgkin Study Group reference radiation oncology panel

    • Michael Oertel
    • Christopher Kittel
    • David Rene Steike
    • Michael Fuchs
    • Christian Baues
    • Dirk Vordermark
    • Rita Engenhart-Cabilic
    • Klaus Herfarth
    • Heinz Schmidberger
    • Peter Lukas
    • Peter Borchmann
    • Hans Theodor Eich
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    P086 (P086) TRIAL IN PROGRESS: PRIORITY (PET guided dose Reduction for InvOlved site Radiotherapy In early sTage unfavourable Hodgkin lymphoma: a randomized, phase III, non-inferiority study)

    • Umberto Ricardi
    • Fabio Matrone
    • Barbara Botto
    • Mario Levis
    • Patrizia Ciammella
    • Andrea Evangelista
    • Ilenia Iamundo De Cumis
    • Stephane Chauvie
    • Francesca Ricci
    • Piero Maria Stefani
    • Luigi Rigacci
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    P087 (P087) AHOD2131: A Randomized Phase 3 Response-Adapted Trial Comparing Standard Therapy with Immuno-oncology Therapy for Children & Adults with Newly Diagnosed Stage I & II Classic Hodgkin Lymphoma

    • Jennifer Seelisch
    • Boyu Hu
    • Lindsay A. Renfro
    • Adam DuVall
    • Yue Wu
    • Steve Yoon-Ho Cho
    • Bradford Scott Hoppe
    • Sarah Milgrom
    • Raymond Mailhot Vega
    • Andrea C Lo
    • David Hodgson
    • Lisa Guilino Roth
    • Natalie Grover
    • Ann Steward LaCasce
    • Justine M Kahn
    • Susan Parsons
    • Pamela Sue Hinds
    • Pamela Blair Allen
    • Andrew M. Evens
    • Heiko Schoder
    • Sharon M Castellino
    • Kara M. Kelly
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    P088 (P088) Individualizing Consolidative Radiotherapy in Intermediate-Stage Hodgkin Lymphoma: A PET-Residual Re-Planning Analysis of Patients from the GHSG HD17 Trial

    • David Rene Steike
    • Michael Oertel
    • Patrick Hölken
    • Sebastian Lohmann
    • Nick Schulze
    • Johannes Rosenbrock
    • Michael Fuchs
    • Dirk Vordermark
    • Rita Engenhart-Cabilic
    • Klaus Herfarth
    • Heinz Schmidberger
    • Peter Lukas
    • Christian Baues
    • Bouthaina Dabaja
    • Peter Borchmann
    • Hans Theodor Eich
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    P089 (P089) Real-world implementation of a modified PET-adapted HD17 approach in early-stage Hodgkin lymphoma: a single-centre audit

    • Athanasia Sinti Papadaki
    • Rory Morrice
    • Kirit Ardeshna
    • Kate Cwynarski
    • Satyen Gohil
    • Irfan Kayani
    • Suganya Sivabalasingham
    • Jonathan Lambert
    • Christopher McNamara
    • Sajir Mohamedbhai
    • Michael Northend
    • Hassan Al-Sader
    • Asma Batool
    • Ingo Ringshausen
    • Ali Rismani
    • Andres Virchis
    • William Townsend
    • Maria Marzolini
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    P090 (P090) Omission of Radiotherapy is Associated with Inferior Progression-Free Survival in Bulky and Interim-PET-Positive Early-Stage Hodgkin Lymphoma: A Propensity-Matched Multicenter Real-World Analysis

    • Alexandra Dreyfuss
    • Nikita Dave
    • Alison Moskowitz
    • Joachim Yahalom
    • Maria Alfaro
    • Nicole Birrer
    • Boyu Hu
    • Rachel Koch
    • Zachary Frosch
    • Meryl Colton
    • Carrie Ho
    • Behzad Amoozgar
    • Tatyana Feldman
    • Abhiraj Saxena
    • Joanna Rhodes
    • Ashley Dunton
    • Nirav Shah
    • Amelia Mantione
    • Harper Hubbeling
    • Michael LaRiviere
    • John Plastaras
    • Beatrice Desai
    • Brandon Imber
    • Reid Muenzen
    • Stefan Barta
    • Jordan Carter
    • Elise Chong
    • Michael Cook
    • Daniel Landsburg
    • Sunita Nasta
    • Stephen Schuster
    • Colin Thomas
    • Emily Tomasulo
    • Jakub Svoboda
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    P091 (P091) Characteristic of patients with a positive end of treatment PET or experiencing early relapse despite interim PET negativity: analysis from the EORTC-LYSA-FIL H10 trial.

    • Luigi Rigacci
    • Wouter Plattel
    • Marc Andrè
    • Luigi Marcheselli
    • Berthe Aleman
    • Umberto Ricardi
    • Caterina Christinelli
    • Manuel Gotti
    • Alessandro Re
    • Martin Hutchings
    • Véronique Edeline
    • Monica Bellei
    • Francesco Merli
    • Aspasia Stamatoulas
    • Sanne Tonino
    • Vincent Ribrag
    • Barbara Botto
    • Massimo Federico
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P084 (P084)

Role of consolidative radiotherapy in preventing relapses and subsequently salvage ASCT in early-stage classic Hodgkin lymphoma

Introduction: The role of consolidative radiotherapy (RT) in upfront management of patients with early-stage classic Hodgkin lymphoma (cHL) is subject of debates. Particularly, its impact on preventing relapses and subsequent necessity of salvage autologous stem cell transplantation (ASCT). Patients and methods: We analyzed in this multicenter retrospective study data of patients with early stage cHL. The study evaluates whether the omission of RT increases risk of relapse and consequently need of ASCT. Relapse rates and frequency of ASCT were compared between patients who got combined modality treatment (CMT) versus chemotherapy alone. Total of 490 patients (median age 27, mean follow-up 57 months) were included with 57.8% patients receiving CMT. After end of treatment, complete metabolic remission (CMR) was documented in 90.4% in CMT versus 90.8% in chemotherapy alone arm. 33.3% of patients with positive EOT-PET gained CMR after RT. Relapse rates in chemotherapy alone and CMT cohort were 10.6% and 8.5% (p=0.92), respectively. Of the 42 patients who had r/r disease during observation time 45.2% and 54.7% were in chemotherapy alone and CMT group, respectively. Among these patients, ASCT was carried out in 42.1% in chemotherapy alone and 65.2% in CMT (HR 0.65, 95% CI 0.35–1.18; p = 0.14). Considering both cohorts, overall 8/207 (3.9%) versus 15/283 (5.3%) had ASCT, respectively (p=0.19). Post-ASCT complete metabolic remission rate was similar (80% in CMT vs 75% in chemotherapy alone; p=0.78). Five-years overall survival rate was not different ((HR: 1.03; p=0.95). During the observational period, one patient in the chemotherapy alone group failed ASCT in comparison with three patients in the CMT group corresponding to ASCT failure rate of 12.5% and 20%, respectively. One patient in CMT cohort had allogeneic stem cel transplantation due to relapse post ASCT. Conclusions: Our real-world data suggests that routine consolidative RT can be omitted in patients with early-stage cHL who achieve a negative EOT-PET, without increasing of the likelihood of requiring ASCT. Conversely, RT demonstrates meaningful efficacy in significant proportion of patients with positive EOT-PET. Therefore, we suggest to reserve consolidative RT for responding patients with early-stage cHL with positive EOT-PET, where it confers clear therapeutic benefit.
  • Reyad Dada
  • John Apostolidis
  • Refaei Belal Ibrahim
  • Asma Ahmed Salem
  • Mostafa Ibrahim Mahmoud
  • Hafiz Asif Iqbal
  • Tarik Boubakra
  • Hamza Ghatasheh
  • Khalid Halahleh
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P085 (P085)

Definition of a risk collective for high cardiac radiation doses - A post-hoc analysis of the HD17 study by the German Hodgkin Study Group reference radiation oncology panel

Background: Radiotherapy (RT) is an essential part of modern treatment strategies for Hodgkin lymphoma (HL). However, efficacy has to be careful weighted against putative toxicity. Identifying those patients with high cardiac radiation exposure prior to RT may be a valuable strategy to guide optimization or even omit RT in favor of a chemotherapy-only treatment. We analyzed patients with a high RT dose to the heart within the patient collective of the HD17 study, as a modern study for intermediate-stage HL. Methods: Overall, 176 patients (134 with involved-node RT) were analyzed by the reference radiation oncology panel as part of the study’s quality assurance. The present analysis focusses on patients exceeding dose recommendatios given by the International Lymphoma Radiation Oncology Group. Dosimetric and toxicity data were taken from the radiation plans and documentation by the study central. Results: From the 176 patients evaluated, 139 had a mediastinal involvement, 43 of whom had a mean heart exposure >15 Gy, defined as a threshold for RT plan optimization (mean: 19.8 Gy). Of these 43 patients, the majority had stage II disease (91 %), no B-symptoms (86 %) and was <50 years of age (86 %). Disease spread to both the upper (95 %) and lower (98 %) mediastinum in most cases. Except for the mediastinum, the most prevalent regions were supraclavicular right/left (63 %/77 %) and infraclavicular right/left (61 %/72 %). Concerning GHSG risk factors, mediastinal bulk, extranodal spread, involvment of > 3 lymph node areas and elevated ESR were seen in 47 %, 16 %, 61 % and 35 %, respectively. In comparison to patients with lower heart doses, bulky disease and extranodal spread were seen more frequently in patients with increased heart dose (p=0.043 and p=0.035, respectively). This was in contrast to an elevated ESR (p=0.058), > 3 areas (p=0.552), stage II HL (p=0.722) as well as involvment of the left axilla, lower or upper mediastinum (p=1.0). Conclusion: Pre-chemotherapy risk factors may be suitable predictors for RT dose exposure and can help to identify patients at higher risk for long-term toxicity. Further analysis on the influence of partial mediastinal involvement as well as modern RT techniques will broaden the perspective.
  • Michael Oertel
  • Christopher Kittel
  • David Rene Steike
  • Michael Fuchs
  • Christian Baues
  • Dirk Vordermark
  • Rita Engenhart-Cabilic
  • Klaus Herfarth
  • Heinz Schmidberger
  • Peter Lukas
  • Peter Borchmann
  • Hans Theodor Eich
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P086 (P086)

TRIAL IN PROGRESS: PRIORITY (PET guided dose Reduction for InvOlved site Radiotherapy In early sTage unfavourable Hodgkin lymphoma: a randomized, phase III, non-inferiority study)

Introduction: Treatment of early-stage Hodgkin lymphoma (HL) is extremely successful, with more than 90% cure rate. The mainstay of treatment for early stage Hodgkin's disease includes an approach combining chemotherapy and radiotherapy. The introduction of 18 F-FDG PET for metabolic response assessment has certainly provided the opportunity for a more individualized approach, both in terms of treatment intensification and de-escalation. Therefore, since H10 trial showed that consolidation radiotherapy cannot be safely omitted even in PET-2 negative patients, it becomes now important to re-consider radiation dose de-escalation from the standard 30 Gy to the 20 Gy level in patients achieving a metabolic complete response (mCR) at early PET. Methods: NCT07256158 PRIORITY is a phase III Italian multicentric, randomized, non-inferiority, interventional study. Patients aged  18 years with unfavourable early stage HL according to GHSG criteria will be treated with 2 cycles of ABVD. Patients in mCR according to 2014 Lugano criteria (DS score 1-3) after 2 cycles ABVD will receive two other ABVD cycles (total 4 cycles) and randomized to standard arm of ISRT 30 Gy vs experimental arm with ISRT 20 Gy. Patients in partial response/progressive disease (DS 4-5) will be withdrawn from trial and will receive further treatment at the discretion of the investigators. The primary endpoint is 3-year Progression-Free Survival (PFS) of the randomized population. Secondary endpoints are: Overall Survival (OS) for the randomized population and for the whole population, PFS for the whole population, incidence of adverse events, RT dose received by organs at risk. Exploratory endpoints are planned: performance of risk-adapted automatic RT re-planning in comparison with manual plans used for clinical treatment, prognostic value of baseline metabolic tumour volume (MTV) and/or tumour lesion glycolysis impact on PFS/OS, association between baseline radiomics and clinical characteristics and/or global clinical outcome. Assuming a 3-year PFS in the standard arm (30 Gy) of 92%, with a non-inferiority margin of 7% for the experimental arm (20 Gy), with 80% power (one-sided alpha 5%), and considering eligibility criteria (Deauville score 1-3 after two ABVD cycles), 518 patients must be enrolled to reach the target. Trial has been recently approved by EC and recruitment is ready to start (June 2026) in 38 Italian centers affiliated to FIL (Fondazione Italiana Linfomi)
  • Umberto Ricardi
  • Fabio Matrone
  • Barbara Botto
  • Mario Levis
  • Patrizia Ciammella
  • Andrea Evangelista
  • Ilenia Iamundo De Cumis
  • Stephane Chauvie
  • Francesca Ricci
  • Piero Maria Stefani
  • Luigi Rigacci
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P087 (P087)

AHOD2131: A Randomized Phase 3 Response-Adapted Trial Comparing Standard Therapy with Immuno-oncology Therapy for Children & Adults with Newly Diagnosed Stage I & II Classic Hodgkin Lymphoma

Background: Chemotherapy (CT) in combination with radiotherapy (RT) is the current frontline standard for early-stage (ES) classic Hodgkin lymphoma (HL), with cure rates of >90%. Recently, novel treatments have aimed to maintain high cure rates while minimizing acute and long-term toxicities associated with CT and RT. Incorporation of novel immunotherapy (IO) agents into frontline settings offer new potential therapy options that may reduce exposure to CT and RT while improving progression-free survival (PFS) and maintaining overall survival (OS). Methods: AHOD2131 (NCT05675410) was collaboratively developed between pediatric and adult oncology members of the National Cancer Institute’s National Clinical Trial Network (NCTN), aiming to harmonize frontline IO-based treatment approaches for ES HL. Study champions from each North American cooperative group (NACGs) (Children’s Oncology Group [COG], SWOG, ECOG-ACRIN, Alliance, NRG) and experts in imaging, radiation oncology, HL biology and patient-reported outcomes (PROs) were included in the development. AHOD2131 is a randomized, phase 3 trial for patients ages 5 to 60 years with newly diagnosed stage I/II HL, investigating the addition of brentuximab vedotin (Bv) with nivolumab compared to standard CT +/- RT. The primary objective is to compare PFS of patients treated through a response-adapted, superiority design with either standard or IO (i.e. BV/Nivo) therapies. There are 11 secondary and exploratory study aims. 12-year OS is a key secondary aim. AHOD2131 was activated in April 2023 with a target enrollment of 1875 patients over 5 years. Patients are initially stratified as favorable or unfavorable risk. All patients receive 2 cycles of ABVD followed by interim PET2 (central review). Patients who are PET2 positive (slow early response [SER]) undergo separate randomizations compared to those who are PET2 negative (rapid early response [RER]). SERs receive involved site RT after completion of further systemic therapy while those with RER receive systemic therapy only (Figure). Results: As of 28 April 2026, 395 sites have activated, and 838 participants have enrolled. To date, 49% are <18 years old and 65% are ES unfavorable risk. Conclusion: This COG-led pan-NCTN trial will be the largest study for ES HL in the history of NACGs. AHOD2131 strengthens the effort between NACGs to conduct collaborative clinical trials and aims to harmonize an improved standard of care for ES HL across the age continuum.
  • Jennifer Seelisch
  • Boyu Hu
  • Lindsay A. Renfro
  • Adam DuVall
  • Yue Wu
  • Steve Yoon-Ho Cho
  • Bradford Scott Hoppe
  • Sarah Milgrom
  • Raymond Mailhot Vega
  • Andrea C Lo
  • David Hodgson
  • Lisa Guilino Roth
  • Natalie Grover
  • Ann Steward LaCasce
  • Justine M Kahn
  • Susan Parsons
  • Pamela Sue Hinds
  • Pamela Blair Allen
  • Andrew M. Evens
  • Heiko Schoder
  • Sharon M Castellino
  • Kara M. Kelly
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P088 (P088)

Individualizing Consolidative Radiotherapy in Intermediate-Stage Hodgkin Lymphoma: A PET-Residual Re-Planning Analysis of Patients from the GHSG HD17 Trial

Background: In intermediate-stage Hodgkin lymphoma, consolidative radiotherapy (RT) is increasingly challenged by chemotherapy-only strategies. In the GHSG HD17 trial, patients with PET-positive residuals after chemotherapy received involved-node radiotherapy (INRT) with 30 Gy. However, further limitation of RT field to focal RT to PET+ residuals has not been tested, yet. We therefore performed an exploratory post-hoc re-planning analysis comparing standard INRT with focal PET-residual RT. Methods: Overall, 21 patients (16 female, 5 male) from the GHSG HD17 trial were evaluated. For each patient, the original INRT plan was compared with a focal PET-based re-plan using the PET/CT after four cycles of chemotherapy (2x eBEACOPP followed by 2x ABVD). Focal target volumes included PET-positive residual sites with a small anatomy-adapted margin of approximately 0.8–1.2 cm. Dose-volume histogram endpoints were assessed for target volume and organs at risk, including heart, lungs, esophagus, thyroid, spinal canal, liver and, where applicable, female breast. Paired comparisons used a two-sided Wilcoxon signed-rank test. Relapse patterns were reviewed in relation to the original and focal fields. Results: Focal PET-based re-planning reduced mean PTV from 1194.0 cm3 to 87.0 cm3, corresponding to a 92.7% reduction (p<0.001). Organ-at-risk exposure was significantly reduced, including mean heart dose from 9.6 Gy to 1.5 Gy, esophageal dose from 20.9 Gy to 4.0 Gy, thyroid dose from 22.7 Gy to 2.9 Gy, spinal canal maximum dose from 29.1 Gy to 11.3 Gy, and mean total lung dose from 9.4 Gy to 2.3 Gy (all p<0.001). Total lung V20 decreased from 46.1% to 11.2% (p<0.001). In female patients, total breast mean dose decreased from 4.1 Gy to 0.6 Gy (p=0.016). Two patients later relapsed: one in-field relapse two months after therapy completion, which would have been covered by the focal PTV, and one abdominal relapse outside the thoracic irradiation field after one year. Conclusion: In patients from the GHSG HD17 trial, focal PET-based radiotherapy re-planning reduced target volume by 90% and relevant organ-at-risk dose. There was no recurrence adjacent to the involved regions which would have been covered by INRT but missed by focal RT-only. PET-residual fields therefore merit prospective evaluation as a potential RT de-escalation strategy, with mature relapse-pattern data required before clinical implementation.
  • David Rene Steike
  • Michael Oertel
  • Patrick Hölken
  • Sebastian Lohmann
  • Nick Schulze
  • Johannes Rosenbrock
  • Michael Fuchs
  • Dirk Vordermark
  • Rita Engenhart-Cabilic
  • Klaus Herfarth
  • Heinz Schmidberger
  • Peter Lukas
  • Christian Baues
  • Bouthaina Dabaja
  • Peter Borchmann
  • Hans Theodor Eich
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P089 (P089)

Real-world implementation of a modified PET-adapted HD17 approach in early-stage Hodgkin lymphoma: a single-centre audit

Background: Intermediate risk classical Hodgkin lymphoma (HL) has excellent outcomes,but radiotherapy (RT) contributes to late toxicity. The GHSG HD17 trial demonstrated that RT can be omitted in PET4-negative patients after escalated BEACOPP×2 and ABVD×2. We evaluated real-world feasibility, safety and early outcomes of a PET-adapted HD17 approach at University College London Hospital using an interim PET2 (iPET2) in a subgroup of patients and substituting procarbazine with dacarbazine. Methods: We retrospectively evaluated patients with early-stage HL treated with an HD17-based approach between August2022 and September2025.Patients received escalated BEACOPDac×2 followed by iPET2,performed according to multidisciplinary team decision, with aim to avoid RT.Deauville scores 1–3 were considered negative(neg) ),in contrast to the HD17 trial definition of Deauville scores 1–2 as negative,and 4–5 positive(pos).End-of-treatment(EoT)PET4 response, RT use, toxicity, relapse and survival were reviewed to 1 April 2026. Results: 40 patients were included;median age was 23.5 years.39 had intermediate-stage disease and 1 had early favourable disease but was treated with this approach to avoid RT for mediastinal disease.iPET2 was performed in 28/40 patients(70%):23/28 (82%) were PET2-neg and de-escalated to ABVD×2, all achieving PET4 complete metabolic response (CMR).5 were PET2-pos;2 received additional escalated BEACOPDac×4(HD18 approach),both were EOT PET-pos and 1 required salvage chemotherapy to CMR. 3 PET2-pos patients de-escalated to ABVD×2; 2 achieved PET4 CMR,1 was PET4-pos and received RT to CMR.12 patients did not undergo iPET2;all followed standard HD17 approach,with 1 PET4-positive patient requiring RT to CMR. Overall, PET4 CMR was achieved in 36/40 patients(90%) including 26/28patients(93%) who underwent iPET2.PET4 positivity was confined to mediastinal disease and occurred mainly in the iPET2-pos group.Post-EoT RT was delivered to 1/28 patients(4%) undergoing iPET2 and 2/40 patients(5%) in total cohort.Grade 3–4 toxicity occurred in 20/40 patients, predominantly during escalated BEACOPDac.With median follow-up of 17 months, 39/40 patients were in CMR,1 relapsed and overall survival was 100%. Conclusion: PET-adapted HD17 management achieved high EoT PET negativity with minimal RT use:no iPET2-neg patients were PET4-pos, while 96% avoided RT and 93% achieved PET4 CMR.iPET2 may identify high risk patients in whom HD18 approach can be a RT sparing alternative.
  • Athanasia Sinti Papadaki
  • Rory Morrice
  • Kirit Ardeshna
  • Kate Cwynarski
  • Satyen Gohil
  • Irfan Kayani
  • Suganya Sivabalasingham
  • Jonathan Lambert
  • Christopher McNamara
  • Sajir Mohamedbhai
  • Michael Northend
  • Hassan Al-Sader
  • Asma Batool
  • Ingo Ringshausen
  • Ali Rismani
  • Andres Virchis
  • William Townsend
  • Maria Marzolini
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P090 (P090)

Omission of Radiotherapy is Associated with Inferior Progression-Free Survival in Bulky and Interim-PET-Positive Early-Stage Hodgkin Lymphoma: A Propensity-Matched Multicenter Real-World Analysis

Background: The role of consolidative radiotherapy (RT) in early-stage classic Hodgkin lymphoma (cHL) remains debated, particularly in the era of PET-adapted therapy. We evaluated real-world treatment patterns, outcomes, and toxicity of combined modality therapy (CMT; chemotherapy and RT) v chemotherapy alone. Methods: We identified 810 consecutive patients with stage I-II cHL treated at eight academic centers between 2012 and 2020. Treatment was analyzed by intention-to-treat. Propensity score matching (PSM) by age, stage, sex, and prognosis (favorable v unfavorable per NCCN) yielded 480 patients for comparison of CMT (N=240) vs chemotherapy alone (N=240). Progression-free survival (PFS) and overall survival (OS) were estimated by the Kaplan-Meier method. Subgroups were assessed by disease bulk and interim PET (iPET2) Deauville score (DS). Results: Median age of the entire cohort was 33 (range 18-84); 436 (54%) were female. By intention-to-treat, 300 (37%) received CMT and 510 (63%) chemotherapy alone, with 90% receiving A(B)VD-based regimens. At median follow-up of 5.4 years, 5-year PFS and OS for the full cohort were 82% and 98%, respectively. In the PSM cohort, 5-year OS did not differ between CMT and chemotherapy alone (99% v 97%; p=0.620), but trended towards improved PFS with CMT (87% v 81%; p=0.053; Fig 1A). CMT improved PFS in bulky disease (92% v 73%; Hazard Ratio [HR] 3.8, 95% CI 1.4-10.2; p=0.005) and iPET2 DS≥4 (75% v 52%; HR 3.0, 95% CI 1.1-7.8; p=0.020; Fig 1B-C). Patients receiving CMT were less likely to relapse at sites of prior disease (7% v 18%; p<0.001). iPET2 DS4-5 was associated with inferior 5-year PFS (46%) v DS1-2 (92%) and DS3 (79%; p<0.001). Among iPET-positive patients, those who received unplanned consolidative RT were less likely to require salvage therapy than those treated with chemotherapy escalation alone (29% v 45%; p=0.037). CMT was associated with higher rates of hyperlipidemia, hypothyroidism, and second malignancy, though 69% of second malignancies occurred outside the RT field. Pulmonary fibrosis was more common with 6 v ≤4 cycles of bleomycin (4% v 0.4%; p=0.008) and when it occurred resulted in worse 5-year OS (50% v 99%; p<0.001). Conclusion: In this large cohort, CMT and chemotherapy alone yielded comparable OS, but CMT conferred a PFS advantage in bulky or iPET2-positive (DS≥4) disease. These findings support a risk-adapted approach in which consolidative RT is preferentially considered for high-risk subgroup.
  • Alexandra Dreyfuss
  • Nikita Dave
  • Alison Moskowitz
  • Joachim Yahalom
  • Maria Alfaro
  • Nicole Birrer
  • Boyu Hu
  • Rachel Koch
  • Zachary Frosch
  • Meryl Colton
  • Carrie Ho
  • Behzad Amoozgar
  • Tatyana Feldman
  • Abhiraj Saxena
  • Joanna Rhodes
  • Ashley Dunton
  • Nirav Shah
  • Amelia Mantione
  • Harper Hubbeling
  • Michael LaRiviere
  • John Plastaras
  • Beatrice Desai
  • Brandon Imber
  • Reid Muenzen
  • Stefan Barta
  • Jordan Carter
  • Elise Chong
  • Michael Cook
  • Daniel Landsburg
  • Sunita Nasta
  • Stephen Schuster
  • Colin Thomas
  • Emily Tomasulo
  • Jakub Svoboda
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P091 (P091)

Characteristic of patients with a positive end of treatment PET or experiencing early relapse despite interim PET negativity: analysis from the EORTC-LYSA-FIL H10 trial.

Introduction: Assessment with early positron emission tomography (ePET) is an important predictor of outcome in both limited and advanced stages. The EORTC-LYSA-FIL 20051 H10 trial included patients with untreated favourable and unfavourable localized stage HL patients. The H10 trial was designed to established whether in ePET negative patients (after two cycles of ABVD) radiotherapy could be safely omitted. The aim of this analysis is to evaluate the clinical characteristics and outcome of the subset of patients who were ePET negative but had either a positive end-of-treatment (EoT) PET or experienced early relapse. regardless of treatment arm. Methods: We evaluated all patients who had a negative ePET in both the standard and experimental arms. Considering the accrual period of the study population, October 2006 and July 2009, the evaluation of the response at EoT was done according to the 1999 Cheson criteria. Very few patients had been evaluated with an EoTPET. We compared the characteristics of patients with negative ePET that maintained in remission with patients with negative ePET but who had early treatment failure. Early treatment failure was defined as either a positive EoT PET or progressive disease or start of new treatment within 6 months of EoT. Results: Of 1925 eligible patients 1402 had a negative ePET. Of these, 1064 (76%) achieved a CR/CRu and 59 (4.2%) had early treatment failure. The remaining 279 patient with a partial response did not progress or start second line treatment. By comparing the characteristics of those who maintained in remission versus early relapses we identified significant differences and a multivariate logistic regression analysis showed that stage II with an OR of 2.67 (95% CI 1.54-4.63) and bulky disease defined by MT ratio with an OR 2.24 (95% CI 1.51-3.33) are associated with worse outcome. The overall survival analysis showed that considering patients with an ePET negative early relapse had a significantly worse OS (86%) versus patients maintaining in remission (97%, p <.001). Survival was not significantly different among patients with an early relapse and a positive interim PET (86% vs 89%). Conclusions: While a negative ePET is associated with a favorable prognosis in early stage HL, a small subgroup of patients experience early relapse with stage II disease and MT ratio >0.35 as independent risk factors for early relapse. In concordance with data on patients in advanced stage HL, early relapse among ePET
  • Luigi Rigacci
  • Wouter Plattel
  • Marc Andrè
  • Luigi Marcheselli
  • Berthe Aleman
  • Umberto Ricardi
  • Caterina Christinelli
  • Manuel Gotti
  • Alessandro Re
  • Martin Hutchings
  • Véronique Edeline
  • Monica Bellei
  • Francesco Merli
  • Aspasia Stamatoulas
  • Sanne Tonino
  • Vincent Ribrag
  • Barbara Botto
  • Massimo Federico
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T082 (T082)

Radiation-free initial treatment of early-stage favorable classic Hodgkin Lymphoma (RAFTING) trial: three-year follow-up

abstract talk Abstract Talk in Early Stages (Saturday, 03.10. 13:15)

Background: The RAdiotherapy-Free Treatment for the INitial Therapy of Good-prognosis early-stage (RAFTING) classic Hodgkin Lymphoma (cHL) is a phase 2, multicenter, prospective study to assess feasibility and effectiveness of a risk-adapted therapy for early favorable cHL (efHL). The protocol is an example of a fully personalized medicine approach in a single-patient basis. Methods: Untreated stage I–IIA efHL patients (p.), aged 18–70 years, without bulky, B-symptoms, or extranodal site, were stratified to high (HR), Low (LR) and very-low risk (VLR). HR p. had either or both risk factors (RF): total metabolic tumor volume (TMTV)  84 ml and/or a positive interim PET (PET-2). Very-Low risk (VLR) or Low-Risk (LR) p. were further identified by the absence/presence of one modified EORTC RF, in which bulky was replaced by a large nodal mass (LNM), with a largest diameter 5-10 cm. VLR and LR p. received 2 and 4 ABVD cycles respectively and HR p. 4 ABVD, INRT (20/30 Gy) + Nivolumab (N) 240 mg q2w, for ≤24 doses. VLR/LR p. with ABVD limited relapse (LIR) in initially involved ± up to 3 new nodal sites were rescued by INRT (36 Gy) and N x 24 q2w. Extended Relapse (ER) was considered a therapy failure requiring an off-study salvage. The primary study endpoint is a 3-Y PFS ≥85% in RT-free p., key 2nd endpoint: 3-Y event-free survival (EFS)-failure to planned treatment or death. All the PET/CT scans were centrally reviewed and TMTV measured with a 41% SUV threshold. Results: Between 03/21 to 10/23, 174/180 (97%) stratified p. are evaluable in a per-protocol analysis as follows: 36 p. belonged to VLR, 89 to LR, and 49 to a HR group. Main RF in LR group were: LNM (49), age >50 (30), ESR >50 mm/h (28), and >4 nodal areas (25). Among HR pts, 35 had a high TMTV, 9 – positive PET-2, and 5 – both. 13 RT-free p. relapsed: 10 p. with LIR and 3 ER. 12 relapses occurred within the first 6 months. Ten p. were rescued per protocol and only 1 relapsed later after N. After a median follow-up of 35(5–60) months, 112 RT-free p. (90% of RT-free p., 64% of all p.) remained disease/RT-free. Two deaths (non-relapsed) and 3 secondary malignancies occurred. The 3-year PFS is 88.6%, with a one-sided 80% lower confidence bound of 86.2%, still above the predefined non-inferiority threshold of 85%. The 3-year EFS was 95.3% (95% CI, 91.8–98.9%). Conclusion: The long-term results of the RAFTING trial confirm that a patient risk-adapted approach could cure >95% of the efHL with 64% being RT-free p.
  • Andrea Gallamini
  • Kateryna Filonenko
  • Marco Picardi
  • Stephane Chauvie
  • Andrea Riccardo Filippi
  • Maria Cristina Pirosa
  • Luca Guerra
  • Federico Fallanca
  • Marta Bednarek
  • Michał Kurlapski
  • Eva Domingo-Doménech
  • Andrea Visentin
  • Caterina Patti
  • Ramón Garcia Sanz
  • Javier Nunez
  • Javier Lopez
  • Agnieszka Giza
  • Adam Wyszomirski
  • Alessandro Rambaldi
  • Davide Rossi
  • Anna Sureda
  • Jan Maciej Zaucha
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T083 (T083)

Integrating E-HIPI and Interim PET to Refine Risk Stratification in Early-Stage Classic Hodgkin Lymphoma

abstract talk Abstract Talk in Early Stages (Saturday, 03.10. 13:15)

Background: The E-HIPI is a baseline prognostic index developed to predict 2-year progression-free survival (PFS) in early-stage classic Hodgkin lymphoma (cHL). Since contemporary treatment is also guided by interim PET, we assessed whether PET after 2 cycles of chemotherapy (PET2) refines E-HIPI-based risk stratification. Methods: We retrospectively analysed patients with early-stage cHL treated in 2007-2025 at 4 Italian centres with ABVD- or BEACOPP-based PET-guided approaches. E-HIPI was calculated using published coefficients for sex, maximum tumour diameter, albumin and hemoglobin, applying the original plausibility exclusions. PET2 was classified by Deauville score (DS), with DS 4–5 being considered as positive. Post-PET2 PFS was evaluated by landmark analysis among patients alive and progression-free at interim assessment. E-HIPI was analysed as continuous score and as low risk (<25th percentile) versus non-low risk. A dynamic classification was defined as: low E-HIPI/PET2-negative, non-low E-HIPI/PET2-negative, and PET2-positive. Results: Overall, 264 patients were included; 130 (49%) were female and median age was 31 years. Stage II disease was present in 244 (92%), bulky disease in 84 (32%) and B-symptoms in 64 (24%). After a median follow-up of 62 months, 38 (14%) patients experienced progression or relapse and 8 (3%) died. E-HIPI showed moderate discrimination for 2-year PFS (C-index 0.654, 95% CI 0.55–0.75). PET2 was available in all patients; 242 (92%) were PET2-negative and 22 (8%) PET2-positive. Two-year post-PET2 PFS was 91% after negative PET2 and 35.6% after positive PET2 (HR [8.8, 95% CI 4.4-17.5; p<0.001). The combined model identified an ultra-low-risk group with low E-HIPI and negative PET2, with 2-year post-PET2 PFS of 96.8%, compared with 89.0% in non-low E-HIPI/PET2-negative patients and 35.6% in PET2-positive patients. Compared with all other patients, the low E-HIPI/PET2-negative group had reduced risk of progression or relapse (HR 0.2, 95% CI 0.05-0.97; p=0.04). Conclusions: In this multicentre PET-guided early-stage cHL cohort, PET2 refined baseline E-HIPI risk stratification. Low E-HIPI combined with negative PET2 identified an ultra-low-risk subgroup with excellent disease control, supporting integrated baseline and early-response models for treatment de-escalation studies. PET2-positive patients may require alternative strategies or novel combinations.
  • Alessandro Cellini
  • Martina De Ferrari
  • Giovanni Manfredi Assanto
  • Alessandra Romano
  • Gabriella Santuccio
  • Candida Vitale
  • Maria Chiara Montalbano
  • Francesco Angotzi
  • Andrea Serafin
  • Nicolo' Danesin
  • Arianna Bevilacqua
  • Mattia D'Antiga
  • Giovanni Leone
  • Marta Coscia
  • Francesco Di Raimondo
  • Ilaria Del Giudice
  • Francesco Piazza
  • Livio Trentin
  • Andrea Visentin

Living beyond lymphoma

Selected for Oral Presentation

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    T092 (T092) Patients with a history of Hodgkin lymphoma have lower quality of life than matched comparators regardless of time elapsed since diagnosis

    • Sissel Johanne Godtfredsen
    • Joachim Baech
    • Mikkel Porsborg Andersen
    • Harman Yonis
    • Paw Jensen
    • Peter Kamper
    • Jacob H. Christensen
    • Rasmus Bo-Dahl Sørensen
    • Martin Hutchings
    • Christian Torp-Pedersen
    • Peter Sogaard
    • Henrik Boggild
    • Kristian H. Kragholm
    • Tarec C. El-Galaly
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    T093 (T093) Award winning The MyHodgkin MyHealth App: patient-derived data for tracking Hodgkin Lymphoma survivorship

    • Nicole Wong Doo
    • Angeline A. Josiah
    • Georgia Klemm
    • Lara Meli
    • Alisha Ganesh
    • Janlyn Falconer
    • Ibrahim Tohidi-Esfahani
    • Ryan Low
    • Patrick Lawrence
    • Pietro R Di Ciaccio
    • Eve Propper
    • Nicole Weekes
    • Elizabeth Harris
    • Nathan Chapman
    • Sharon Winton
    • Judith Trotman

Posters

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    P094 (P094) Evidence of Statistical Cure for Hodgkin Lymphoma With Contemporary Treatment: A Non-mixture Cure Model Analysis

    • Jie Chen
    • Yunhong Huang
    • Ming Jiang
    • Zhihua Yao
    • Yue Wang
    • Wenhui Zhang
    • Jun Zhu
    • Yuqin Song
    • Shujuan Wen
    • Yunfei Shi
    • Weiping Liu
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    P095 (P095) Chemotherapy-induced peripheral neuropathy and quality of life among Hodgkin lymphoma survivors treated at an older age - A national cross-sectional study

    • Renate B. Galleberg
    • Kjersti Lia
    • Unn Merete Fagerli
    • Idun B Bø
    • Knut B Smeland
    • Siri Rostoft
    • Marianne J Hjermstad
    • Jeanette Johansen
    • Sameer Bhargava
    • Cecilie E Kiserud
    • Kari Sørland
    • Floortje Mols
    • Øystein Fluge
    • Alexander Fosså
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    P096 (P096) Frailty as a predictor of survival in older patients with classical Hodgkin lymphoma: A retrospective, multicenter study from the RELINF Spanish Lymphoma Registry of the GELTAMO Spanish Lymphoma Group

    • Eva Domingo-Doménech
    • Carmen Martinez Muñoz
    • Rosa Maria Rodriguez Nuñez
    • Blanca Sanchez Gonzalez
    • Miriam Moreno
    • David Alonso Castronuño
    • Maria Jimena Cannata-Ortiz
    • Pilar Gomez Prieto
    • Laurentino Benito
    • Tamara Torrado
    • Joan Buch
    • Carolina Arevalo
    • Juan Carlos Caballero
    • Nazaret Dominguez
    • Raquel Santiago
    • Isabel Gonzalez-Gascon
    • Maria Moya Arnao
    • Cecilia Carpio
    • Maria Dolores Gutierrez-Meca Maestre
    • Luis Antonio Lopez Gomez
    • Eukene Gainza
    • Maria Rocio Figueroa Mora
    • Paula Fernandez-Caldas
    • Paola Villafuerte Gutierrez
    • Samuel Romero
    • Belen Navarro
    • Izaskun Zeberio Etxetxipia
    • Emilia Pardal
    • Antonio Gutierrez
    • Eva Donato
    • Javier Nuñez
    • Teresa Cobo
    • Ramón Garcia Sanz
    • Maria Isabel Gomez Roncero
    • Cristina Barrenetxea
    • Haridian de la Nuez
    • Andrea Dorado Lopez
    • Roberto Trelles
    • Luis Ignacio Sanchez Val
    • Sofia Martin-Consuegra
    • Maria Luisa Bengochea
    • Carmen Maria Alonso Prieto
    • Elena Ramila
    • Maria Jesus Peñarrubia
    • Alfonso Ortiz
    • Ignacio Mahillo
    • Raul Cordoba
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    P097 (P097) The Psychological Impact of Lung Cancer Screening in Hodgkin Lymphoma Survivors

    • Morgan Brusven
    • Tania Seale
    • Kim Linton
    • Rachel Broadbent
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    P098 (P098) Impact of Exercise interventions during chemotherapy in functional capacity and patient-reported outcomes in patients with Hodgkin lymphoma

    • Maren Martinez de Rituerto Zeberio
    • Begoña Mendibil Esquisabel
    • Helena Goicoechea Pellejero
    • Mikel Tous Espelosin
    • Iñigo Olazabal Eizaguirre
    • Jon Madinabeitia
    • June Iriondo Alzola
    • Sara Maldonado Martín
    • Izaskun Zeberio Etxetxipia
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    P099 (P099) Factors Associated with Survivorship Care Engagement Among Pediatric Hodgkin Lymphoma Survivors

    • Ksenya Shliakhtsitsava
    • Anandini Rao
    • Lynn Gargan
    • Cindy Cochran
    • Tanya Watt
    • Eman Rettig
    • Daniel Bowers
    • Rebecca Eary
    • Amy Hughes
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    P100 (P100) Long-term follow up after Lymphoma treatment in young adults

    • Urska Rugelj
    • Lorna Zadravec Zaletel
    • Danijela Štrbac
    • Miha Toplak
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P094 (P094)

Evidence of Statistical Cure for Hodgkin Lymphoma With Contemporary Treatment: A Non-mixture Cure Model Analysis

Background: Whether patients with Hodgkin lymphoma (HL) achieve statistical cure in the modern treatment era remains incompletely characterized. The current study was aimed to estimate overall and subgroup-specific cure fractions, determine cure time, and validate 5-year overall survival (OS) as a surrogate for cure fraction in a large multicenter cohort. Methods: A total of 1,164 HL patients treated between 1996 and 2020 were enrolled. Relative survival was estimated using the Ederer II method with reference to Chinese national life tables. Statistical cure was assessed using a non-mixture cure model; cure fractions were estimated across 13 predefined clinical subgroups. Linear regression evaluated associations between landmark OS rates and cure fractions. Results: Over a median follow-up of 7.2 years, 166 patients (14.3%) died. The estimated overall cure fraction was 91.5% (95% CI, 89.5%–93.5%), with a cure time of approximately 4 to 5 years. Cure fractions varied substantially across subgroups: age ≥60 years (78.7% vs. 93.0%; Δ= 14.3 pp), advanced-stage disease (86.5% vs. 96.1%; Δ= 9.6 pp), ECOG performance status ≥2 (83.6% vs. 93.1%; Δ= 9.5 pp), and B symptoms (86.8% vs. 95.8%; Δ= 9.0 pp). In multivariate analysis, advanced-stage disease (adjusted OR = 0.372; P =0.013) and older age (per 10-year increment; adjusted OR = 0.454; P<0.001) were the independent determinants of reduced cure probability. The 5-year OS rate demonstrated the strongest correlation with subgroup-specific cure fractions (R2 = 0.92; P <0.001). Conclusions: This study provides the first comprehensive population-level evidence of statistical cure in patients with HL, establishing a cure fraction of 91.5% and a cure time of 4 to 5 years. The 5-year OS constitutes a valid surrogate for cure fraction, with direct implications for clinical trial design and individualized survivorship care planning. Keywords: Hodgkin lymphoma; Statistical cure; Cure model; Relative survival; Conditional survival; Cure fraction
  • Jie Chen
  • Yunhong Huang
  • Ming Jiang
  • Zhihua Yao
  • Yue Wang
  • Wenhui Zhang
  • Jun Zhu
  • Yuqin Song
  • Shujuan Wen
  • Yunfei Shi
  • Weiping Liu
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P095 (P095)

Chemotherapy-induced peripheral neuropathy and quality of life among Hodgkin lymphoma survivors treated at an older age - A national cross-sectional study

Background: Chemotherapy induced peripheral neuropathy (CIPN) is a potentially debilitating long-term side effect of Hodgkin lymphoma (HL) treatment that can impact health and lead to a reduced quality of life. In this national cross-sectional study, we evaluated the prevalence and severity of CIPN among older tumor-free HL survivors (HLSs) at a median of 8 years after diagnosis. Methods: Two hundred and ninety HLSs aged >60 years at diagnosis were invited to participate and 193 (67%) completed a 95-item questionnaire including patient-reported outcome measures assessing physical and mental health related quality of life (HRQoL), fatigue, activities of daily living and anxiety/depression. CIPN was assessed via the validated European organisation for research and treatment of cancer, quality of life questionnaire for chemotherapy-induced neuropathy 20 (EORTC QLQ-CIPN20). Findings were compared to a Dutch age– and sex-matched control population. Details regarding treatment were extracted from patient records. Results: Of the consenting participants 185 (96%) had received at least one treatment regimen containing a potentially neurotoxic compound. At a median of 8 years after diagnosis, HLSs reported a significantly higher neuropathy sum score (NSS) than controls (20.8 versus 7.4, p<0.001), irrespective of the neurotoxic agent received (vincristine, vinblastine, brentuximab vedotin or combinations thereof). Dose reductions due to treatment-emergent CIPN was most commonly done in patients receiving vincristine. Development of CIPN CTCAE grade ≥1 during treatment or CIPNCTCAE ≥2 one year or more after treatment predicted a higher NSS at time of survey. Multivariable regression analysis showed a significant association between the total doses of neurotoxic drugs received and NSS, most clearly related to the dose of vincristine. Also, a higher total comorbidity score at survey was positively correlated with NSS. Survivors with higher CIPN symptom burden were significantly more fatigued, had higher levels of anxiety and depression and lower HRQoL at survey, but showed similar levels of independence in functions of daily life. Conclusion: Older HLSs report dose-dependent higher CIPN symptom burden compared to controls at a median of 8 years after treatment. Neuropathy symptom burden was associated with worse fatigue, anxiety, depression and HRQoL, highlighting the long-term impact of treatment-related neuropathy on survivorship outcomes.
  • Renate B. Galleberg
  • Kjersti Lia
  • Unn Merete Fagerli
  • Idun B Bø
  • Knut B Smeland
  • Siri Rostoft
  • Marianne J Hjermstad
  • Jeanette Johansen
  • Sameer Bhargava
  • Cecilie E Kiserud
  • Kari Sørland
  • Floortje Mols
  • Øystein Fluge
  • Alexander Fosså
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P096 (P096)

Frailty as a predictor of survival in older patients with classical Hodgkin lymphoma: A retrospective, multicenter study from the RELINF Spanish Lymphoma Registry of the GELTAMO Spanish Lymphoma Group

Introduction: Survival among older patients with classical Hodgkin lymphoma (cHL) has improved in recent decades. However, outcomes remain poor in patients aged ≥70 years. Frailty has been associated with inferior outcomes and reduced treatment tolerance in hematologic malignancies. Although geriatric assessment is recommended to guide treatment decisions, its implementation in routine practice remains limited. Objectives: To evaluate the impact of comorbidities and frailty on clinical outcomes in older patients with cHL included in the Spanish Lymphoma Registry (RELINF) of the GELTAMO group. Methods: We conducted a retrospective multicenter study including 673 patients aged ≥60 years with cHL from 46 Spanish centers. Baseline characteristics, activities of daily living (ADL), instrumental activities of daily living (IADL), geriatric syndromes, and comorbidities were collected. Comorbidities were assessed using the Cumulative Illness Rating Scale-Geriatrics (CIRS-G). Statistical analyses were performed using R. Results: Median age at diagnosis was 72 years (range, 60–93); 57.8% were male, 65.7% had advanced-stage disease, and 43.9% had extranodal involvement. CIRS scores were available for 417 patients (median, 4; range, 0–13). ADL impairment was present in 13.9%, IADL impairment in 17.7%, and geriatric syndromes in 14.4% of evaluated patients. In the univariate analysis, older age, cardiovascular disease, extranodal involvement, advanced stage, ECOG >2, ADL and IADL impairment, geriatric syndromes, cardiac and psychiatric comorbidities were associated with worse overall survival. Among laboratory parameters, absolute lymphocyte count, hemoglobin, albumin, and erythrocyte sedimentation rate were associated with survival. No significant differences were observed among treatment approaches except for palliative regimens, which were associated with inferior survival (HR 11.5; 95% CI, 7.73–17.2; p<0.001). In the multivariate analysis, age, ECOG performance status, anemia, geriatric syndromes, and palliative treatment remained independently associated with overall survival. Conclusions: Functional reserve and resilience significantly influence survival in older patients with cHL. Comprehensive geriatric assessment should be systematically incorporated into routine clinical practice to identify frailty and patients at higher risk. More effective and safer therapeutic strategies are needed to improve outcomes in this population.
  • Eva Domingo-Doménech
  • Carmen Martinez Muñoz
  • Rosa Maria Rodriguez Nuñez
  • Blanca Sanchez Gonzalez
  • Miriam Moreno
  • David Alonso Castronuño
  • Maria Jimena Cannata-Ortiz
  • Pilar Gomez Prieto
  • Laurentino Benito
  • Tamara Torrado
  • Joan Buch
  • Carolina Arevalo
  • Juan Carlos Caballero
  • Nazaret Dominguez
  • Raquel Santiago
  • Isabel Gonzalez-Gascon
  • Maria Moya Arnao
  • Cecilia Carpio
  • Maria Dolores Gutierrez-Meca Maestre
  • Luis Antonio Lopez Gomez
  • Eukene Gainza
  • Maria Rocio Figueroa Mora
  • Paula Fernandez-Caldas
  • Paola Villafuerte Gutierrez
  • Samuel Romero
  • Belen Navarro
  • Izaskun Zeberio Etxetxipia
  • Emilia Pardal
  • Antonio Gutierrez
  • Eva Donato
  • Javier Nuñez
  • Teresa Cobo
  • Ramón Garcia Sanz
  • Maria Isabel Gomez Roncero
  • Cristina Barrenetxea
  • Haridian de la Nuez
  • Andrea Dorado Lopez
  • Roberto Trelles
  • Luis Ignacio Sanchez Val
  • Sofia Martin-Consuegra
  • Maria Luisa Bengochea
  • Carmen Maria Alonso Prieto
  • Elena Ramila
  • Maria Jesus Peñarrubia
  • Alfonso Ortiz
  • Ignacio Mahillo
  • Raul Cordoba
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P097 (P097)

The Psychological Impact of Lung Cancer Screening in Hodgkin Lymphoma Survivors

Background: People previously treated for Hodgkin lymphoma (HL) are at increased risk of developing lung cancer. This study examined the psychological impact of receiving an invitation and undergoing lung cancer screening in HL survivors enrolled in a single-centre low-dose CT (LDCT) screening pilot. Methods: One hundred and twenty-six HL survivors were invited to complete questionnaires measuring health-related quality of life (Short Form 12 (SF-12)); anxiety (State-Trait Anxiety Inventory (STAI-6)); severity of worry (Brief Worry Score (BWS)), and frequency of cancer worry (Revised Impact of Events (RIES)). Questionnaires were completed at invitation (baseline), pre-LDCT and 2, 6 and 12 months post-LDCT. Results: Ninety-nine participants completed all questionnaires; a further 24 completed baseline questionnaires before declining further participation in the pilot. Three participants were diagnosed with lung cancer and did not complete follow-up questionnaires. The mean age of participants was 52, and the mean years since treatment completion was 21. 67% were never smokers. Cancer worry severity (BWS) was elevated at baseline and remained elevated during follow-up. Across all questionnaires, higher scores were observed among younger participants, those treated with ABVD chemotherapy compared to other chemotherapy regimens, and those with fewer years since treatment completion. Participants who completed baseline questionnaires only and did not undergo LDCT reported significantly higher baseline anxiety and cancer worry than those who underwent LDCT screening. Identification of indeterminate pulmonary nodules on LDCT was not associated with significant differences in psychological outcomes. Conclusions: HL survivors demonstrated high cancer worry severity at baseline and over the 12 months following invitation to lung cancer screening. It remains unclear whether these levels reflect pre-existing cancer-related concern or are influenced by the screening process itself, showing a neutral impact on worry. Further research in larger, more diverse cohorts is needed to clarify the impact of lung cancer screening on cancer worry, anxiety, and quality of life and to inform supportive care strategies for this high-risk population.
  • Morgan Brusven
  • Tania Seale
  • Kim Linton
  • Rachel Broadbent
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P098 (P098)

Impact of Exercise interventions during chemotherapy in functional capacity and patient-reported outcomes in patients with Hodgkin lymphoma

Background: Exercise interventions (EI) during chemotherapy may improve functional capacity (FC) and patient-reported outcomes in patients with Hodgkin lymphoma (HL). However, the relationship between objective exercise performance, fatigue, and quality of life (QL) after treatment completion remains insufficiently characterized. The aim of this preliminary analysis from the EDONOLA study was to examine the subgroup of patients with HL and explore associations between functional capacity and QL outcomes. Methods: QL questionnaires (HM-PRO and QLQ-FA12) and functional capacity assessments (Modified Shuttle Walk Test [MSWT] and Cardiopulmonary Exercise Testing [CPET], were analysed. Patients were evaluated before (T0) and after (T2) ABVD CT combined with either an EI or usual care. Ten adults with HL requiring systemic treatment were included (mean age: 44 years; 80% female) . Descriptive statistics were used to summarize the data and are presented as medians and interquartile ranges (IQR). Changes from T0 to T2 were explored descriptively, and Spearman’s rank correlation coefficients were calculated to assess associations. Results: The EI group demonstrated greater improvements in FC than the control group. The median increase in MSWT distance was 80 m in the EI group compared with 50 m in the control group (Table 1). Correlation analyses revealed weak-to-moderate associations between changes in FC and changes in QL for fatigue, although none reached statistical significance. A moderate negative correlation was observed between changes in MSWT distance and HM-PRO Part A scores (r = –0.44, p = 0.38), suggesting that greater improvements in walking performance may be associated with better perceived health status. The EI group showed larger improvements in both absolute and relative VO2peak values. Conclusions: Comparison of changes from T0 to T2 showed a favourable trend in the EI group relative to the control group. Median changes in FC measures suggest greater improvements following the EI. The observed negative correlation between MSWT distance and HM-PRO Part A scores may indicate that improved FC is associated with fewer limitations in daily activities and better perceived QL. Although the EI group demonstrated enhanced cardiorespiratory fitness, considerable inter-individual variability was observed, and no statistically significant associations were confirmed. Given the limited sample size, these findings should be considered exploratory.
  • Maren Martinez de Rituerto Zeberio
  • Begoña Mendibil Esquisabel
  • Helena Goicoechea Pellejero
  • Mikel Tous Espelosin
  • Iñigo Olazabal Eizaguirre
  • Jon Madinabeitia
  • June Iriondo Alzola
  • Sara Maldonado Martín
  • Izaskun Zeberio Etxetxipia
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P099 (P099)

Factors Associated with Survivorship Care Engagement Among Pediatric Hodgkin Lymphoma Survivors

Background: Childhood Hodgkin lymphoma (HL) survivors remain at risk for treatment-related late effects and require long-term survivorship follow-up. Factors associated with sustained survivorship care engagement remain poorly characterized. We leveraged a longitudinal cohort of childhood HL survivors to identify factors associated with ongoing engagement in survivorship care. Methods: We conducted a retrospective cohort study of pediatric HL survivors diagnosed before age 19 years who attended at least one survivorship clinic visit between 2013 and 2024. Demographic, treatment, and survivorship data were obtained from an electronic health record-based survivorship database. Survivors were risk-stratified for late effects based on chemotherapy and radiation exposures. Survivorship engagement was assessed using the Attendance Continuity Score (ACS), defined as the ratio of observed to expected survivorship visits according to institutional follow-up recommendations. Survivors were categorized as engaged or disengaged based on longitudinal attendance patterns. Results: Fifty-four HL survivors were included. Median age at diagnosis was 10.9 years, and median time from therapy completion to first survivorship visit was 3.0 years. All survivors received chemotherapy, 53.7% received radiation therapy, and 7.4% underwent hematopoietic stem cell transplantation. Overall, 51.9% were classified as high risk for severe late effects, while 29.6% were at high risk for infertility and 29.6% for secondary breast cancer. Forty-one survivors (75.9%) were classified as engaged and 13 (24.1%) as disengaged. Disengaged survivors were younger at survivorship referral (11.8 vs 14.2 years, p=0.030), first survivorship visit (12.5 vs 14.9 years, p=0.036), and last survivorship visit (15.3 vs 17.6 years, p=0.022). ACS was significantly lower among disengaged survivors (0.54 vs 1.31, p<0.001). Treatment exposures and late-effects risk profiles did not differ between groups. Conclusions: Nearly one-quarter of pediatric HL survivors disengaged from survivorship care despite substantial risk for treatment-related late effects. Younger age at survivorship referral and program entry was associated with subsequent disengagement, whereas treatment intensity and late-effects risk were not. Earlier entry into survivorship care alone may be insufficient to ensure long-term engagement, highlighting the need for developmentally and culturally tailored survivorship and transition strategies.
  • Ksenya Shliakhtsitsava
  • Anandini Rao
  • Lynn Gargan
  • Cindy Cochran
  • Tanya Watt
  • Eman Rettig
  • Daniel Bowers
  • Rebecca Eary
  • Amy Hughes
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P100 (P100)

Long-term follow up after Lymphoma treatment in young adults

Background: In Slovenia, a specialized late-effects follow-up clinic for childhood cancer survivors has been in operation for 40 years. During the past 20 years, we have also included survivors treated for lymphoma in young adulthood. Given the excellent cure rates of Hodgkin lymphoma and the long life expectancy of survivors, long-term follow-up is essential. Active surveillance for treatment-related late effects and their timely management can help reduce morbidity and improve quality of life among survivors. At our institution, we analyzed data on late effects among patients with Hodgkin lymphoma treated in Slovenia between 1983 and 2010. Methods: The Cancer Registry of the Republic of Slovenia provided data on all patients diagnosed with and treated for Hodgkin lymphoma in Slovenia aged 18 to 30 years. Data on late effects were obtained from the medical records of the Late Effects Follow-up Clinic and subsequently analyzed statistically. Results: We analyzed the data of 413 patients. At the time of data cut-off, 337 patients were alive, and 76 patients had died. In 46 patients, the cause of death was lymphoma, in 16 a second malignant disease, 4 died because of acute myocardial infarction, 1 had GVHD, and 10 died of other causes. Among patients in follow-up, 37.5% had at least one manifestation of cardiovascular disease. A total of 79 patients developed a second malignant neoplasm. The most common second malignancy was breast cancer (n = 13), followed by non-melanoma skin cancer (n = 12), thyroid cancer (n = 11), gynecological cancers (n = 11), hematologic malignancies (n = 5), lung cancer (n = 4), melanoma (n = 4), other lymphomas (n = 3), central nervous system tumors (n = 3), and head and neck cancers (n = 3). Two patients developed prostate cancer, while one patient each developed colorectal cancer, liver cancer, bladder cancer, and sarcoma. In survivors exposed to abdominal irradiation, colonoscopy has been advised and has been performed in 60% of eligible patients. Carcinoma was detected in one patient and lymphoma in another, while other findings included benign and premalignant lesions. Additional late effects evaluated included gonadal dysfunction, thyroid disease, metabolic syndrome, chronic kidney disease, chronic pulmonary disease, and psychological disorders. Conclusion: Hodgkin lymphoma survivors face significant late morbidity. Risk-adapted lifelong follow-up is crucial for detecting and managing treatment-related complications.
  • Urska Rugelj
  • Lorna Zadravec Zaletel
  • Danijela Štrbac
  • Miha Toplak
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T092 (T092)

Patients with a history of Hodgkin lymphoma have lower quality of life than matched comparators regardless of time elapsed since diagnosis

abstract talk Abstract Talk in Living Beyond Lymphoma (Sunday, 04.10. 15:30)

Background: Modern treatment strategies have led to excellent survival rates for Hodgkin lymphoma (HL); however, the long-term burden of the disease remains a concern. This study examines health-related quality of life (QoL) in individuals with HL compared to a matched general population cohort, with a specific focus on time since HL diagnosis. Methods: A cross-sectional digital survey was conducted, inviting all patients with a history of HL in Denmark and up to 10 age- and sex-matched general population comparators per patient. QoL was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Core-30 questionnaire (QLQ-C30). Adjusted mean differences (MD) between groups were calculated using linear regression, adjusted for age and sex, and stratified by time since HL diagnosis: 0–5 years (short follow-up [FU]), >5–10 years (medium FU), and >10 years (long FU). Minimal clinically important difference (MCID) thresholds were defined as small (MD >5–10 points), moderate (MD >10–20 points), and large (MD >20 points). Results: The final study population included 1,519 individuals with a history of HL (37% of 4,156 invited) and 5,110 comparators (12% of 41,558 invited). By time since diagnosis, 245 individuals were in the short group (with 703 comparators), 234 in the medium group (with 718 comparators), and 1,040 in the long group (with 3,689 comparators). Median time since HL diagnosis was 16 years (IQR: 8–28). QoL was clinically meaningfully lower than in patients with a history of HL compared to comparators across all time strata (QLQ-C30 summary score for short FU: 84 [95% CI: 82-86] vs. 91 [95% CI: 91-92]; medium: 85 [95% CI: 83-87] vs. 93 [95% CI: 92-93]; long: 86 [95% CI: 85-87] vs. 92 [95% CI: 91-92]). Patients with previous HL reported clinically meaningfully higher levels of fatigue, dyspnea, pain, insomnia, and financial difficulties than comparators (Table 1). Notably, fatigue levels appeared to improve with increasing time since diagnosis, whereas dyspnea appeared to worsen over time. Conclusion: A history of HL was associated with a persistent QoL gap compared to age- and sex-matched general population comparators. The enduring nature of these deficits suggests the need for specialized survivorship initiatives.
  • Sissel Johanne Godtfredsen
  • Joachim Baech
  • Mikkel Porsborg Andersen
  • Harman Yonis
  • Paw Jensen
  • Peter Kamper
  • Jacob H. Christensen
  • Rasmus Bo-Dahl Sørensen
  • Martin Hutchings
  • Christian Torp-Pedersen
  • Peter Sogaard
  • Henrik Boggild
  • Kristian H. Kragholm
  • Tarec C. El-Galaly
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T093 (T093)

The MyHodgkin MyHealth App: patient-derived data for tracking Hodgkin Lymphoma survivorship

abstract talk Abstract Talk in Living Beyond Lymphoma (Sunday, 04.10. 15:30)

Award winning Karl Musshoff Prize: Best Clinical Abstract

Background: Very long term follow up (LTFU) after HL therapy remains essential to track long-term sequelae. Ideal features of a LTFU tool include longitudinal design, reach to diverse populations, capture of patient-reported outcomes (PROs), sustainability and patient acceptability. The MyHodgkin MyHealth (MHMH) App (ANZCTRN12624001013550) was developed in partnership with HL consumers to meet these needs. Methods: MHMH participants download the App to review study information and self-consent in-App. Access to the Pilot is limited within Australia. The .NET MAUI cross-platform App feeds separate encrypted Amazon Web Server databases keeping identifiable information separate from responses to questionnaires. Baseline survey results are presented here; longitudinal follow-up and PRO modules will go live in Q3-4 2026. Results: MHMH launched in March 2025. As of 12 June 2026, 300 participants are enrolled, 231 have entered survey data. Of these, 77.5% baseline surveys are complete. Age at diagnosis was median 37.5y (range 14.7-83.8y). Residence was metropolitan (68.9%), regional/rural (27.8%), remote (1%). Median time from diagnosis to enrolment was 42.5 mths (range 2.1m – 53y). First line treatment was reported in 225/231: chemo alone (64.4%), chemo/radiotherapy (25.8%), chemo/immunotherapy (4.4%), chemo/immuno/radiotherapy (1.3%), radiotherapy (2.2%). First-line chemo regimen was reported in 199: 117 (58.8%), received ABVD, 40 (20.1%) escBEACOPP, other in 17, and 20 unsure. In 23/193 respondents there were 32 second cancer events: non-melanoma skin cancer (10), non-Hodgkin lymphoma (5) and lung (3), breast (3) and thyroid (2) cancers. There was an association between radiotherapy and developing a second cancer (OR 2.45, 95% CI 1.01-5.94, p=0.03). In 192 respondents, 26 self-reported a new or worsening lung condition since completing HL therapy, with a trend toward an association with radiotherapy (OR 2.24, 95%CI 0.96-5.19, p=0.07) but not bleomycin (OR 0.8, 95%CI 0.32-1.98, p=0.64). Regarding neuropathy, 120/192 (65.5%) self-reported experiencing neuropathic symptoms after treatment. Conclusion: MHMH demonstrates proof of concept of a mobile App platform developed in close partnership with HL consumers, putting HL research into the hands of survivors. Recruitment is ongoing and future plans include integration of MHMH as a PRO and LTFU tool in clinical trials is planned and scale-up to global research populations.
  • Nicole Wong Doo
  • Angeline A. Josiah
  • Georgia Klemm
  • Lara Meli
  • Alisha Ganesh
  • Janlyn Falconer
  • Ibrahim Tohidi-Esfahani
  • Ryan Low
  • Patrick Lawrence
  • Pietro R Di Ciaccio
  • Eve Propper
  • Nicole Weekes
  • Elizabeth Harris
  • Nathan Chapman
  • Sharon Winton
  • Judith Trotman

NLPHL

Selected for Oral Presentation

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    T101 (T101) Single-Nuclei and Spatial Transcriptomic Analysis of Nodular Lymphocyte-Predominant Hodgkin Lymphoma (NLPHL)

    • Hua Dong
    • Samira Rambow-Makhzami
    • Max Vorneweg
    • Finn Wichmann
    • Philipp Jurmeister
    • Ina Bühnen
    • Andreas Rosenwald
    • Wolfram Klapper
    • Bastian von Tresckow
    • Christian Reinhardt
    • Frederik Klauschen
    • Heinz-Wolfram Bernd
    • Martin-Leo Hansmann
    • Dennis Eichenauer
    • Sylvia Hartmann
    • Florian Rambow
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    T102 (T102) Malignant LP cells build a stroma-poor, avascular niche that concentrates IDO1+ macrophages and excludes regulatory T cells in NLPHL and THRLBCL

    • Ilja Kalashnikov
    • Suvi-Katri Leivonen
    • Kerttu Kalander
    • Matias Autio
    • Johannes Dunkel
    • Anniina Färkkilä
    • Sirpa Leppä

Posters

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    P103 (P103) Data Scarcity in Rare Lymphoma: Synthetic Patient Generation and Survival Analysis in NLPHL

    • Gabriele Santangelo
    • Eleonora Fresi
    • Virginia Ferretti
    • Martha Berliner
    • Sofia Pedrali
    • Alessandro Mazzacane
    • Arianna Dagliati
    • Manuel Gotti
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    P104 (P104) Pembrolizumab In Relapsed/Refractory Nodular Lymphocyte-Predominant Hodgkin Lymphoma: A Case Report

    • Pedro Rodrigues Santos
    • Francesca Pierdomenico Maciel
    • Pedro Sousa
    • Gonçalo Esteves
    • José Cabeçadas
    • Maria Gomes da Silva
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    P105 (P105) Management and Outcomes in Pediatric Nodular Lymphocyte-Predominant Hodgkin Lymphoma: Evidence from a Brazilian Multicenter Cohort

    • Adriana Morais
    • Juliana Costa
    • Ana Rosa Costa
    • Monica Palese
    • Michael Binkley
    • Jamie Flerlage
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P103 (P103)

Data Scarcity in Rare Lymphoma: Synthetic Patient Generation and Survival Analysis in NLPHL

Background: Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare B-cell lymphoma with generally favorable survival but risk of relapse and transformation, and limited evidence for standardized treatment due to small cohorts. Rituximab is a key therapeutic option, but data scarcity restricts robust clinical conclusions. In this context, synthetic data generation is investigated as a strategy to address data scarcity by expanding data availability while preserving the statistical and clinically relevant properties of real-world cohorts, enabling more reliable survival and treatment-response analyses in rare disease settings. Methods: Real-world anonymized NLPHL patient data derived from a multicenter data collection coordinated by IRCCS Policlinico San Matteo in Pavia were used, including longitudinal clinical, laboratory, treatment, and outcome variables. Synthetic data were generated using a diffusion-based architecture for mixed-type tabular data, with generation conditioned on treatment type (rituximab-based vs conventional therapy). Synthetic data quality was assessed through replication of Kaplan–Meier progression-free survival (PFS) analyses compared with the real cohort, using disease progression as the event of interest and time from treatment initiation to progression as survival time. Results: The real-world cohort comprised 292 patients, while the synthetic dataset included 1000 patients after post-processing removal of anomalous samples. Preliminary survival analyses compared PFS between real and synthetic cohorts. Kaplan–Meier PFS curves and corresponding confidence intervals were evaluated; log-rank test showed no significant difference between curves (p=0.9). Conclusion: This study evaluated a conditional diffusion model for synthetic data generation in NLPHL, a rare disease with limited cohort sizes. Conditioning on treatment allowed generation of synthetic cohorts preserving clinically relevant distributions, with utility supported by agreement between real and synthetic Kaplan–Meier survival curves. However, results are limited by the retrospective single-cohort design and small sample size, and synthetic data should be considered complementary to real data. Future work should explore outcome-conditioned generation and multi-center validation to improve time-to-event modeling and robustness.
  • Gabriele Santangelo
  • Eleonora Fresi
  • Virginia Ferretti
  • Martha Berliner
  • Sofia Pedrali
  • Alessandro Mazzacane
  • Arianna Dagliati
  • Manuel Gotti
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P104 (P104)

Pembrolizumab In Relapsed/Refractory Nodular Lymphocyte-Predominant Hodgkin Lymphoma: A Case Report

Background: Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare B-cell malignancy, accounting for 5-6% of Hodgkin lymphomas, usually with very favorable outcomes. However, 20-30% of patients will relapse, with a 10-year risk of transformation into an aggressive large B-cell Lymphoma of 4-10%. The management of relapsed/refractory (R/R) NLPH remains challenging. While PD-1 blockade has established activity in classical Hodgkin lymphoma, data in NLPHL are scarce. Case Report: A 24-year-old male presented in 2018 with stage IIA NLPHL (unknown histological variant at diagnosis), located in the inguinal region. He was first treated with 4 cycles of ABVD and involved-field radiotherapy but relapsed 2 years later, with retroperitoneal disease and B symptoms. A new biopsy confirmed NLPHL and he received rituximab monotherapy (4 infusions), achieving a partial response. A year later he complained of lumbar pain and stage IV disease was demonstrated, with multiple extranodal sites (pleural, peritoneal and bone marrow). Third line with ESHAP was started, with the intention to consolidate with high dose chemotherapy and autologous stem cell transplantation (SCT), but no response was obtained. At this time a new biopsy excluded transformation and showed a type D histological variant. Stage IV disease was present. The patient started a fourth line with rituximab-bendamustine, again progressing under treatment and requiring dorsal radiotherapy for pain control. A new biopsy confirmed persistence of NLPHL with PD1 expression in tumor microenvironment T-Cells. At this time a sixth line treatment was proposed with pembrolizumab monotherapy. After 6 cycles complete metabolic response (CMR) was achieved, with resolution of extensive nodal, pleural, pulmonary, paravertebral and bone disease. Patient then underwent consolidation with allogeneic SCT with a matched unrelated donor and reduced intensity conditioning in March 2026. Complete metabolic response is ongoing. Conclusion: This case illustrates the potential use of PD-1 blockade as an effective salvage and bridging strategy to allogeneic SCT in the rare instance of heavily pre-treated NLPHL. Durable CMR was achieved in this patient, previously refractory to five chemotherapy regimens. This data support further investigation of checkpoint inhibition at earlier lines in this uncommon lymphoma subtype.
  • Pedro Rodrigues Santos
  • Francesca Pierdomenico Maciel
  • Pedro Sousa
  • Gonçalo Esteves
  • José Cabeçadas
  • Maria Gomes da Silva
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P105 (P105)

Management and Outcomes in Pediatric Nodular Lymphocyte-Predominant Hodgkin Lymphoma: Evidence from a Brazilian Multicenter Cohort

Childhood nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare, indolent lymphoma lacking an evidence-based standard of care worldwide. In Brazil, where resources can be scarce, non-specific therapeutic protocols developed for other lymphoma subtypes are often used, but there are no data to understand current practices and patient outcomes. A retrospective analysis of data from patients treated for NLPHL at Brazilian centers is necessary to assess these fundamental baseline data. This multicenter retrospective study aims to analyze the clinical, histopathological, and therapeutic profile of pediatric NLPHL cases in Brazil. Secondary objectives include characterizing immunohistochemistry findings and evaluating clinical outcomes. In partnership with Global nLPHL One Working Group (GLOW) and the Consorcio Latinoamericano de Enfermedades Hemato-oncologicas Pediatricas (CLEHOP) members, 27 Brazilian institutions were invited to participate in a retrospective study of NLPHL. Patients aged <19 years diagnosed with NLPHL between January 2023 and June 2025 were included. Data were extracted from physical and electronic medical records using standardized electronic spreadsheets. Statistical analysis was descriptive. Preliminary analysis includes 15 patients from 7 institutions. The cohort has male predominance (80%). Most patients were diagnosed at early stages: 47% at stage I, 47% at stage II, and 6% at stage IV. Immunohistochemistry showed CD20 positivity in 100% of cases and CD30 positivity in 27% of cases. Management strategies included observation after surgical resection in 27% (4/15), chemotherapy + radiotherapy in 6% (1/15) and chemotherapy alone in 67% (10/15),with primarily CVP-based regimens. Rituximab was added in 90% of these chemotherapy regimens (10/11). With a median follow-up of 22.6 months, 80% achieved a complete response, while 3 patients (20%) experienced disease recurrence, with one death after disease progression. Notably, 2 of the 3 patients who relapsed had been managed with observation alone, and all of them were rescued with chemotherapy afterward. Preliminary results from this Brazilian registry indicate that although pediatric NLPHL appears to have an excellent overall outcome, disease recurrence remains a significant issue even in early-stage patients. This systematic collection of this multicenter data is essential for building evidence to understand how to support strategies for this rare cancer .
  • Adriana Morais
  • Juliana Costa
  • Ana Rosa Costa
  • Monica Palese
  • Michael Binkley
  • Jamie Flerlage
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T101 (T101)

Single-Nuclei and Spatial Transcriptomic Analysis of Nodular Lymphocyte-Predominant Hodgkin Lymphoma (NLPHL)

abstract talk Abstract Talk in NLPHL (Monday, 05.10. 09:30)

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) typically exhibits favorable prognosis compared to classical Hodgkin lymphoma. However, a subset of patients experience disease relapse, which can be difficult to manage, particularly in early relapses. The molecular mechanisms underlying relapse remain poorly understood. Characterization of lymphoma (LP) cells and their spatial interactions within the tumor microenvironment is crucial for understanding relapse biology and developing precision medicine approaches. We performed single-nuclei RNA sequencing and spatial transcriptomic profiling on FFPE samples from NLPHL patients stratified by relapse status, revealing cellular heterogeneity at single cell resolution. Nuclei from 17 patients (n=9 R, n=8 NR) were analyzed, yielding 80,855 high-quality nuclei after quality control. Following Harmony integration (by patient) to correct batch effects, nuclei were clustered using Seurat's Louvain algorithm to identify nine distinct major cell types using marker gene combinations. Single-nuclei analysis revealed distinct transcriptional profiles distinguishing LP cells from normal B cells, with candidate biomarker genes showing expression differences between relapse and non-relapse patients. CellChat analysis based on snRNA-seq data identified complex intercellular communication networks involving multiple ligand-receptor pairs across different cell types. Spatial transcriptomics was performed using the 10x Genomics Xenium platform, followed by cell type annotation through label transfer from snRNA-seq data, identifying 30 cellular subtypes at single-cell resolution and revealing the characteristic popcorn-like structures where LP cells are encircled by T cells. Our integrated approach combining single-cell transcriptomics with spatial validation provides comprehensive insights into NLPHL relapse mechanisms at cellular and molecular levels. The spatially validated intercellular communication networks suggest candidate therapeutic targets, potentially informing future approaches in NLPHL treatment.
  • Hua Dong
  • Samira Rambow-Makhzami
  • Max Vorneweg
  • Finn Wichmann
  • Philipp Jurmeister
  • Ina Bühnen
  • Andreas Rosenwald
  • Wolfram Klapper
  • Bastian von Tresckow
  • Christian Reinhardt
  • Frederik Klauschen
  • Heinz-Wolfram Bernd
  • Martin-Leo Hansmann
  • Dennis Eichenauer
  • Sylvia Hartmann
  • Florian Rambow
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T102 (T102)

Malignant LP cells build a stroma-poor, avascular niche that concentrates IDO1+ macrophages and excludes regulatory T cells in NLPHL and THRLBCL

abstract talk Abstract Talk in NLPHL (Monday, 05.10. 09:30)

Background: Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare B-cell malignancy in which infrequent neoplastic lymphocyte-predominant (LP) cells reside within an immunologically active tumor microenvironment (TME) typically surrounded by T-follicular helper (Tfh) rosettes. In contrast, THRLBCL loses these rosettes and shifts to a macrophage-rich TME. Whether the LP cell reprograms its neighbors remains unknown. Design: We performed 20-marker cyclic immunofluorescence (CyCIF) on 1.53 million cells from 27 patients (16 NLPHL and 11 THRLBCL). Cells were segmented, scored for per-marker positivity with an in-house phenotyping pipeline, and assigned to 33 single-cell phenotypes using a fixed marker-rule scheme spanning lymphoid, myeloid, and functional states. We compared cellular composition across entities. For each phenotype, we quantified enrichment within 50 μm of LP cells relative to the tissue-wide background (per-patient log2 fold change, Wilcoxon vs tissue-wide, BH-FDR) and related spatial features to event-free survival (EFS). Results: Median age was 53 years (range 16-75), and most patients were male (24/26). Over a median 17-year follow-up, 7 relapses (NLPHL 4, THRLBCL 3), 1 transformation (NLPHL), and 9 deaths (NLPHL 5, THRLBCL 4) occurred. From NLPHL to THRLBCL, bystander B cells were depleted (41% to 6%, q<0.001) and all macrophage subsets increased, most markedly IDO1+ macrophages (0.7% to 3.0%, q<0.01). Four phenotypes showed peri-LP enrichment or exclusion that was significant in both entities, defining a conserved niche. IDO1+ M1-like macrophages were enriched within 50 μm of LP cells, whereas regulatory T cells, myofibroblasts, and endothelial cells were excluded (q<0.05). In NLPHL, the niche was further enriched for PD1+ CD4+ Tfh rosettes, dendritic cells, and activated helper and cytotoxic T cells. In THRLBCL, these enrichments were absent, and the peri-LP niche was instead enriched for IDO1+ M2-like macrophages. The disease entity was not prognostic (for EFS, P=0.62). Within NLPHL, peri-LP macrophage features showed a consistent but FDR-nonsignificant trend toward worse EFS (q=0.3). Conclusion: Across NLPHL and THRLBCL, LP cells organize a conserved local niche by recruiting IDO1+ macrophages and excluding regulatory T cells and stroma. CD4+PD1+ rosettes also mark this niche in NLPHL and are replaced by an IDO1+ macrophage program toward THRLBCL. Spatial prognostic biomarkers will require larger cohorts.
  • Ilja Kalashnikov
  • Suvi-Katri Leivonen
  • Kerttu Kalander
  • Matias Autio
  • Johannes Dunkel
  • Anniina Färkkilä
  • Sirpa Leppä

Relapsed and refractory

Selected for Oral Presentation

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    T106 (T106) Phase 1 PRIMAVERA Study of the PRMT5 Inhibitor AZD3470 in Patients with Relapsed/Refractory Classic Hodgkin Lymphoma

    • Pier Luigi Zinzani
    • Franck Morschhauser
    • Vincent Ribrag
    • Elizabeth H. Phillips
    • Herve Ghesquieres
    • Hun Ju Lee
    • Peter Borchmann
    • Paul J. Bröckelmann
    • Tae Min Kim
    • Katharine Lewis
    • Jakub Svoboda
    • Antonia Rodriguez Izquierdo
    • Won Seog Kim
    • Anna Sureda
    • Graham P. Collins
    • Kaitlyn Beyfuss
    • Cedric Dos Santos
    • Richard F. Olsson
    • Enrico Derenzini
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    T107 (T107) Treatment patterns and survival outcomes of patients relapsing after frontline Nivolumab-AVD in advanced stage classical Hodgkin lymphoma (cHL)

    • Harsh Shah
    • Allison Bock
    • Peirong Hao
    • Xi Qiao
    • Robert Stuver
    • Swetha Thiruvengadam
    • Azra Borogovac
    • Reid Merryman
    • Nicole Araujo
    • Ayo Falade
    • Samin Houshyar
    • Daniel Reef
    • Gordon Smilnak
    • Kanithra Sekaran
    • Efrat Luttwak
    • Dahlia Sano
    • Ajay Major
    • Ritwick Mynam
    • Grace Baek
    • John Sharp
    • John Vaughn
    • Praveen Ramakrishnan Geethakumari
    • Sanjal Desai
    • Jessica Allen
    • Kelsey Baron
    • Tiffany Chang
    • Nivetha Ganesan
    • Vrutti Patel
    • Marisa Palmeri
    • Anuja Abhyankar
    • Drew Gerber
    • Madiha Iqbal
    • Hua-Jay Cherng
    • Alex Niu
    • Joanna Rhodes
    • Jakub Svoboda
    • Catherine Diefenbach
    • Timothy Voorhees
    • Mengyang Di
    • Priyanka Pophali
    • Yasmin Karimi
    • Reem Karmali
    • Krithika Shanmugasundaram
    • Natalie Grover
    • Urshila Durani
    • Ivana N. Micallef
    • Jonathan W. Friedberg
    • Tatyana Feldman
    • Matthew Mei
    • Pallawi Torka
    • Philippe Armand
    • Alison Moskowitz
    • Alex Herrera
    • Narendranath Epperla
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    T108 (T108) Primary Analysis of the GHSG Pembro-CORE Trial: PET-Adapted PD-1-Based Salvage Therapy Omitting High-Dose Chemotherapy in First-Relapsed Hodgkin Lymphoma

    • Hishan Tharmaseelan
    • Ina Bühnen
    • Helen Kaul
    • Sarah Gillessen
    • Carsten Kobe
    • Karin G. Schrenk
    • Philipp Ernst
    • Max S. Topp
    • Ulf Schnetzke
    • Nico Freund
    • Stephanie Sasse
    • Wolfram Klapper
    • Michael Fuchs
    • Sven Borchmann
    • Paul J. Bröckelmann
    • Peter Borchmann
    • Bastian von Tresckow

Posters

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    P109 (P109) Immune Checkpoint Inhibitor Combined with Radiotherapy for Relapsed/Refractory Classical Hodgkin Lymphoma: A Transplant-Free Retrospective Study

    • Yue Liu
    • Jingnan Wang
    • Yunpeng Wu
    • Xin Liu
    • Yongwen Song
    • Shu-Nan Qi
    • Ye-Xiong Li
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    P110 (P110) How to manage BrECADD failure? Early Outcomes of Second-Line Treatment in classic Hodgkin Lymphoma

    • Christian Peter Jaworek
    • Janina Jablonski
    • Lisa Marie Sgonina
    • Annika Rudat
    • Pascal Fichtel
    • Thomas Melchardt
    • Susanne Ghandili
    • Andreas Rank
    • Mathias Hänel
    • Julia Meissner
    • Theresa Halbsguth
    • Hishan Tharmaseelan
    • Justin Ferdinandus
    • Paul J. Bröckelmann
    • Peter Borchmann
    • Bastian von Tresckow
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    P111 (P111) KEYFORM-008: Randomized Phase 2 Study of Coformulated Favezelimab/Pembrolizumab Versus Chemotherapy in Participants With Relapsed or Refractory Classic Hodgkin Lymphoma

    • Paul J. Bröckelmann
    • David Lavie
    • Guilherme Perini
    • Muhit Ozcan
    • Nathalie Johnson
    • Won Seog Kim
    • Carolina Mahuad
    • Norma Gutiérrez
    • Senem Maral
    • Cecile Borel
    • Tae Min Kim
    • Iara Goncalves
    • Deepa Jagadeesh
    • Yasmin Karimi
    • Nina Wagner-Johnston
    • John Timmerman
    • Ryan Lynch
    • Graham P. Collins
    • Yulia Sidi
    • Pallavi Pillai
    • Rushdia Yusuf
    • Alex Herrera
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    P112 (P112) Preliminary Results of Nivolumab and Axatilimab in Patients with Relapsed/​Refractory Classical Hodgkin Lymphoma refractory to anti-PD-1 therapy

    • Harsh Shah
    • Dipenkumar Modi
    • Kenneth Boucher
    • James Marvin
    • Jerry Zak
    • Anthony Pomicter
    • Kelsey Baron
    • Daniel Ermann
    • Alison Moskowitz
    • Radhakrishnan Ramchandren
    • Deborah Stephens
    • Boyu Hu
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    P113 (P113) Eight-year outcomes after nivolumab discontinuation in patients with relapsed/refractory classic Hodgkin lymphoma

    • Liudmila Fedorova
    • Kirill Lepik
    • Polina Kotselyabina
    • Elena Kondakova
    • Andrey Chekalov
    • Evgeniya Borzenkova
    • Natalia Mikhailova
    • Alexander Kulagin
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    P114 (P114) Low-Dose Nivolumab Combined with Salvage Chemotherapy in Relapsed/Refractory Classic Hodgkin Lymphoma: Outcomes from a Tertiary Care Centre in North India

    • Charanpreet Singh
    • Aditya Jandial
    • Arihant Jain
    • Alka Khadwal
    • Rajender Basher
    • Amanjit Bal
    • Gaurav Prakash
    • Pankaj Malhotra
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    P115 (P115) Outcomes in Double-Exposed Classical Hodgkin Lymphoma: The Impact of Treatment Sequence and Salvage Strategies After Brentuximab Vedotin and Checkpoint Inhibitor Failure

    • Massimiliano Marinoni
    • Tomohiro Aoki
    • Sita Bhella
    • Inna Gong
    • Robert Kridel
    • Vishal Kukreti
    • Anca Prica
    • Abi Vijenthira
    • Chloe Yang
    • Woodrow Wells
    • Danielle Rodin
    • David Hodgson
    • Michael Crump
    • John Kuruvilla
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    P116 (P116) PD-1 Inhibitor maintenance after Auto-HCT in r/r Classical Hodgkin lymphoma with prior PD-1 exposure: interim phase II results

    • Polina Kotselyabina
    • Aminat Balaeva
    • Liudmila Fedorova
    • Vladimir Bogatyrev
    • Nikita Shorokhov
    • Nikita Mochkin
    • Mobil Akhmedov
    • Mariya Vernyuk
    • Irina Cherkashina
    • Azat Karabekov
    • Vladislav Sarzhevskiy
    • Elena Demina
    • Vadim Keimakin
    • Natalia Mikhailova
    • Alexander Kulagin
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    P117 (P117) Association of prior PD-1 inhibitor exposure with pre-engraftment syndrome after ASCT in relapsed/refractory Hodgkin lymphoma

    • Dávid Tóthfalusi
    • Gréta Melani Csatlós
    • Boglárka Dobó
    • Fanni Borics
    • László Imre Pinczés
    • Árpád Illés
    • Zsófia Miltényi
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    P118 (P118) Autologous hematopoietic cell transplantation remains relevant despite PD-1 inhibitor-based second-line therapy in classic Hodgkin lymphoma: interim results from the Prolgo-HL study

    • Liudmila Fedorova
    • Polina Kotselyabina
    • Kirill Lepik
    • Andrey Chekalov
    • Vladislav Markelov
    • Valeria Shpirko
    • Anastasia Semenova
    • Gayane Tumyan
    • Stanislav Volchenkov
    • Angelina Piletskaya
    • Ilya Zyuzgin
    • Natalia Konoplya
    • Natalia Mikhailova
    • Alexander Kulagin
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    P119 (P119) Efficacy of Ultra-Low-Dose Nivolumab in Combination with Gemcitabine and Cisplatin as Remission-Induction Therapy in Primary Progressive and Relapsed Hodgkin Lymphoma: A Randomized Phase II study with two ultra-low-dose schedules

    • Mithun Prakash
    • Nutan Joshi
    • Sujith Karumathil
    • Sushil Selvarajan
    • Sharon Lionel
    • Uday Kulkarni
    • Aby Abraham
    • Biju George
    • Vikram Mathews
    • Anu Korula
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    P120 (P120) From Clinical Trials to Clinical Practice: A Decade of Experience with Nivolumab in Relapsed/Refractory Classical Hodgkin Lymphoma

    • Alice Sykorova
    • Jan Koren
    • Eva Maule
    • Lubica Gaherova
    • Marie Lukasova
    • Juraj Duras
    • Katerina Steinerova
    • Pavla Stepankova
    • Blanka Vackova
    • Jozef Michalka
    • Jana Markova
    • Vit Prochazka
    • Barbara Brizova
    • Marek Trneny
    • Zdenek Kral
    • Petra Blahovcova
    • Heidi Mocikova
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    P121 (P121) Brentuximab vedotin as bridging and maintenance therapy in hematopoietic cell transplant in a national access program for relapsed or refractory classical Hodgkin lymphoma patients

    • Omar Fernandez-Vargas
    • Maria Silvia Rivas-Vera
    • Gladys Agreda-Vásquez
    • Ingrid Mucius
    • Marco Balandrán-Ruíz
    • David Gómez-Almaguer
    • Jorge Cruz-Rico
    • Perla Colunga-Pedraza
    • Carolina Balderas-Delgado
    • Carlos Best
    • Gabriel Barragán
    • Mariela Cardiel
    • María Luisa Alcivar
    • Sergio Galvez-Acosta
    • Rosa Elena Sosa
    • Daniela Pérez Karen
    • Ana Lucía Ron-Magaña
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    P122 (P122) BCL-2 Inhibition Combined with Other Therapeutic Agents Demonstrates Synergistic Efficacy in Hodgkin Lymphoma Cells

    • Alex Niu
    • Noah Brosnick
    • Cory Mavis
    • Matthew Cortese
    • Francisco Hernandez-Ilizaliturri
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    P123 (P123) Real-World Data on the Single-Agent Pembrolizumab Therapy in Relapsed / Refractory Classic Hodgkin Lymphoma Patients in the Czech Republic.

    • Jozef Michalka
    • Heidi Móciková
    • Katarína Hradská
    • Alice Sýkorová
    • Vít Procházka
    • František Folber
    • Eva Maule
    • Ľubica Gahérová
    • Juraj Ďuraš
    • Barbora Obadalová
    • Pavla Štěpánková
    • Marie Lukášová
    • Zdeněk Král
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    P124 (P124) Activity of Nivolumab with Decitabine Cedauzurine (DEC-C) in Relapsed/Refractory Hodgkin Lymphoma (cHL): Results from an ETCTN Phase 1 Study

    • Justin Kline
    • Joseph Tuscano
    • Guarav Goyal
    • Matthew Mei
    • Alison Davis
    • Geoff Shapiro
    • Catherine Diefenbach
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    P125 (P125) Three cycles of nivolumab (N) before BGD chemotherapy improves the remission rate before autologous hematopoietic cell transplantation (aHCT) in relapsed/refractory Hodgkin Lymphoma: N-BURGUND trial of the Polish Lymphoma Research Group (PLRG).

    • Michal Taszner
    • Ewa Paszkiewicz-Kozik
    • Adam Wyszomirski
    • Justyna Rybka
    • Karolina Chromik
    • Agnieszka Kołkowska-Leśniak
    • Edyta Subocz
    • Łukasz Targoński
    • Paulina Ceklarz
    • Magdalena Witkowska
    • Ryszard Swoboda
    • Katarzyna Domańska-Czyż
    • Agnieszka Giza
    • Małgorzata Kobylecka
    • Conrad-Amadeus Voltin
    • Joanna Romejko-Jarosińska
    • Beata Ostrowska
    • Monika Świerkowska
    • Agnieszka Druzd-Sitek
    • Michał Kurlapski
    • Marta Bednarek
    • Bogdan Małkowski
    • Grzegorz Romanowicz
    • Janusz Hałka
    • Tomasz Wróbel
    • Sebastian Giebel
    • Grzegorz Helbig
    • Ewa Lech-Marańda
    • Jan Maciej Zaucha
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    P126 (P126) REAL WORLD EFFICACY AND SAFETY COMPARISON OF SALVAGE REGIMENS COMBINING BRENTUXIMAB VEDOTIN AND CHEMOTHERAPY IN SECOND-LINE HODGKIN LYMPHOMA: A LYSA MULTICENTER RETROSPECTIVE STUDY.

    • Juliette Wencel
    • Arnaud Pages
    • Florian Chevillon
    • Robin Noël
    • Lucie Laemmel
    • Maxime Vignac
    • Emilie Corvilain
    • Pamela Sfeir
    • Milena Kohn
    • Guillemette Fouquet
    • Maxence Lohez
    • Baptsite Delapierre
    • Gaétan Basile
    • Gaelle Laboure
    • Amina Cherait
    • Carole Soussain
    • Adrien Grenier
    • Thorsten Braun
    • Laure Ricard
    • Axel Andre
    • Bénédicte Deau
    • Morgane Cheminant
    • Jean Galtier
    • Pilar Dutari
    • Loïc Renaud
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    P127 (P127) (Bv)DHAP + G-CSF as an effective peripheral stem cell mobilization regimen in adult patients with relapsed/refractory Hodgkin lymphoma

    • Maryia Shapetska
    • Igar Iskrau
    • Marta Valevskaya
    • Olga Gerasimovich
    • Victoria Smolnikova
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    P128 (P128) EHA-4448 REAL-WORLD OUTCOMES OF PEMBROLIZUMAB PLUS GVD AS SALVAGE THERAPY AND BRIDGE TO AUTOLOGOUS STEM CELL TRANSPLANTATION IN RELAPSED/REFRACTORY CLASSICAL HODGKIN LYMPHOMA: A MULTICENTER GATLA STUDY

    • Astrid Pavlovsky
    • Fernando Warley
    • Luciano Salvano
    • Maria Orlova
    • Luciana Guanchiale
    • Laura Korin
    • Carolina Mahuad
    • Jose Ignacio Trucco
    • Amalia Cerutti
    • Florencia Negri Aranguren
    • Guadalupe Antelo Perez
    • Bruno Wannesson
    • Javier Romano
    • Lautaro Sardu
    • Veronica Musso
    • Etelvina Lucia MacChiavello
    • Nadia Scebba
    • Trinidad Viviani
    • Lorena Fiad
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    P129 (P129) You Don't Always Need a Transplant: Checkpoint Inhibitors Can Deliver Lasting Remissions in Relapsed and Refractory Classical Hodgkin Lymphoma

    • Vivek Radhakrishnan
    • Rida Shakeel
    • Deedar Singh
    • Robert Lown
    • Sean Lim
    • David Dutton
    • Angharad Pryce
    • Luke Bennett
    • Andrew Bates
    • Andrew Davies
    • Peter Johnson
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    P130 (P130) Second-Generation Epigenetic Clocks Reveal Accelerated Biological Aging in Relapsed/Refractory Hodgkin Lymphoma

    • Mahek Shah
    • Anuja Abhyankar
    • Nour Nassour
    • Francisco Hernandez-Ilizaliturri
    • Joyce Ohm
    • Alex Niu
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    P131 (P131) Autologous Stem Cell Transplantation after Anti-PD-1 Therapy in Heavily Pretreated Patients with Relapsed/Refractory Classical Hodgkin Lymphoma: Real-World Outcomes

    • Iuliia Protopopova
    • Nikita Mochkin
    • Vladislav Sarzhevskiy
    • Elena Demina
    • Vladimir Melnichenko
    • Nikita Shorokhov
    • Anastasia Samoylova
    • Aisel Mamedova
    • Anna Bannikova
    • Anatoliy Rukavitsyn
    • Elena Smirnova
    • Vladimir Bogatyrev
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    P132 (P132) Allogeneic Hematopoietic Stem Cell Transplantation for Relapsed/Refractory Classical Hodgkin Lymphoma in the Brentuximab Era: Updated Single-Center Experience

    • Natalya Milanovich
    • Alena Dziuba
    • Oksana Marozava
    • Yury Strongin
    • Oksana Nechay
    • Tatsiana Talako
    • Natalia Volkovets
    • Aliaksandr Avadok
    • Anatoly Uss
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    P133 (P133) Recurrent Hemophagocytic Lymphohistiocytosis and Hepatic Failure in EBV-Associated Hodgkin Lymphoma

    • Ignacio Tobarra
    • Marc Bosch
    • M Laura Fox
    • Josep Castellví
    • Cristina García
    • Pau Abrisqueta
    • Cecilia Carpio
    • Jhon Kevin Fuentes
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    P134 (P134) IMPACT OF PRE-TRANSPLANT BRENTUXIMAB VEDOTIN ON TOXICITIES AND OUTCOMES OF AUTOLOGOUS STEM CELL TRANSPLANTATION IN PATIENTS WITH RELAPSED/REFRACTORY HODGKIN LYMPHOMA

    • Clara Sanches
    • Miguel Neto
    • Filipa Osório
    • Ana Isabel Brito
    • Margarida Badior
    • Inês Carvalhais
    • Ana Carneiro
    • Pedro Medeiros
    • Filipa Moita
    • Ana Luísa Pinto
    • Ricardo Pinto
    • Fernanda Trigo
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    P135 (P135) Immunophenotyping of CD8+ T cells from classical Hodgkin Lymphoma patients treated with PD-1 blockade

    • Matthew Salaciak
    • Tho-Alfakar Al-Aubodah
    • Samantha Worme
    • Laura Widawski
    • Claudia L. Kleinman
    • Ioannis Ragoussis
    • Ryan Rys
    • Madelyn Abraham
    • Angelo Rizzolo
    • Paige McCallum
    • Christophe Goncalves
    • Gerben Duns
    • Christian Steidl
    • Sonia Del Rincon
    • Koren K. Mann
    • Ciriaco Piccirillo
    • Francois E. Mercier
    • Nathalie Johnson
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    P136 (P136) Post-ASCT Brentuximab Vedotin (BV) maintenance in high-risk relapsed/refractory Hodgkin lymphoma in the era of novel salvage therapies: a bias-adjusted analysis of 4 LYSA real-world cohorts.

    • Amira Marouf
    • Tesla Murari Mirimo
    • Jean Galtier
    • Gaétan Basile
    • Pilar Dutari
    • Cédric Rossi
    • Fanny Cherblanc
    • Loïc Chartier
    • Krimo Bouabdallah
    • Robin Noel
    • Hervé Ghesquières
    • Bénédicte Deau-Fischer
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    P137 (P137) Anti PD1 containing salvage regimen is highly effective in chemorefractory HL patients

    • Francesca Pierdomenico Maciel
    • Carolina Freitas
    • Diana Viegas
    • Inês Coelho
    • Maria Inês Barbosa
    • Alina Ionita
    • Susana Carvalho
    • Maria Gomes da Silva
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P109 (P109)

Immune Checkpoint Inhibitor Combined with Radiotherapy for Relapsed/Refractory Classical Hodgkin Lymphoma: A Transplant-Free Retrospective Study

Background: Despite advances with immune checkpoint inhibitors (ICIs) in relapsed or refractory classical Hodgkin lymphoma (r/r cHL), many patients still require intensive consolidation. Combining ICIs with modern radiotherapy (RT) may provide a non-transplant salvage alternative. Methods: We retrospectively analyzed patients with biopsy-proven r/r cHL treated at a single institution (2018–2024) who received ICIs (with or without chemotherapy) and modern RT (volumetric modulated arc therapy or tomotherapy), delivered concurrently or sequentially (interval ≤ 3 months). The treatment outcomes were analyzed according to clinical factors, and toxicities were displayed. Results: Twenty-eight patients were included, and 64.3% had primary refractory disease and 78.6% relapsed after frontline ABVD. Ten patients (35.7%) received ICI monotherapy, while the remainder received ICI-based combinations. All patients completed modern RT. At a median follow-up of 36.5 months (range 4.1–75.4), the estimated 3-year progression-free survival (PFS) and overall survival (OS) rates were 79.6% and 100%, respectively. Six relapses (21.4%) occurred exclusively outside irradiated fields. PFS was significantly associated with stage IV disease and high GHSG score (both P<0.001). Treatment was well tolerated, with no grade ≥3 radiation-related adverse events. Conclusion: ICIs combined with modern RT achieved high rates of durable disease control in selected patients with r/r cHL and may represent a viable non-transplant salvage strategy. Prospective studies are warranted to define optimal patient selection and integration with systemic therapy.
  • Yue Liu
  • Jingnan Wang
  • Yunpeng Wu
  • Xin Liu
  • Yongwen Song
  • Shu-Nan Qi
  • Ye-Xiong Li
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P110 (P110)

How to manage BrECADD failure? Early Outcomes of Second-Line Treatment in classic Hodgkin Lymphoma

While PET-guided BrECADD achieves high primary cure rates in classic Hodgkin lymphoma (cHL), the few relapsing or primary refractory cases may be difficult to treat. In this setting, high-dose chemotherapy (HDCT) followed by autologous stem cell transplantation (autoSCT) is usually indicated. Herein, we analyze salvage strategies and early outcomes in patients after failure of BrECADD. To better understand the optimal salvage strategy after BrECADD failure, we performed a retrospective multicenter real-world study. Inclusion criteria were (1) BrECADD as 1st line therapy, (2) refractory/relapsed cHL, (3) HDCT in 2nd line planned (intention-to-HDCT) or performed. Centers in Austria, Germany, Israel, and Switzerland were invited to contribute eligible cases. For this early-results analysis, data collection focused on patient and disease characteristics, salvage treatment approaches, treatment response and outcomes with descriptive analyses. 19 eligible patients were included at data cutoff on 22 April 2026. 13 (68%) completed therapy and for 6 (32%), treatment is ongoing. Salvage comprised conventional chemotherapy in 13 patients (68%; DHAP, n=10; DHAC, n=2; ASHAP, n=1) and PD1 inhibitor-based regimens in 6 patients (32%; Pembro-GVD, n=5; Nivo-ICE, n=1). Among patients who completed upfront conventional salvage, 3/10 (30%) experienced further progression and were subsequently switched to PD1 inhibitor-based therapy. After completion of therapy, relapse occurred in 1/10 patients (10%) treated with upfront conventional salvage, while no relapse was observed after upfront PD1 inhibitor-based salvage. Radiotherapy was administered in 4/13 patients (31%). Consolidation therapy included brentuximab vedotin in 4/13 (31%; received or ongoing), and pembrolizumab in 2/13 (15%; received or ongoing). Febrile neutropenia occurred in 5/19 patients (26%; grade 3 n=4, grade 4 n=1), neuropathy in 3/19 (16%; grade 2 n=3), and mucositis after HDCT in 2/13 (15%; grade 1 n=1, grade 2 n=1). Median observation time was 11 months (range 0-64; n=19) and median follow-up after HDCT was 12 months (range 2-63, n=13). In conclusion, early outcomes after BrECADD failure appear overall favorable, with responses to both conventional and PD1 inhibitor-based salvage in selected patients. PD1-based approaches show activity, including in chemotherapy-refractory cases. Subgroup analyses remain limited by small numbers.
  • Christian Peter Jaworek
  • Janina Jablonski
  • Lisa Marie Sgonina
  • Annika Rudat
  • Pascal Fichtel
  • Thomas Melchardt
  • Susanne Ghandili
  • Andreas Rank
  • Mathias Hänel
  • Julia Meissner
  • Theresa Halbsguth
  • Hishan Tharmaseelan
  • Justin Ferdinandus
  • Paul J. Bröckelmann
  • Peter Borchmann
  • Bastian von Tresckow
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P111 (P111)

KEYFORM-008: Randomized Phase 2 Study of Coformulated Favezelimab/Pembrolizumab Versus Chemotherapy in Participants With Relapsed or Refractory Classic Hodgkin Lymphoma

Background: PD-1 blockade (eg, pembrolizumab) is standard treatment for relapsed or refractory (R/R) classic Hodgkin lymphoma (cHL), but most patients experience progressive disease (PD), and optimal post–PD-1 therapy is undefined. Favezelimab (anti-LAG3) plus pembrolizumab showed promising activity and manageable safety in participants (pts) with anti–PD-1–refractory R/R cHL in a phase 1/2 study. We report results from KEYFORM-008 (NCT05508867), a randomized, open-label, phase 2 study of coformulated favezelimab/pembrolizumab vs chemotherapy in anti–PD-1–refractory R/R cHL. Methods: Adults with R/R cHL, ECOG PS 0-2, and PD per investigator ≤12 weeks from last dose of anti–PD-(L)1–based therapy (received for ≥3 months with ≥2 doses) were randomly assigned 1:1 to favezelimab 800 mg/pembrolizumab 200 mg IV Q3W or chemotherapy (gemcitabine 800-1200 mg/m2 IV on days 1 and 8 of a 21-day cycle or bendamustine 90-120 mg/m2 IV on days 1 and 2 of a 21- or 28-day cycle). Prior brentuximab vedotin and autologous stem cell transplant were required. Crossover to favezelimab/pembrolizumab was allowed for pts who received chemotherapy with PD per Lugano criteria by BICR. Primary end point was PFS per Lugano criteria by investigator. Secondary end points included OS, ORR, and DOR per Lugano criteria by investigator, and safety. Primary hypothesis for PFS was evaluated using a stratified log-rank test and at 5% (1-sided) alpha level. Results: Overall, 203 pts were randomly assigned to favezelimab/pembrolizumab (n=104) and chemotherapy (n=99); 52 pts in the chemotherapy arm crossed over, with 17 ongoing treatment. At data cutoff (Sept 3, 2025), median follow-up was 17.6 months (range, 7.9-34.3). Efficacy data are reported in the table. Treatment-related AEs (TRAEs) occurred in 79 pts (76.0%) with favezelimab/pembrolizumab and 81 pts (83.5%) with chemotherapy. Grade 3-5 TRAEs occurred in 19 (18.3%) and 39 pts (40.2%). One treatment-related death occurred in the chemotherapy arm only (sepsis). Summary/Conclusion: Primary end point was met, with improved PFS and late curve separation at 6 months, although few pts at risk thereafter warrant caution. DOR was longer; OS trended favorably but remains immature. ORR was lower for favezelimab/pembrolizumab, but disease control rates (CR+PR+SD) were similar between arms. KEYFORM-008 was discontinued due to sponsor’s business decision to end the entire favezelimab clinical development program and was unrelated to safety or efficacy.
  • Paul J. Bröckelmann
  • David Lavie
  • Guilherme Perini
  • Muhit Ozcan
  • Nathalie Johnson
  • Won Seog Kim
  • Carolina Mahuad
  • Norma Gutiérrez
  • Senem Maral
  • Cecile Borel
  • Tae Min Kim
  • Iara Goncalves
  • Deepa Jagadeesh
  • Yasmin Karimi
  • Nina Wagner-Johnston
  • John Timmerman
  • Ryan Lynch
  • Graham P. Collins
  • Yulia Sidi
  • Pallavi Pillai
  • Rushdia Yusuf
  • Alex Herrera
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P112 (P112)

Preliminary Results of Nivolumab and Axatilimab in Patients with Relapsed/​Refractory Classical Hodgkin Lymphoma refractory to anti-PD-1 therapy

Background: Patients (pts) with relapsed/refractory (r/r) classical Hodgkin lymphoma (cHL) progressing on anti-PD-1 therapy have poor outcomes. Tumor Associated Macrophages (TAMs) expressing colony stimulating factor 1 receptor (CSF1-R) have been implicated in resistance to anti-PD-1 therapy through (i) direct inhibition of cytotoxic T lymphocytes (CTLs) and (ii) phagocytosis of the anti-PD-1 antibody. Pre-clinical studies suggest that combination of anti-PD-1 and anti-CSF1-R blockade can result in upregulation of CTLs and increased PD-L1 expression. Methods: We designed a phase 2 dose de-escalation trial of nivolumab and axatilimab (anti-CSF1-R monoclonal antibody) in pts with r/r cHL who have sub-optimal response to anti-PD-1-based therapy to determine the safety and efficacy of the combination (NCT05723055). Pts received axatilimab 3 mg/kg (with DL-1 dose of 2mg/kg) and nivolumab 480 mg Q4 weeks until progression or toxicity. Results: Six pts have been enrolled with a median age of 46 years (range, 27-78). The median lines of prior therapy were 4 (range, 2-8) and 50% had prior autologous stem cell transplant. Five pts had progressive disease and 1 pt had partial response (PR) on anti-PD-1 based therapy as the last line of treatment. No dose limiting toxicities were observed. Three pts had G 1-2 periorbital edema. There were 4 treatment-related G3 adverse events (AEs) including: asymptomatic CPK elevation (2), hypotension (1), and meningitis (1). Immune-related AEs were G 1-2 rash (2), G1 pneumonitis (1), and G3 meningitis (1). The pt with G3 meningitis was in complete response (CR) after 17 cycles of treatment and discontinued further treatment after developing meningitis. Of the 5 pts evaluable for response, the best ORR was 80% (40% CR and 40% PR) (Fig 1, top panel). Median time to response was 2.2 months (mo). Median duration of response was 16 mo (95% CI 1.8 mo – NA) and median duration of response in complete responders was 17.3 mo. With a median follow up of 5.75 mo, median PFS was 5.5 mo (95% CI 3.5 mo– NA) with 1-year PFS of 40% (95% CI 14% - 99%). In the correlative blood analysis, we observed an increase in dendritic cells and a decrease in neutrophils in responders (Fig 1, bottom panel). Conclusions: The combination demonstrated a manageable safety profile and encouraging preliminary antitumor activity, including durable CR in a subset of pts. Anti-CSF1-R treatment can restore or enhance the effectiveness of immune checkpoint blockade.
  • Harsh Shah
  • Dipenkumar Modi
  • Kenneth Boucher
  • James Marvin
  • Jerry Zak
  • Anthony Pomicter
  • Kelsey Baron
  • Daniel Ermann
  • Alison Moskowitz
  • Radhakrishnan Ramchandren
  • Deborah Stephens
  • Boyu Hu
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P113 (P113)

Eight-year outcomes after nivolumab discontinuation in patients with relapsed/refractory classic Hodgkin lymphoma

Background: The optimal duration of immune checkpoint inhibitor (ICI) therapy in relapsed/refractory classic Hodgkin lymphoma (r/r cHL) and its curative potential remain uncertain. Limited data suggest that discontinuation of therapy after achievement of complete response (CR) may lead to durable remissions, while ICI retreatment can be effective. We analyzed long-term outcomes in an expanded cohort of patients who discontinued nivolumab (nivo) in CR and evaluated the efficacy and safety of nivo retreatment. Methods: This retrospective study included 47 patients with r/r cHL treated with nivo at a dose of 3 mg/kg (60%) or 40 mg (40%) (Table 1). All patients discontinued therapy in CR. At relapse, nivo monotherapy was reinitiated in 19 pts. After discontinuation, patients were monitored every 6 months for 2 years, then clinically with imaging as indicated. Responses were assessed by PET/CT using LYRIC criteria; adverse events (AEs) by CTCAE 5.0. PFS and OS were evaluated after discontinuation, and ORR, PFS, OS, and AEs were evaluated after retreatment. Univariate Cox regression assessed clinical factors associated with PFS (primary r/r, sex, prior auto-HCT, prior brentuximab vedotin, number of prior therapy lines, presence of B symptoms, ECOG PS at nivo initiation, nivo dose, occurrence of severe AEs, completion of 24 cycles of nivo, and early CR at 3 mo). Results: Median follow-up was 95 (13-111) mo. Nivo was discontinued due to AEs (n=5, 11%), cessation of the national nivo compassionate use program (n=19, 40%), or patient/physician decision (n=23, 49%). Relapse occurred in 24 (51%) pts. Median PFS was 25.8 mo (95%CI: 14.5-NA); 8-y PFS was 46.8% (95% CI: 34.2-64.2). Median OS was not reached; 8-y OS was 89.8% (95% CI: 80.8-99.8). No clinical factors were significantly associated with PFS. ORR after nivo retreatment (n=19) was 74% (CR 47%). Median follow-up was 68 (25-96) mo. Median PFS was 22.7 mo (95% CI: 16.5-NA); 5-y PFS was 34.7% (95% CI: 18.4-65.5). Median OS was not reached; 5-y OS was 76.5% (95% CI: 58.7-99.5). AEs during retreatment occurred in 42% of patients, with grade 3–4 in 16%. Conclusion: Long-term follow-up of patients with r/r cHL who discontinued nivo in CR demonstrates that a substantial proportion of patients remain relapse-free, raising the possibility of cure in this population. These findings should be considered when developing treatment strategies, including decisions regarding the role of consolidative allogeneic HCT.
  • Liudmila Fedorova
  • Kirill Lepik
  • Polina Kotselyabina
  • Elena Kondakova
  • Andrey Chekalov
  • Evgeniya Borzenkova
  • Natalia Mikhailova
  • Alexander Kulagin
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P114 (P114)

Low-Dose Nivolumab Combined with Salvage Chemotherapy in Relapsed/Refractory Classic Hodgkin Lymphoma: Outcomes from a Tertiary Care Centre in North India

Background: Immune checkpoint inhibitors (ICIs) have established activity in relapsed/refractory classic Hodgkin lymphoma (r/r cHL). Outcomes of patients receiving salvage with a combination of ICIs with chemotherapy are excellent. However, ICIs are often unavailable to a large population globally due to their high cost, leading to regional innovations including utilisation of a lower dose of these drugs. We report outcomes of low-dose nivolumab combined with salvage chemotherapy in r/r cHL at a tertiary care centre in North India. Methods: This was a retrospective analysis of patients with r/r cHL treated with low dose nivolumab-based therapy between 2020 and 2026. Nivolumab was given at a fixed dose of 40 mg per cycle along with chemotherapy (without steroids). Progression-free survival (PFS), event-free survival (EFS, with receipt of next therapy counted as an event), and overall survival (OS) were calculated by the Kaplan–Meier method. Results: The cohort comprised of 27 patients: 15 males (55.6%) and 12 females; median age 27 years (IQR 22–31). Most patients had advanced-stage disease at baseline (n=17, 63.0%) and refractory disease to ABVD (n=20, 74.1%). Nivolumab was used as second-line therapy in 16 patients (59.3%), third-line in 8 (29.6%), and fourth-line in 3 (11.1%). The median Nivolumab dosing was 0.66 mg/kg per patient (IQR- 0.57-0.71) with a median cumulative Nivolumab dose of 120 mg (IQR- 120-240mg). Patients received a median of 3 cycles of therapy (range 2–6). Chemotherapy combinations included gemcitabine and cisplatin (n=9) or vinorelbine, ifosfamide, bendamustine and etoposide (n=18). Complete response (CR) was achieved in 22 patients (81.5%) and overall response rate was 96.3% (n=26). Nineteen patients (70.4%) proceeded to auto-HSCT. At a median follow-up of 31 months (range 3–75), 2-year PFS was 83.6% (95% CI 61.9–93.6%), 2-year EFS was 73.0% (95% CI 51.5–86.2%), and 2-year OS was 94.4% (95% CI 66.6–99.2%). Grade III/IV toxicity occurred in 3 patients (11.1%); there were no treatment-related deaths. Conclusion: Low-dose nivolumab combined with chemotherapy achieves high response rates and favourable survival with acceptable toxicity in patients with r/r cHL. In settings where standard-dose ICIs are inaccessible, this is a practical and cost-effective bridging approach to auto-HSCT. Prospective evaluation in larger cohorts is warranted.
  • Charanpreet Singh
  • Aditya Jandial
  • Arihant Jain
  • Alka Khadwal
  • Rajender Basher
  • Amanjit Bal
  • Gaurav Prakash
  • Pankaj Malhotra
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P115 (P115)

Outcomes in Double-Exposed Classical Hodgkin Lymphoma: The Impact of Treatment Sequence and Salvage Strategies After Brentuximab Vedotin and Checkpoint Inhibitor Failure

Background: Brentuximab Vedotin (BV) and checkpoint inhibitors (CPIs) revolutionized classical Hodgkin lymphoma (cHL) treatment, improving outcomes in both relapsed/refractory (RR) and primary treatment setting. The outcomes of patients (pts) with active disease after exposure to both agents are unclear and the impact of treatment sequencing is not well understood. We aimed to characterize RR-cHL pts with progressive disease (PD) after both BV/CPI to describe subsequent treatment outcomes, treatment sequencing and survival. Methods: We conducted a retrospective analysis of RR-cHL pts with PD after treatment with BV and CPI (pembrolizumab or nivolumab) at Princess Margaret from 2012 to 2024. Patients exposed to both novel agents were classified as "Double Exposed" (DE). Results: We identified 24 DE cHL patients with PD after treatment with sequential BV and CPI. Median age: 40 years (20-75 years); 62% male. 74% had received 4+ lines of therapy (median 4, 2-6) and 63% had undergone ASCT. Advanced stage: 83% - Extranodal disease: 62%. 71% were actively on treatment with a novel agent at PD (BV-CPI 81%, CPI-BV 100%, p=0.526). A trend in disparity of refractoriness to the most recent novel agent was observed (CPI-BV: 87.7%, BV-CPI: 50%, p=0.178) [Fig 1A]. Median follow-up was 37.9 months (3-121 mo); median overall survival (OS) was 46 mo for the entire cohort (7-121 mo). Median OS for subgroups: BV-CPI 46 mo; CPI-BV 12.5 mo (p=0.59). [Fig 1B]. The median progression-free survival (PFS) after the second agent was 7.4 mo (2-107 mo): BV-CPI 11.6 mo; CPI-BV 4.2 mo (p=0.0098) [Fig 1C]. Time to next treatment (TTNT) was longer for CPI-BV (35.41 vs 13.33 mo; p=0.025). 16 pts (67%) received further treatment while 8 (33%) went on to palliative therapy. Overall response rate (ORR) was 56% for pts receiving treatment with a variety of options used [Fig 1D]. Conclusions: DE BV/CPI pts represent a young, clinically aggressive, heavily treated RR- cHL population with progressive disease with poor outcomes. While the order of drug administration did not significantly impact OS, it may affect PFS and TTNT, highlighting the importance of studying treatment sequencing. With a proportion of pts transitioning to palliative care or not responding to subsequent therapy, BV/CPI DE pts have a need for novel treatment approaches. Our preliminary data underscore the critical need to optimize sequencing and salvage strategies to improve outcomes in this challenging population.
  • Massimiliano Marinoni
  • Tomohiro Aoki
  • Sita Bhella
  • Inna Gong
  • Robert Kridel
  • Vishal Kukreti
  • Anca Prica
  • Abi Vijenthira
  • Chloe Yang
  • Woodrow Wells
  • Danielle Rodin
  • David Hodgson
  • Michael Crump
  • John Kuruvilla
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P116 (P116)

PD-1 Inhibitor maintenance after Auto-HCT in r/r Classical Hodgkin lymphoma with prior PD-1 exposure: interim phase II results

Background: Maintenance therapy with PD-1 inhibitors after auto-HCT shows promising activity in relapsed/refractory classical Hodgkin lymphoma (r/r cHL). We report interim results of a prospective multicenter study evaluating PD-1 maintenance in patients previously exposed to PD-1 inhibitors. Methods: This international multicenter phase 2 trial included adult patients with histologically confirmed r/r cHL who underwent auto-HCT after second or later lines of therapy (NCT06812858). Patients received PD-1 inhibitor maintenance per center choice (Fig.1): nivolumab (nivo) 40 mg, 3 mg/kg, or 240 mg IV every 14 days (up to 12 cycles), or pembrolizumab (pembro) 200 mg IV every 21 days (up to 8 cycles). Response evaluation is performed by PET/CT after auto-HCT and following the completion of maintenance therapy (LYRIC). Results: Forty-seven patients (median age 34 [range 19–56]) were enrolled across four centers (2024–2026). All patients had at least one AETHERA risk factor (median 2, range 1–4). Primary refractory disease occurred in 53% (n=25), early relapse in 28% (n=13). All patients received PD-1 inhibitors prior to auto-HCT, with the last salvage regimen before auto-HCT also including PD-1 inhibitors. Brentuximab vedotin was given before auto-HCT in 32% (n=15). Prior to auto-HCT, the best response to PD-1 inhibitor-based salvage therapy was complete response (CR) in 87% (n=41) and partial response (PR) in 13% (n=6). Pre-HCT status included CR in 83% (n=39), PR in 15% (n=7), and indeterminate response in 2% (n=1). Auto-HCT was performed as consolidation of second-line therapy in 43% (n=20) and third-line or later in 57% (n=27). All patients were in CR prior to the maintenance (PET/CT). Maintenance consisted of full-dose nivo in 36% (n=17), nivo 40 mg in 43% (n=20), and pembro in 21% (n=10). During maintenance, grade 1–2 adverse events (AEs) based on CTCAE v5.0 occurred in 49% (n=23) and grade 3–4 in 4% (n=2), with no treatment-related deaths. The most common AEs were fatigue (13%), thrombocytopenia (13%), upper respiratory tract infection (11%), leukopenia (11%), anemia (9%), and rash (9%). Three patients required therapy discontinuation due to immune-related AEs (grade 3 pneumonitis, grade 4 diarrhea, grade 2 hypothyroidism). After a median follow-up of 10 months (range 1–35), no relapses or deaths were observed. Conclusion: Interim results demonstrate high efficacy and manageable toxicity in r/r cHL post auto-HCT.
  • Polina Kotselyabina
  • Aminat Balaeva
  • Liudmila Fedorova
  • Vladimir Bogatyrev
  • Nikita Shorokhov
  • Nikita Mochkin
  • Mobil Akhmedov
  • Mariya Vernyuk
  • Irina Cherkashina
  • Azat Karabekov
  • Vladislav Sarzhevskiy
  • Elena Demina
  • Vadim Keimakin
  • Natalia Mikhailova
  • Alexander Kulagin
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P117 (P117)

Association of prior PD-1 inhibitor exposure with pre-engraftment syndrome after ASCT in relapsed/refractory Hodgkin lymphoma

Background: PD-1 inhibitors are increasingly incorporated into salvage treatment strategies before autologous stem cell transplantation (ASCT) in relapsed/refractory Hodgkin lymphoma (R/R HL). However, inflammatory complications during the early peri-transplant period remain insufficiently characterized. We evaluated inflammatory events after ASCT, focusing on engraftment syndrome (ES)-like manifestations occurring before neutrophil recovery. Methods: We retrospectively analyzed 64 consecutive adult HL patients undergoing ASCT at a single center between 2018 and 2025. ES was assessed according to Spitzer and Maiolino criteria. ES-compatible manifestations developing before neutrophil engraftment were classified as pre-engraftment syndrome (pre-ES). Clinically significant events were defined as inflammatory episodes requiring systemic corticosteroid treatment after exclusion of infection. Results: Conventional ES after ASCT was infrequent. No patient fulfilled Spitzer criteria within the standard engraftment period, while three patients (4.7%) met Maiolino criteria without requiring corticosteroid therapy. When the conventional engraftment timeframe was disregarded, pre-ES manifestations were identified in 34 patients (53.1%) according to Maiolino criteria, although most cases were mild and self-limiting. Three patients developed steroid-requiring pre-ES; each fulfilled Spitzer criteria outside the standard engraftment window. All severe pre-ES cases occurred exclusively in patients previously exposed to PD-1 inhibitors. Prior PD-1 inhibitor therapy was significantly associated with steroid-requiring pre-ES (P=0.0007), although interpretation is limited by the small number of events. Patients with severe pre-ES also exhibited higher early post-transplant CRP levels. Conclusions: While classical ES after ASCT in HL was uncommon, pre-ES manifestations were frequent. Steroid-requiring pre-ES occurred exclusively in PD-1–exposed patients, suggesting a distinct inflammatory phenotype in this setting. Early recognition and prompt corticosteroid treatment after exclusion of infection may help prevent severe complications. Prospective studies are warranted to better define risk factors, underlying mechanisms, and optimal monitoring strategies in this high-risk population.
  • Dávid Tóthfalusi
  • Gréta Melani Csatlós
  • Boglárka Dobó
  • Fanni Borics
  • László Imre Pinczés
  • Árpád Illés
  • Zsófia Miltényi
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P118 (P118)

Autologous hematopoietic cell transplantation remains relevant despite PD-1 inhibitor-based second-line therapy in classic Hodgkin lymphoma: interim results from the Prolgo-HL study

Backgrounds: Recent advances in 2d-line treatment, particularly the incorporation of PD‐1 inhibitors (iPD-1) into salvage regimens before auto-HCT, have markedly improved outcomes in classic Hodgkin lymphoma (cHL). These changes have prompted a re-evaluation of high-dose chemotherapy and auto-HCT, with growing interest in alternative consolidation strategies. This study aimed to assess the feasibility of omitting auto-HCT in patients who achieved an early complete response (CR) to prolgolimab (prolgo). Methods: This prospective, multicenter, single-arm phase II trial included adult cHL pts after first-line therapy without prior iPD-1 (NCT05757466). The study protocol is shown in Fig. 1. Response was assessed every 3 months by PET-CT (LyRIC). Primary endpoint was ORR, secondary - OS, PFS, DoCR. Intention-to-treat (ITT) population was used for safety, per-protocol (PP) for efficacy. Four pts were excluded from PP due to protocol deviation (n=2), consent withdrawal (n=1), gr 3 AE (n=1). Results: 32 pts with r/r cHL were enrolled (04.2023-05.2026); 28 were included in the PP analysis. The median follow-up was 24 mo (8-37). After 6 cycles of mono-prolgo, CR was achieved in 9 pts (32%). Among patients with CR, 8 pts (89%) had completed 24 cycles of therapy. In this cohort, relapse occurred in 5 pts (63%). The median PFS was 24 mo (95%CI 24-NA); 2-y PFS was 71% (95%CI 45-100). Eighteen of 19 pts without CR were switched to the prolgo-bendamustine (benda) arm, where ORR was 89% (CR 83%). Among patients who achieved a response, auto-HCT was performed in 7 pts (39%) after prolog+benda, while 1 pt was preparing for auto-HCT. Ten patients did not undergo auto-HCT after completion of the protocol due to patient preference (n=7) or progression (n=1). In patients proceeding directly to auto-HCT, the only event was early post-transplant death; no relapses occurred. Median OS and PFS were not reached; 2-year OS and PFS were 83% (95% CI, 58–100%). Overall, 26 pts completed therapy per protocol. ORR at the end of treatment was 92% (n=24, CR 88%); 2y PFS was 60% (95%CI 43-85); 2y OS was 88% (95%CI 75-100%). Conclusion: Despite the high CR rates observed with mono-prolgo and prolgo-benda, a high relapse rate was noted, likely associated with omission of auto-HCT in both cohorts, underscoring the importance of this treatment component. Further risk stratification is required to identify a genuinely low-risk subgroup in whom omission of auto-HCT may be a safe and reasonable option.
  • Liudmila Fedorova
  • Polina Kotselyabina
  • Kirill Lepik
  • Andrey Chekalov
  • Vladislav Markelov
  • Valeria Shpirko
  • Anastasia Semenova
  • Gayane Tumyan
  • Stanislav Volchenkov
  • Angelina Piletskaya
  • Ilya Zyuzgin
  • Natalia Konoplya
  • Natalia Mikhailova
  • Alexander Kulagin
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P119 (P119)

Efficacy of Ultra-Low-Dose Nivolumab in Combination with Gemcitabine and Cisplatin as Remission-Induction Therapy in Primary Progressive and Relapsed Hodgkin Lymphoma: A Randomized Phase II study with two ultra-low-dose schedules

Background: Patients with relapsed/refractory (R/R) classical Hodgkin lymphoma (cHL),achieve complete remission (CR) in only 40–50% of cases with first-line salvage chemotherapy. Although nivolumab is highly effective in R/R cHL, the minimum biologically effective dose remains unknown. In a prior phase II study, we demonstrated a 90% overall response rate(ORR) using low-dose nivolumab (40 mg) with standardized flow cytometric analysis showing near-complete PD-1 receptor saturation and persistence of receptor occupancy at trough time-points (https://doi.org/10.1016/j.bict.2025.100011). In-vitro, we have also demonstrated complete PD-1 receptor saturation with lower doses of nivolumab (20mg and 10mg). These findings suggest that efficacy may be retained with further dose and schedule de-escalation, potentially improving affordability and access to PD-1 blockade. Methods: This investigator-initiated, single-centre, randomized phase II trial evaluates ultra-low-dose nivolumab combined with gemcitabine, cisplatin, and dexamethasone (GCD) in patients aged ≥12 years with R/R cHL. Patients are randomized 1:1 to receive GCD plus nivolumab 20 mg for two cycles (Arm A) or GCD plus a single 20 mg dose during cycle 1 only (Arm B). The primary endpoint is ORR by end-of-treatment FDG-PET. Secondary endpoints include CR rate, toxicity, PD-1 receptor saturation, proportion proceeding to autologous stem cell transplantation, and 2-year PFS. Peripheral blood samples collected before and 2 hours after nivolumab administration, and at response assessment, will be analyzed for PD-1 receptor occupancy and T-cell activation. Patients achieving less than CR after two cycles will discontinue protocol therapy. Statistical Considerations: Salvage chemotherapy alone yields ORRs of approximately 40–50%, whereas PD-1-based chemo-immunotherapy achieves ORRs approaching 85%. Assuming an ORR of 85% with ultra-low-dose nivolumab plus GCD, a sample size of 30 patients (15 per arm) provides 80% power at a two-sided significance level of 0.05 to demonstrate significant improvement over historical chemotherapy outcomes, while generating preliminary comparative data regarding the adequacy of single versus repeated ultra-low-dose nivolumab administration. Current Status: Registered, Currently recruiting; Clinical Trials Registry of India,[CTRI/2025/06/089253 [20/06/2025] Off-Label Disclosure: Nivolumab is being evaluated at a dose of 20 mg (1–2 doses), below the FDA-approved dosing regimen.
  • Mithun Prakash
  • Nutan Joshi
  • Sujith Karumathil
  • Sushil Selvarajan
  • Sharon Lionel
  • Uday Kulkarni
  • Aby Abraham
  • Biju George
  • Vikram Mathews
  • Anu Korula
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P120 (P120)

From Clinical Trials to Clinical Practice: A Decade of Experience with Nivolumab in Relapsed/Refractory Classical Hodgkin Lymphoma

Background: Nivolumab (nivo) is an established treatment option for patients (p) with relapsed/refractory classical Hodgkin lymphoma (R/R cHL). Methods: Among 82 p treated with nivo between 2015 and 2025, 69 p receiving nivo monotherapy were analyzed. Clinical characteristics, treatment responses, survival, outcomes, and toxicity were evaluated in this retrospective analysis. Results: Median age at nivo initiation was 42 years (y) (range, 20–77), with 52% aged ≤ 60y, most p were male (n=45; 65%). Patients received median of 3 (range, 1-12) prior treatment lines, 64% had advanced stage, 51% extranodal involvement, 5.7% bulky disease and 19% B symptoms. Prior autologous SCT was performed in 78% of p, while 67% were previously exposed to brentuximab vedotin (BV). Median time from diagnosis to first nivo dose was 34.7 months (range, 6–299). Median number of nivo administrations was 19 (range, 1–165). Median dose was 240 mg (range, 165–480mg) with administration every 2 weeks in 64p. Best overall response rate (ORR) was 75% (complete remission, CR 42%). Treatment-related toxicity occurred in 22 p (32%); grade 3–4 in 7 (32%) of these p. Reasons for nivo discontinuation were CR (n=12), partial remission (PR; n=2), stable disease (n=1), progression (PD; n=33), toxicity (n=6), and other reasons (n=7). Ten p underwent nivo retreatment (8p were evaluable for BOR). Two p achieved CR and 3 p remain in treatment. Median treatment duration was 5.5 months (range, 2-15). During follow-up, 10 p received allogeneic SCT. After median follow-up of 49.2 months, median progression-free survival (PFS) and overall survival (OS) were 18.3 and 70.2 months. 3y PFS and OS were 21.4% and 76.7% (Fig.1). Median duration of response was 19.2, 30 and 12.8 months for ORR, CR and PR. Previous treatment with BV did not influence survival. At last follow-up, 24 p were in CR (22 p remained alive). Causes of death (n=25) included PD (n=10), infections (n=7), secondary malignancies (n=3), allogeneic SCT-related complications (n=1), other (n=2) and unknown causes (n=2). Conclusion: Our findings support nivo monotherapy as an effective and well-tolerated option for heavily pretreated patients, with improved outcomes over the past decade, although its role may evolve as immunotherapy shifts to earlier treatment lines. This work was supported by the grant AZV NU22-03-00182 from the Ministry of Health of the Czech Republic and by the Cooperatio Program, research area “Oncology and Haematology”.
  • Alice Sykorova
  • Jan Koren
  • Eva Maule
  • Lubica Gaherova
  • Marie Lukasova
  • Juraj Duras
  • Katerina Steinerova
  • Pavla Stepankova
  • Blanka Vackova
  • Jozef Michalka
  • Jana Markova
  • Vit Prochazka
  • Barbara Brizova
  • Marek Trneny
  • Zdenek Kral
  • Petra Blahovcova
  • Heidi Mocikova
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P121 (P121)

Brentuximab vedotin as bridging and maintenance therapy in hematopoietic cell transplant in a national access program for relapsed or refractory classical Hodgkin lymphoma patients

Background: Hematopoietic cell transplantation (HCT) is standard treatment for people with relapsed or refractory classical Hodgkin lymphoma (R/RcHL), but controlling the disease before HCT is crucial for success. Brentuximab vedotin (BV), an anti-CD30 antibody-drug conjugate, has proven useful as maintenance after HCT. We examined BV as bridging and post-HCT maintenance therapy through Mexico’s Patient Access Program (PAP) in R/RcHL. Methods: We retrospectively analyzed data from R/RcHL patients in the PAP from January 2017 to December 2021. Of 231 people identified, 193 (83.5%) were deemed eligible for HCT (autologous or allogeneic) by their physicians. We collected demographic data, disease status, prior therapy, BV use (doses, purpose, timing), transplant type, eligibility, completion, and outcomes (relapse, death, survival). Patients were grouped by BV use as bridging and/or maintenance therapy. Main outcomes included HCT completion rate, post-HCT relapse, relapse-free survival (RFS), and overall survival (OS). Results: Among 193 eligible patients, 71 (36.8%) underwent HCT (59 autologous, 12 allogeneic [9 matched related, 3 haploidentical]). Two patients had an allo-HCT after relapsing from an auto-HCT. The rest (n=122) missed HCT due to limited access (62), progression (42), refusal (6), death (3), stem-cell mobilization failure (3), or other reasons. BV was used as bridging in 46/193 (23.8%); 28/46 (60.9%) later had HCT, vs. 43/147 (29.3%) without BV bridging (p<0.001). Of 71 who had HCT, 28 got BV as a bridge; 12/28 (42.9%) also received BV as post-HCT maintenance. Of those not given BV as a bridge, 17/43 (39.5%) still got BV as maintenance. In total, 29 people had post-HCT BV maintenance (median 12 doses). Post-HCT relapse happened in 19 (median time: 10.5 months); 24.1% (7/29) relapsed in the maintenance group vs. 28.6% (12/42) without it (p=0.6780). No significant RFS (p=0.4917) or OS (p=0.3529) differences were seen with BV maintenance. Of maintenance patients, 41.4% also had BV as bridging. The 36-month OS rate was higher in HCT vs. non-HCT patients (100% vs. 85.9%). Conclusions: BV use as bridge to HCT may increase the likelihood of undergoing HCT. While post-HCT maintenance with BV did not significantly improve OS or RFS, several factors could explain this result, including prior BV exposure or insufficient power of the study
  • Omar Fernandez-Vargas
  • Maria Silvia Rivas-Vera
  • Gladys Agreda-Vásquez
  • Ingrid Mucius
  • Marco Balandrán-Ruíz
  • David Gómez-Almaguer
  • Jorge Cruz-Rico
  • Perla Colunga-Pedraza
  • Carolina Balderas-Delgado
  • Carlos Best
  • Gabriel Barragán
  • Mariela Cardiel
  • María Luisa Alcivar
  • Sergio Galvez-Acosta
  • Rosa Elena Sosa
  • Daniela Pérez Karen
  • Ana Lucía Ron-Magaña
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P122 (P122)

BCL-2 Inhibition Combined with Other Therapeutic Agents Demonstrates Synergistic Efficacy in Hodgkin Lymphoma Cells

Background: Relapsed/refractory (R/R) Hodgkin lymphoma (HL) remains difficult to treat, with particularly poor outcomes following relapse post-autologous stem cell transplant and check point inhibitors, and limited treatment options. The shift of active agents into the frontline setting further underscores the need for new therapies in R/R HL. B-cell lymphoma 2 inhibition (BCL2i) has shown activity, but remains underexplored, particularly in combination strategies. Similarly, Bruton’s tyrosine kinase inhibitors (BTKI) have demonstrated preliminary efficacy in R/R HL. Thus, we aimed to evaluate BCL2i with venetoclax (ven) in combination with other agents, including BTKi, to assess cytotoxic effects in HL cell lines. Methods: HL cell lines L1236, L428 and L540 were utilized for this analysis. Ven was combined with Ibrutinib (ibr), acalabrutinib (acal), zanubrutinib (zanu), pirtobrutinib (pir), brentuximab vedotin (bv) and doxorubicin (doxo) to assess synergistic cytotoxicity. HL cells were exposed for 48 hours. Cell viability changes were determined by measuring adenosine triphosphate content using Cell Titer-Glo Assay. The half maximal inhibitory concentration (IC50) was calculated with Graph Pad Prism Software. Experiments were performed in triplicates on three separate occasions. Data was analyzed using SPSS 21.0 software. Synergy coefficients for ven combinations were calculated by CalcuSyn software. Results: Ven monotherapy demonstrated activity across all three HL cell lines, with the lowest IC50 observed in L540 (Fig 1A). Ven was subsequently combined with dox producing synergistic cytotoxicity across all cell lines, with the lowest IC50 in L428 (Fig 1B & 1C). Ven was then paired with bv with similar synergistic killing of all HL cells, with the lowest IC50 seen in L540 (Fig 1D & 1E). Ven also showed synergistic activity when combined with multiple BTKis, all of which showed synergistic efficacy in HL cell killing, with the lowest IC50 values observed with ibr and pir (Figure 1F-1M). Conclusions: In this study, we evaluated the synergistic activity and potential efficacy of BCL2i (ven) in combination with other agents in HL cell lines. We found that ven combined with doxo, bv, and multiple BTKi’s consistently produced synergistic cytotoxicity across HL models. These findings highlight BCL2i-based combinations as a potential therapeutic approach for R/R HL and support further investigation to enable progression toward clinical trials.
  • Alex Niu
  • Noah Brosnick
  • Cory Mavis
  • Matthew Cortese
  • Francisco Hernandez-Ilizaliturri
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P123 (P123)

Real-World Data on the Single-Agent Pembrolizumab Therapy in Relapsed / Refractory Classic Hodgkin Lymphoma Patients in the Czech Republic.

Background: Pembrolizumab has demonstrated significant anti-tumour activity and durable long-term disease control in patients (pts) with relapsed or refractory classic Hodgkin lymphoma (R/R cHL). Herein we present retrospective analysis on efficacy and safety of pembro treatment including optional approach with autologous hematopoietic stem cell transplantation (ASCT). Patients and methods: Weˈve analysed data of 44 R/R cHL pts after at least 2 lines of treatment between June 2019 and May 2026 in the Czech Republic. Pembro was administered every 3 weeks until disease progression, unacceptable toxicity or a maximum of 35 cycles. Results: There were 28 men and 16 women, median age was 65 years (20-83). Median number of previous therapies was 3 (2-13) and the majority of pts (71%) started pembro in an advanced stage of the disease (III-IV). The median number of pembro courses was 10 (1-35), and the median duration of treatment was 8.2 months. Response was evaluated in 41 pts (93%) and assessed per Lugano criteria. Overall response rate (ORR) was 68% with a complete response (CR) rate in 46% and a partial response (PR) in 22%. In the subgroup of pts ˂ 65 years the ORR was 75% (CR 60%, PR 15%) while pts ≥ 65 years had ORR 62% (CR 33%, PR 29%). The most common reason for withdrawal was disease progression (50%) and ASCT (16%). With a median follow-up (FU) of 22 months, the 2year progression-free survival (PFS) was 41% (median PFS 14 months) and the 2year overall survival (OS) 88% (median OS not reached). In the pts ˂ 65 years, the 2year PFS was 55% whilst in ≥ 65 years 32%, but the difference was not statistically significant (fig.1). Two pts with localized disease underwent radiation therapy after pembro and 7 of the responding pts in CR proceeded to ASCT and subsequent 8 cycles of pembro maintenance per treating physicianˈs discretion. All of them remain in CR at the last FU. Treatment-related adverse events were reported in 12 pts (27%), but only 4 cases (9%) were grade 3. Eight pts died (18%), one of COVID-19, one of pneumocystis pneumonia, but always in the context of progressive lymphoma. Discussion: Even though response rates were lower in the subgroup of pts ≥ 65 years, pembro often represents the only reasonable therapeutical option for them in the 3rd line setting. For the younger pts it may represent an efficient salvage therapy prior to ASCT. Increasing use of protocols combining pembro with chemotherapy can change current therapeutical landscape.
  • Jozef Michalka
  • Heidi Móciková
  • Katarína Hradská
  • Alice Sýkorová
  • Vít Procházka
  • František Folber
  • Eva Maule
  • Ľubica Gahérová
  • Juraj Ďuraš
  • Barbora Obadalová
  • Pavla Štěpánková
  • Marie Lukášová
  • Zdeněk Král
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P124 (P124)

Activity of Nivolumab with Decitabine Cedauzurine (DEC-C) in Relapsed/Refractory Hodgkin Lymphoma (cHL): Results from an ETCTN Phase 1 Study

Patients with classic Hodgkin lymphoma (cHL) who relapse after checkpoint inhibitor (CPI) have limited treatment options; effective therapies remain an unmet need. Epigenetic silencing leading to exhausted T-cells is a mechanism of CPI resistance. We tested the combination of oral decitabine and cedazuridine (DEC-C) a fixed-dose formulation of the hypomethylating agent decitabine, in combination with the checkpoint inhibitor (CPI) Nivolumab (Nivo) in a Phase 1 multicenter NCI/CTEP study of patients with R/R cHL and DLBCL. We present the cHL cohort here. A total of 15 patients were treated between 07/23 and 3/26. DEC-C was given at a dose of 35mg/100mg daily x 5 (DL 1) or x 3 (DL-1) with standard dose Nivo. Two patients were treated in DL 1 and 13 patients in DL-1. Patients were heavily pre-treated with a median of 4 prior lines of therapy (range 2 to 16); 10 patients had prior hematopoietic stem cell transplant (HCT): 7 auto, 3 allo. 12 patients received prior CPI; all CPI treated patients relapsed after CPI, and 10 were considered refractory. 15 patients are evaluable for safety. All patients had adverse events (AEs) across all grades which were low grade and included anemia, thrombocytopenia, nausea, headache, dyspnea, fatigue, and transaminase elevation. Gr 3 and 4 AEs considered at least possibly related were primarily hematologic and included neutropenia (7), anemia (2), thrombocytopenia (2), leukopenia (5), lymphocytopenia (2), and neutropenic fever (2); Gr 3 and 4 non-hematologic AEs included: dyspnea (2), hypokalemia (2), hyperkalemia (1), and cardiomyopathy (1). 12 of 15 patients are currently evaluable for response, of the 3 who are not evaluable, one died within a month of starting therapy due to disease, one came off treatment due to AEs, and one is too early for assessment. The overall response rate was 8/12 (66.7%) with 1 CR and 7 PR; an additional 4 (33.33%) patients had stable disease for a clinical benefit rate of 100%. The 12- month PFS is 64% with a median PFS of 511 days, 95% CI (0.347, 0.835). The median OS is not reached, with one year OS of 79%, 95% CI (0.479, 0.927). DEC-C in combination with Nivo had manageable toxicity with durable clinical benefit in heavily pretreated predominantly HCT and CPI refractory cHL patients, for whom PFS is generally short. Future platforms could build on this strategy to maximize efficacy for these patients with limited treatment options.
  • Justin Kline
  • Joseph Tuscano
  • Guarav Goyal
  • Matthew Mei
  • Alison Davis
  • Geoff Shapiro
  • Catherine Diefenbach
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P125 (P125)

Three cycles of nivolumab (N) before BGD chemotherapy improves the remission rate before autologous hematopoietic cell transplantation (aHCT) in relapsed/refractory Hodgkin Lymphoma: N-BURGUND trial of the Polish Lymphoma Research Group (PLRG).

Introduction: Achieving complete metabolic response (CMR-Deauville score-DS1-3) before aHCT in patients (pts) with relapsed/refractory classical Hodgkin Lymphoma (r/r cHL) improves the long-term outcomes. BGD chemotherapy (bendamustine 90mg/m2 D1,2; gemcitabine 800 mg/m2 on D1,4; dexamethasone 40 mg on D1–4.) in the 2nd line induces CMR in ca.70% of r/r HL pts. In the phase-2 N-BURGUND trial (EudraCT 2021-002630-17), we test the hypothesis that short exposure to Nivolumab (Nivo) prior to BGD increases CMR rate by 15%. Methods: Patients aged ≥18 years with r/r stage (IIAX+IIB-IV) HL after 1st-line treatment were eligible and received N 240 mg IV Q2W for 3 cycles followed by PETNIV0 and 2xBGD combined with CD34+ cell mobilization, followed by PETBGD. Responding pts (DS1-4 assessed centrally) are subjected to aHCT and post-transplant brentuximab (BV) if eligible. The primary endpoint is CMR in PETBGD. The secondary endpoints: PETNIV0 response and 2-year progression-free survival (2-Y PFS). Results: Between 12/22 and 11/24, 86 pts (50% female) with r/r cHL were enrolled across 9 PLRG centers. Median age was 36 years (20-71); 71 (83%) pts received ABVD, 2 (2%) BV+AVD, and 13 (15%) BEACOPPesc as 1st line therapy. 56 (65%) pts were primary refractory, including 12 to BEACOPPesc and 2 to BV+AVD; 50 (58%) pts had an early relapse (<12 months). All pts, except 1, have completed 3xN and 2xBGD. The negative (-) PETNIVO rate was 34,5% (96%CI:23.9%–44.7%), whereas the (-) PETBGD 84% (95%CI 73.9%–90.7%). After 2xBGD all (-) PETNIVO pts had also (-) PETBGD; Out of 55 (+) PETNIVO pts: 41 became (-), the rest remained (+) PETBGD. AHCT was not performed in 10 (12%) pts: 6 because of early progression, 2 because of withdrawal of consent, 1 due to myocardial infarction, and 1 due to lack of compliance. 50 (66%) pts received BV after aHCT at median number 13 (1-16). After median follow-up 24 months 16 pts progressed:1 who withdrew the consent for aHCT, 6 before and 9 after aHCT. 2 pts died: 1 from tuberculosis and 1 from myocardial infarction. 2-Y PFS in ITT population is 76.2% (95%CI:67.3%-86.4%) and per protocol 79% (95%CI:70.2%-88.9%). 2-Y PFS in pts with (-) PETNIVO is 93.1% (95%CI:84.3%-100%) and significantly better compared to (+) PETNIVO 67.4% (95% CI: 55.6%-81.7%) with HR: 0.20 (95% CI:0.05-0.86), p=0.016, Figure. Conclusion: A short Nivo prior to standard 2nd line BGD improves CMR from historical 70% to 84%. CMR after 3xNivo identifies pts with excellent 93% PFS.
  • Michal Taszner
  • Ewa Paszkiewicz-Kozik
  • Adam Wyszomirski
  • Justyna Rybka
  • Karolina Chromik
  • Agnieszka Kołkowska-Leśniak
  • Edyta Subocz
  • Łukasz Targoński
  • Paulina Ceklarz
  • Magdalena Witkowska
  • Ryszard Swoboda
  • Katarzyna Domańska-Czyż
  • Agnieszka Giza
  • Małgorzata Kobylecka
  • Conrad-Amadeus Voltin
  • Joanna Romejko-Jarosińska
  • Beata Ostrowska
  • Monika Świerkowska
  • Agnieszka Druzd-Sitek
  • Michał Kurlapski
  • Marta Bednarek
  • Bogdan Małkowski
  • Grzegorz Romanowicz
  • Janusz Hałka
  • Tomasz Wróbel
  • Sebastian Giebel
  • Grzegorz Helbig
  • Ewa Lech-Marańda
  • Jan Maciej Zaucha
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P126 (P126)

REAL WORLD EFFICACY AND SAFETY COMPARISON OF SALVAGE REGIMENS COMBINING BRENTUXIMAB VEDOTIN AND CHEMOTHERAPY IN SECOND-LINE HODGKIN LYMPHOMA: A LYSA MULTICENTER RETROSPECTIVE STUDY.

The treatment of R/R HL involves polychemotherapy combined with Bv or anti-PD1 followed by ASCT for eligible patients. Polychemo combinations are based on phase II studies. No direct comparison allows for an evidence-based choice and treatment selection reflects habits. Aim: To compare the efficacy and toxicity of Bv-chemo regimens in patients with R/R HL who have been treated in a second line setting. Method: This retrospective multicenter study included patients with R/R Hodgkin lymphoma treated with Bv-chemo with intent to proceed to ASCT across 19 LYSA centers in France between 2014 and 2025. Result: 288 patients were included: 81 (28%) treated with Bv-benda, 110 (38%) with Bv-ICE and 97 (34%) with Bv-DHAC/X/P (Bv-DHA). The median age was 33 years, and median follow-up was 41 months. ABVD first line treatment was more frequent in patients receiving Bv-benda (p<0.01). Age, stage at relapse and time to relapse were also significantly different (p<0.01, p<0.01 and p=0.01). 97 patients (34%) had a refractory disease and 118 (41%) relapsed more than 1 year after EOT. 215 patients (75%) underwent ASCT after second line, 24 (8%) after third line. CR was observed in 72.4% of patients without difference between treatment groups (78% for Bv-benda, 76% for Bv-ICE and 67% for Bv-DHA; p=0.21). Similarly, 3 years PFS was 62% (712% (IC95% 61-80) for Bv-benda, 59 % (IC95% 50-68) with Bv-ICE, 59% (IC95% 48-68) with Bv-DHA), with no significant difference in PFS (log rank p=0.48). In multivariable Cox analysis adjusted for first-line treatment, age, time to relapse, and stage at relapse, PFS was not significantly (p=0.20): using Bv-DHA as the comparator, the HR for the Bv-benda group was 0.6 (95% CI, 0.3-1.1) and 0.8 (95% CI, 0.5-1.4) for Bv-ICE group. Hematological toxicity was higher with Bv-ICE in terms of both RBC (p<0.001) and platelet transfusions (p<0.001). Hospitalization median duration was significantly shorter in patients treated with Bv-benda (1.7 days/cycle) compared to those treated with Bv-ICE (4.3 days/cycle) or Bv-DHA (3.2 days/cycle). Severe infections rates were similar between the groups (p=0.81). Recrutement is ongoing and updated data will be presented at conference. Conclusion: Bv-benda, Bv-ICE and Bv-DHA showed similar efficacy as 2nd line salvage treatments for HL, with Bv-ICE being associated with significantly increased toxicity. These results provide real-world comparative data that may guide treatment selection among Bv-based salvage regimens.
  • Juliette Wencel
  • Arnaud Pages
  • Florian Chevillon
  • Robin Noël
  • Lucie Laemmel
  • Maxime Vignac
  • Emilie Corvilain
  • Pamela Sfeir
  • Milena Kohn
  • Guillemette Fouquet
  • Maxence Lohez
  • Baptsite Delapierre
  • Gaétan Basile
  • Gaelle Laboure
  • Amina Cherait
  • Carole Soussain
  • Adrien Grenier
  • Thorsten Braun
  • Laure Ricard
  • Axel Andre
  • Bénédicte Deau
  • Morgane Cheminant
  • Jean Galtier
  • Pilar Dutari
  • Loïc Renaud
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P127 (P127)

(Bv)DHAP + G-CSF as an effective peripheral stem cell mobilization regimen in adult patients with relapsed/refractory Hodgkin lymphoma

High-dose chemotherapy with autologous stem cell transplantation (auto-HSCT) remains the accepted standard of care for patients with Hodgkin lymphoma (HL) that has failed or relapsed after first-line chemotherapy. Mobilization of hematopoietic stem cells (HSCs, CD34+ cells) into the peripheral blood is a crucial step. In 5-40% of patients with relapsed or refractory HL, mobilization is ineffective. The use of chemomobilization regimens (chemotherapy followed by the administration of G-GSF) can be highly effective. Aim: to determine the dynamics of CD34+ cells in peripheral blood and evaluate the effectiveness using peripheral stem cell mobilization regimen (Bv)DHAP + G-CSF in adult patients with HL. Material and methods: the study included 115 adult patients with refractory form or a relapse of HL, treated at the Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology from 2019 to 2025. As a peripheral stem cell mobilization regimen (Bv)DHAP + G-HSF (10 mcg/kg/day from the 9th day until the mobilization effect was achieved) was administered. The number of CD34+ cells in peripheral blood was determined from days 14 to 17 using flow cytometry. Mobilization was considered effective when the CD34+ cell level reached 10 cells/μl. Continuous and categorical variables are presented as median (interquartile range) and abs. (%); for categorical variables, when demonstrating differences in the compared groups, the odds ratio (OR) is determined. Results: 60 women (52.2%), 55 men (47.8%); median age 35 years. After salvage therapy 73 (63,5%) patients had a complete response. The number of previous lines of therapy in patients ranged from 2 to 5. Mobilization effect was achieved in 93 patients (80.9%) from days 14 to 17, while no effect was achieved in 22 (19.1%). The median maximum number of circulating CD34+ cells in peripheral blood using the (Bv)DHAP + G-CSF HSC mobilization regimen is shown in Figure. The following statistically significant risk factors for unsatisfactory mobilization were identified: 3 or more lines of chemotherapy (OR 4.26 [1.6 – 11.8]), platelet count less 200 (OR 2.9 [1 – 8.5]); leukocyte count 4.5 or less (OR 3.26 [1.15 – 8.5]) in patients before the mobilization regimen. Conclusion: (Bv)DHAP + G-CSF was found to be an effective peripheral stem cell mobilization regimen in adult patients with relapsed/refractory Hodgkin lymphoma. The mobilization effect may be achieved in 80.9%.
  • Maryia Shapetska
  • Igar Iskrau
  • Marta Valevskaya
  • Olga Gerasimovich
  • Victoria Smolnikova
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P128 (P128)

EHA-4448 REAL-WORLD OUTCOMES OF PEMBROLIZUMAB PLUS GVD AS SALVAGE THERAPY AND BRIDGE TO AUTOLOGOUS STEM CELL TRANSPLANTATION IN RELAPSED/REFRACTORY CLASSICAL HODGKIN LYMPHOMA: A MULTICENTER GATLA STUDY

Background: In a phase 2 study of 39 pts. with R/R classical Hodgkin lymphoma (R/R cHL) candidates for autologous stem cell transplantation (ASCT), pembrolizumab plus gemcitabine, vinorelbine and liposomal doxorubicin (P-GVD) achieved a complete metabolic response (CMR) rate of 95%, with 95% proceeding to ASCT, supporting P-GVD as a highly effective bridge to transplant. Aims: To report real-world outcomes in a broader, unselected population of pts. with R/R cHL eligible for ASCT treated with P-GVD. Methods: Retrospective multicenter study within the GATLA cooperative group of consecutive pts. with R/R cHL eligible for ASCT treated with P-GVD. Baseline characteristics, PET response, immune-related adverse events (irAEs) and transplant rates were analyzed. Results: 52 pts. initiated P-GVD (median age 32 years, IQR 17–69). 46 (88.5%) received ABVD as first-line and 6 (11.5%) BV-AVD. AETHERA high-risk features were present in 88.5%: 69.2% primary refractory, 11.5% relapsed within the first year, 36.5% extranodal relapse; B symptoms in 65.4% and bulky disease in 32.7%. P-GVD was given as first salvage in 35 pts (67.3%) and second salvage in the remainder. PET assessment was available in 49 pts (94.2%); 3 discontinued after 1 cycle due to toxicity. After 2 cycles, 38 pts underwent PET/CT: 29 (76%) CR, 5 (13%) PR, 4 (11%) PD; 25 did not receive further P-GVD (CR 21, PR 2, PD 2). 13/38 received additional cycles and re-evaluated after 3–4 cycles (CR 8, PR 3, PD 2); 24 pts had PET/CT after 3–4 cycles total. Overall, 36/49 pts (73.5%) achieved CMR. 36 (73.5%) proceeded to ASCT (30 CMR, 6 PR); 6 CMR pts did not undergo ASCT; 1 received allogeneic transplant; 4/36 relapsed post-ASCT. (Fig.1) Median follow-up 14.7 months (IQR 10.3–26.2); 3/52 died: 1 COVID-19 during P-GVD, 1 GVHD post-allogeneic transplant, 1 sudden death. IrAEs in 8/52 pts (15.4%), manageable with standard interventions. Summary/Conclusion: P-GVD produced a CMR rate of 73.5% and enabled 77.6% to proceed to ASCT, lower than the 95% reported by Moskowitz et al. in the phase 2 trial. These differences likely reflect a less selected population, including 2nd salvage pts. and a higher proportion of primary refractory disease. Nonetheless, P-GVD remained an effective bridge to transplantation in routine practice, providing real-world context for PD-1–based chemo-immunotherapy as a bridge to ASCT. Our cooperative group is now conducting a prospective trial to more clearly define its safety profile and efficacy.
  • Astrid Pavlovsky
  • Fernando Warley
  • Luciano Salvano
  • Maria Orlova
  • Luciana Guanchiale
  • Laura Korin
  • Carolina Mahuad
  • Jose Ignacio Trucco
  • Amalia Cerutti
  • Florencia Negri Aranguren
  • Guadalupe Antelo Perez
  • Bruno Wannesson
  • Javier Romano
  • Lautaro Sardu
  • Veronica Musso
  • Etelvina Lucia MacChiavello
  • Nadia Scebba
  • Trinidad Viviani
  • Lorena Fiad
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P129 (P129)

You Don't Always Need a Transplant: Checkpoint Inhibitors Can Deliver Lasting Remissions in Relapsed and Refractory Classical Hodgkin Lymphoma

The PD1-targeting checkpoint inhibitors (CPI) nivolumab and pembrolizumab are established treatments for relapsed/refractory (R/R) classical Hodgkin Lymphoma (cHL) (Keynote-087/204, Checkmate-205). We retrospectively studied CPI-treated R/R cHL patients, evaluating survival, response, toxicity and post-CPI therapy in R. Between 2015-2025, 26 patients received CPI monotherapy (pembrolizumab n=16, nivolumab n=10) for R/R cHL. Median age was 40 (range 22-87) and 14 were female. The median number of prior treatments was 3 (2-11); 69% had advanced stage at diagnosis. The commonest first-line treatment was ABVD (n=19); 19 had primary refractory disease. Second-line treatments were ICE (n=10) or GDP (n=7), and third-line: brentuximab (n=10) or chemotherapy (n=8). Nine had autologous and 5 allogeneic stem cell transplant (SCT) pre-CPI (2 had both). CPI was salvage therapy in third line (n=5) or fourth line and beyond (n=21). Median CPI treatment duration was 13 months. For the cohort, ORR, complete response (CR), partial response (PR), stable disease (SD) and progression (PD) were 73.07%, 69.23%(n=18), 3.8%(n=1), 3.8% and 11.53%(n=3) respectively; 3 died before assessment. Median response duration was 21.9 months (95% CI 8.2-46.9). Eight proceeded to SCT as consolidation in CR (n=6), PR (n=1) or SD (n=1); median time from last CPI to transplant was 8.15 weeks. Post-transplant, 5 remain in CR, 3 progressed/relapsed. GVHD occurred in 6 patients, all grade 1-2. Of 12 in CR without SCT, 9 remain in CR (median treatment 13.4 months). Eight CPI-associated immune-related adverse events(AE) occurred in 6 patients (hepatitis, colitis, autoimmune haemolytic anaemia, panhypopituitarism, arthropathy, pneumonitis, neurotoxicity and thyrotoxicosis). At a median follow-up of 4 years, 14 patients remain in CR. Median PFS was 4.07 years (95% CI 2.4-NE); 5-year Kaplan-Meier PFS was 47% (95% CI 23-67) overall and 66% (95% CI 16-91) in the SCT group. Median OS not reached; estimated 5-year OS 59% (95% CI 30-79). On Cox regression, older age was associated with significantly higher progression risk (HR 1.06, 95% CI 1.02-1.10; p=0.001) on univariate and multivariate analysis. Our study demonstrates the real-world effectiveness of CPIs, with unselected patients achieving durable responses and an acceptable AE profile. It confirms that heavily pretreated patients can be safely consolidated with SCT, while many non-SCT patients in CR maintain durable remission. A UK-wide study is ongoing.
  • Vivek Radhakrishnan
  • Rida Shakeel
  • Deedar Singh
  • Robert Lown
  • Sean Lim
  • David Dutton
  • Angharad Pryce
  • Luke Bennett
  • Andrew Bates
  • Andrew Davies
  • Peter Johnson
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P130 (P130)

Second-Generation Epigenetic Clocks Reveal Accelerated Biological Aging in Relapsed/Refractory Hodgkin Lymphoma

Background: Relapsed/refractory (R/R) Hodgkin lymphoma (HL) is associated with poor clinical outcomes arising from multiple contributing factors. Biological aging has recently emerged as an area of interest; however, its role in driving R/R HL is not well defined. Epigenetic age acceleration (EAA), derived from DNA methylation-based clocks, may capture treatment- and disease-related aging processes in HL. First-generation epigenetic clocks predict chronological age, whereas second-generation clocks are designed to reflect biologic aging and health-related outcomes. Thus, we conducted a single-center study comparing EAA in R/R HL patients to that of healthy individuals. Methods: EAA was evaluated in 20 patients with R/R HL diagnosed from 2020 to 2022, and 60 healthy, non-cancer controls. Pre-banked peripheral blood samples collected at the time of relapse were obtained and processed using the Illumina EPIC v2 array to generate DNA methylation data. Methylation data were analyzed to calculate EAA using first-generation (Horvath, Hannum) and second-generation (PhenoAge, GrimAge2) epigenetic clocks. Comparisons were performed between R/R HL patients and controls, as well as across patient subgroups stratified by clinical characteristics. Results: Second-generation clocks demonstrated statistically significant increases in EAA in R/R HL patients compared with controls (PhenoAge: p = 0.0009; GrimAge2: p = 0.035). Additionally, R/R HL patients showed higher median EAA than control patients (median PhenoAge acceleration: 10.89 [IQR, 15.31] vs −3.17 [IQR, 5.36]; median GrimAge acceleration: 3.21 [IQR, 7.47] vs −1.84 [IQR, 3.60]). Among first-generation clocks, Horvath’s clock demonstrated significant age deceleration in relapsed HL patients compared with controls (median age acceleration: -3.16 vs 0.69, p = 0.007) whereas Hannum’s clock showed no significant difference. EAA did not differ significantly according to ethnicity, cHL status or treatment exposure (p > 0.05 for all comparisons). Conclusion: In this single-center analysis, we observed that second-generation epigenetic clocks detected significantly increased biological aging in patients with R/R HL. These findings support a potential association between biological aging and R/R HL, indicating that EAA may represent a biomarker of underlying disease biology and treatment-related aging. Further studies are needed to clarify the prognostic and clinical impact of accelerated epigenetic aging in HL.
  • Mahek Shah
  • Anuja Abhyankar
  • Nour Nassour
  • Francisco Hernandez-Ilizaliturri
  • Joyce Ohm
  • Alex Niu
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P131 (P131)

Autologous Stem Cell Transplantation after Anti-PD-1 Therapy in Heavily Pretreated Patients with Relapsed/Refractory Classical Hodgkin Lymphoma: Real-World Outcomes

Background: Autologous stem cell transplantation (ASCT) after anti-PD-1 therapy is an effective option in relapsed/refractory classical Hodgkin lymphoma (cHL). However, real-world outcomes often diverge from clinical trials, as patients are heavily pretreated and frequently undergo ASCT in the ≥3rd-line setting. This study provides real-world data from our clinical practice. Aims: To evaluate ASCT outcomes after anti-PD-1-based regimens in the entire cohort and the ≥3rd-line subgroup (ASCT after anti-PD-1 in the ≥3rd-line setting), identify prognostic factors for PFS, and characterize relapse patterns. Methods: We retrospectively analyzed patients with cHL who underwent ASCT after anti-PD-1-based regimens (2018–2024). Patients receiving salvage therapy between anti-PD-1 and ASCT were excluded. Survival was estimated using Kaplan-Meier method. Prognostic factors included: number of prior lines of therapy, time interval from anti-PD-1 to ASCT (<60 vs ≥60 days), and refractory status to the pre-anti-PD-1 line. Results: A total of 112 patients were analyzed (median age 35 years, range 19–56). The median number of prior lines of therapy was 2 (range, 2–7). Prior to anti-PD-1, 58%, 34%, and 15% of patients were refractory to 1, 2, and 3 consecutive lines, respectively. Anti-PD-1 was administered as monotherapy (37.5%) or with chemotherapy (62.5%). The median number of anti-PD-1 cycles was 6 (range, 2–52). Pre-ASCT Responses: complete response (CR) (83%), partial response (PR) (12.5%), progressive disease (0.9%) and indeterminate response (3.6%). Conditioning regimens: BEAM (20%) and BeEAC (80%). Post-ASCT maintenance: brentuximab vedotin (13.4%) and anti-PD-1 (15.1%). At a median follow-up of 37 months (range, 1–91), 3-year OS and PFS were 90% and 77% for the entire cohort (Figure 1). In the ≥3rd-line subgroup, 3-year OS and PFS were 90% and 78%. No prognostic factors significantly impacted PFS in the entire cohort. However, in the ≥3rd-line subgroup, refractory status to the pre-anti-PD-1 line was associated with shorter PFS (3-year PFS 64% vs 85%; p=0.02). A total of 14 relapses occurred, with 13 within 18 months of ASCT (range, 4–24 months). All relapsing patients had pre-ASCT CR or PR. Conclusion: ASCT after anti-PD-1 demonstrates high effectiveness for heavily pretreated patients in routine practice. In the ≥3rd-line subgroup, refractory status to the pre-anti-PD-1 line was associated with shorter PFS. Most relapses occurred within 18 months post-ASCT.
  • Iuliia Protopopova
  • Nikita Mochkin
  • Vladislav Sarzhevskiy
  • Elena Demina
  • Vladimir Melnichenko
  • Nikita Shorokhov
  • Anastasia Samoylova
  • Aisel Mamedova
  • Anna Bannikova
  • Anatoliy Rukavitsyn
  • Elena Smirnova
  • Vladimir Bogatyrev
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P132 (P132)

Allogeneic Hematopoietic Stem Cell Transplantation for Relapsed/Refractory Classical Hodgkin Lymphoma in the Brentuximab Era: Updated Single-Center Experience

Background: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a potentially curative option for patients with relapsed/refractory classical Hodgkin lymphoma (R/R cHL) after failure of salvage therapy and high-dose chemotherapy. PD-1 inhibitor-based salvage regimens have shown high response rates in clinical trials and real-world cohorts, but their use is constrained by limited regulatory approval and restricted reimbursement in many real-world settings. Consequently, many patients still proceed to allo-HSCT after brentuximab vedotin (BV)-based therapy with limited exposure to PD-1 inhibitors. Methods: This retrospective single-center study included 19 consecutive patients with R/R cHL who underwent allo-HSCT. Demographic characteristics, time from diagnosis to allo-HSCT, prior therapies, and survival outcomes were updated as of June 15, 2026. Prior treatment exposure included autologous HSCT (auto-HSCT), BV-containing therapy, and BV plus nivolumab before allo-HSCT. Overall survival (OS) was estimated using the Kaplan-Meier method. Results: The median age at allo-HSCT was 29.6 years (range, 20.3-42.9), and the median time from diagnosis to allo-HSCT was 4.9 years (range, 0.7-11.8). Prior auto-HSCT had been performed in 16 patients (84.2%). BV-based therapy before allo-HSCT was administered in 10 patients (52.6%), including 8 treated with BV alone and 2 with BV plus nivolumab. With a median follow-up of 23.2 months, the estimated 1-, 3-, and 5-year OS rates were 78.3% (95% CI, 59.4-97.2), 60.4% (95% CI, 37.3-83.5), and 31.1% (95% CI, 4.2-58.0), respectively (Figure 1). Ten deaths were recorded: 6 were associated with disease relapse/progression and 4 with graft-versus-host disease (GvHD)-related complications. Conclusions: In this updated single-center cohort, allo-HSCT provided meaningful survival despite extensive exposure to auto-HSCT and BV-based regimens, with only limited pre-transplant use of PD-1 inhibitors reflecting real-world access barriers. Long-term OS remained modest, with mortality driven by both relapse and GvHD-related complications, underscoring the need to optimize disease control before transplant and reduce post-transplant toxicity.
  • Natalya Milanovich
  • Alena Dziuba
  • Oksana Marozava
  • Yury Strongin
  • Oksana Nechay
  • Tatsiana Talako
  • Natalia Volkovets
  • Aliaksandr Avadok
  • Anatoly Uss
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P133 (P133)

Recurrent Hemophagocytic Lymphohistiocytosis and Hepatic Failure in EBV-Associated Hodgkin Lymphoma

Introduction: Classic Hodgkin lymphoma (cHL) is a highly curable neoplasm. However, <30% of patients have a relapse/refractory disease. The concurrence of cHL and hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening event usually mediated by Epstein-Barr virus (EBV) with a dismal prognosis. We report a clinical case of 42 year-old male that debuted with HLH related to EBV(+) cHL. Case presentation: A 42-year-old male was admitted with B symptoms and cytopenias. Positron emission tomography-computed tomography (PET/CT) showed nodal and extranodal hypermetabolic activity. A high plasma EBV viral load was detected. The patient experienced a rapid clinical deterioration with multiorgan failure (renal and hepatic failure). The clinical presentation was consistent with HLH confirmed by bone marrow aspirate. The lymph node biopsy demonstrated EBV(+) cHL. Thus, treatment with ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine) for 6 cycles was started. At the end of treatment evaluation, patient had a second event of HLH in the context of lymphoma progression. Then, Br-ESHAP (Brentuximab vedotin, etoposide, methylprednisolone, cytarabine and cisplatin) was initiated with transient improvement. Due to persistent HLH event, anakinra and high dose of steroids was added to therapy. After a fourth HLH episode, third-line treatment with nivolumab was started. Remarkable clinical improvement and resolution of EBV reactivation were observed with this treatment. The HLH recurrences linked to EBV reactivation prompted evaluation by a multidisciplinary team due to suspicion of an underlying primary immunodeficiency. Although the genetic panel (NGS) did not identify known causal mutations, the committee dismissed autologous transplantation and ruled out the use of an HLA-identical familial donor to avoid the potential transmission of an unknown genetic defect. Finally, the patient underwent allogeneic hematopoietic stem cell transplantation from an unrelated donor (9/10). Last evaluation, confirmed complete remission with full donor chimerism. Conclusion: In this patient, relapsed EBV(+) cHL associated with HLH, nivolumab offered a targeted and highly effective treatment which allowed HLH resolution and cleared viremia, serving as a bridge to allogeneic transplantation. Beyond suspicion of immunodeficiency and in absence of molecular genetic characterization, selection of an unrelated donor is recommended to avoid familial susceptibility.
  • Ignacio Tobarra
  • Marc Bosch
  • M Laura Fox
  • Josep Castellví
  • Cristina García
  • Pau Abrisqueta
  • Cecilia Carpio
  • Jhon Kevin Fuentes
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P134 (P134)

IMPACT OF PRE-TRANSPLANT BRENTUXIMAB VEDOTIN ON TOXICITIES AND OUTCOMES OF AUTOLOGOUS STEM CELL TRANSPLANTATION IN PATIENTS WITH RELAPSED/REFRACTORY HODGKIN LYMPHOMA

Background: Up to 30% of patients with Hodgkin lymphoma (HL) will relapse or are refractory to front-line therapy. Salvage chemotherapy followed by autologous stem cell transplantation (ASCT) remains the standard of care in this setting. Brentuximab vedotin (BV) is increasingly used as salvage therapy prior to ASCT in relapsed/refractory (R/R) HL. However, its impact on transplant-related toxicities and outcomes remains unclear. Methods: We performed a retrospective single-center study including 44 adult patients with R/R HL who underwent ASCT between January 2019 and January 2026. Patients were stratified according to pre-transplant exposure to BV (BV group, n=25) or standard salvage chemotherapy (SOC group, n=19). Mobilization efficacy, engraftment kinetics, toxicities, and post-transplant outcomes were compared. Results: Median age at transplantation was 35 years (18–62), 54.5% were male. At diagnosis, most patients presented with advanced-stage disease (Lugano stage III–IV, 75.0%), 47.7% with B symptoms and 27.3% with bulky disease. Primary refractory disease following first-line therapy (ABVD) was significantly more frequent in the BV group (80.0% vs 47.4%). Patients in the BV group more frequently received ≥3 regimens prior to ASCT, including BV combined with ESHAP, DHAP, ICE, bendamustine, or anti-PD-1-based therapies. BV-related adverse events were predominantly mild and manageable: ≤G2 peripheral neuropathy (n=2), ≥G3 infections (n=3), and transient ≤G2 hepatic toxicity (n=1). Most patients underwent BEAM conditioning (97.7%). Median infused CD34+ cell dose was comparable between groups, although poor mobilization occurred more frequently among BV-treated patients (16.0%). Median neutrophil and platelet engraftment times were similar between groups. No significant differences were observed regarding infectious complications, hospitalization duration, or transplant-related mortality. CR rates at day +100 post-ASCT were comparable between the BV and SOC groups (72.0% vs 73.7%). No statistically significant differences were observed in PFS or OS between the two groups (figure 1). Conclusion: These findings support the use of BV-containing regimens as an effective and well-tolerated pre-transplant salvage strategy in R/R HL. BV may reduce exposure to intensive multiagent salvage chemotherapy, although further studies with larger cohorts and longer follow-up are needed to better define its impact on long-term survival outcomes and toxicities.
  • Clara Sanches
  • Miguel Neto
  • Filipa Osório
  • Ana Isabel Brito
  • Margarida Badior
  • Inês Carvalhais
  • Ana Carneiro
  • Pedro Medeiros
  • Filipa Moita
  • Ana Luísa Pinto
  • Ricardo Pinto
  • Fernanda Trigo
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P135 (P135)

Immunophenotyping of CD8+ T cells from classical Hodgkin Lymphoma patients treated with PD-1 blockade

Introduction: Classical Hodgkin lymphoma (cHL) features rare Hodgkin–Reed–Sternberg (HRS) cells within a dense, dysfunctional immune infiltrate. While PD-1 blockade helps some relapsed cHL patients, durable responses are uncommon. In solid tumors, progression from intermediate to terminal T-cell exhaustion drives resistance to PD-1 blockade. We evaluated T-cell exhaustion states in relapsed cHL. Methods: We performed longitudinal single-cell RNA sequencing (scRNA-seq) of PBMCs from one patient during PD-1 inhibitor (PD1i) therapy. T-cell clones in blood and tissue were tracked by TCR sequencing. Gene expression was analyzed using Seurat and assessed for memory stem-like and terminal effector-like signatures. Findings were validated at the protein level by flow cytometry in 11 relapsed HL patients (pre- and post-PD1i) and 6 healthy age-matched controls, and by PhenoCycler imaging of 24 tissue biopsies (13 diagnostic, 11 post-PD1i). Results: scRNA-seq identified 25,268 cells, 10,593 were T cells. Markers defined nine PBMC clusters, with key transcriptional changes in T cells. TCR analysis detected clonotypes in 39.5% of T cells, with overlap between scRNA-seq, bulk PBMCs, and tumor tissue. At relapse, CD8+ T cells expanded, inverting the CD4+/CD8+ ratio. Longitudinal analysis of gene expression networks showed a shift from TCF1+ precursor to CX3CR1+ T-bet+ intermediate exhausted states, coinciding with relapse and expansion of a dominant CD8+ clonotype. Flow cytometry of PBMC confirmed enrichment of CD8+ CX3CR1+ T-bet+ cells in relapsed cHL, mainly PD1i non-responders, compared to controls (p = 7.3 × 10−3). Healthy controls had more CD8+ TCF1+ CD127+ stem-like cells compared to relapse cHL patients (p = 1.07 × 10−2). Spatial imaging of cHL tissue post PD1i had increased CX3CR1, PD-1, and T-bet expression in CD8+ T cells, while diagnostic cHL tissue had lower CX3CR1 and higher TCF7 (p = 2.44 × 10−4). Thus, diagnostic cHL T cells, in blood and tissue, are mainly stem-like, while relapsed HL contains more intermediate/terminally exhausted T cells, likely contributing to poor PD1i responses. Conclusions: Multiomic analyses show CD8+ T-cell states change dynamically during PD1i in cHL. Durable responses likely depend on maintaining progenitor-exhausted T cells, while relapse involves the accumulation of intermediate-exhausted CD8+ T cells. This may explain better PD-1 inhibitor responses in frontline versus later lines of therapy.
  • Matthew Salaciak
  • Tho-Alfakar Al-Aubodah
  • Samantha Worme
  • Laura Widawski
  • Claudia L. Kleinman
  • Ioannis Ragoussis
  • Ryan Rys
  • Madelyn Abraham
  • Angelo Rizzolo
  • Paige McCallum
  • Christophe Goncalves
  • Gerben Duns
  • Christian Steidl
  • Sonia Del Rincon
  • Koren K. Mann
  • Ciriaco Piccirillo
  • Francois E. Mercier
  • Nathalie Johnson
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P136 (P136)

Post-ASCT Brentuximab Vedotin (BV) maintenance in high-risk relapsed/refractory Hodgkin lymphoma in the era of novel salvage therapies: a bias-adjusted analysis of 4 LYSA real-world cohorts.

Introduction: AETHERA showed that Brentuximab Vedotin (BV) maintenance after autologous stem-cell transplantation (ASCT) improved PFS in BV-naïve high-risk relapsed/refractory classical Hodgkin lymphoma (R/R cHL). However, BV and PD-1 inhibitors before ASCT may reduce its added value. To address this question, we analyzed 4 French LYSA cohorts using methods accounting for treatment-selection confounding and immortal time bias. Methods: Adult R/R cHL patients eligible for BV maintenance after ASCT were analyzed. BV maintenance was compared with observation. Propensity scores included demographic and relapse-risk factors; inverse probability weighting was applied. Immortal time bias from delayed BV initiation was addressed using a weighted Cox model with BV as a time-varying exposure and a clone-censor-weight analysis comparing BV initiation within 4 months versus no maintenance. Outcomes were PFS and OS from ASCT Results: Among 304 patients, 256 with complete propensity-score covariates were analyzed. Median age was 31 years; 60% were male. At relapse, 65% had disseminated disease, 49% primary refractory disease, and 25% early relapse. Most had received BV before ASCT (n=216, 84%) and achieved CR before ASCT (n=217, 85%). Post-ASCT management was BV maintenance (n=165, 64%) or observation (n=91, 35%). After a median follow-up of 39 months, 2-year PFS/OS were 81%/96% with BV and 76%/95% with observation (p=0.086/0.98). After weighting, BV maintenance was not associated with improved outcomes. In the time-varying Cox model, BV was not associated with PFS (HR 0.80, 95% CI 0.46–1.41; p=0.45) or OS (HR 1.71, 95% CI 0.50–6.02; p=0.40). Among BV-exposed patients, PFS did not differ by maintenance use (p=0.34), whereas BV maintenance was associated with improved PFS in the small BV-naïve subgroup (n=38; p<0.001). In patients in CR before ASCT, the apparent unadjusted PFS benefit of BV maintenance (p=0.046) disappeared after adjustment and immortal-time bias correction (HR 0.77, 95% CI 0.42-1.42; p=0.41). Conclusion: In 4 LYSA cohorts, the added value of post-ASCT BV maintenance appeared limited after prior exposure to novel agents when robust causal methods were applied. A potential benefit was mainly observed in the small BV-naïve subgroup, whereas no clear benefit was evident after BV-based salvage, particularly in patients achieving CR before ASCT. These findings support refinement of post-ASCT consolidation strategies beyond historical AETHERA criteria.
  • Amira Marouf
  • Tesla Murari Mirimo
  • Jean Galtier
  • Gaétan Basile
  • Pilar Dutari
  • Cédric Rossi
  • Fanny Cherblanc
  • Loïc Chartier
  • Krimo Bouabdallah
  • Robin Noel
  • Hervé Ghesquières
  • Bénédicte Deau-Fischer
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P137 (P137)

Anti PD1 containing salvage regimen is highly effective in chemorefractory HL patients

Despite the introduction of new drugs, relapsed/refractory Hodgkin Lymphoma (R/R HL) remains challenging. Pembro-GVD (pembrolizumab, gemcitabine, vinorelbine and liposomal doxorubicine) has emerged as an effective salvage regimen before consolidation with high dose chemotherapy and autologous stem cell transplantation (ASCT). However, there are limited real life data regarding its efficacy and safety in 3rd line. We present a retrospective, unicentric analysis of 10 R/R HL who received pembro-GVD in 3rd line (2nd salvage) between 7/2023 and 9/2025. We evaluated overall response rate (ORR) and complete response rate (CRR) by PET-CT scan according to Lugano criteria, as well as transplant rate. Refractory disease was defined as progression at end of treatment in PET/CT. Toxicity and treatment discontinuation was assessed per cycle. Median age at diagnosis was 34,9 (20-56) years and 7/10 patients were males. At diagnosis, 8/10 presented with advanced disease (6 in stage III-IV), 8/10 with B symptoms and 3/10 with bulky disease. They were all treated with a PET-guided strategy, starting with 2 cycles of ABVD, and 4/10 intensified to escBEACOPDAC. Six patients had refractory disease, 2 an early relapse (<6 months) and 2 a late relapse. As 1st salvage, all patients received a platinum-based regimen associated to brentuximab vedotin; 8 were refractory. Median number of pembro-GVD cycles was 3 (2-4). Response was assessed after 2 cycles in 8 patients and after 3 cycles in 2: ORR was 100% and CR rate 80%. Six patients continued pembro monotherapy until ASCT (median: 2 cycles). All but one patient proceeded to ASCT in response. After ASCT, all patients achieved CR. After a median follow-up of 18,5 months all patients but one maintained CR. Adverse events occurred in 8/10 patients at any time during treatment: 7 immuno-related (four G3-4) and 7 haematological toxicities (one G2 and 6 G3-4; two febrile neutropenia). Dose reduction or treatment delays occurred in 5 patients; treatment was discontinued due to toxicity after 3rd cycle in 4 patients. No deaths occurred. In this small series of patients with adverse prognosis, pembro-GVD in 3rd line was effective as salvage regimen and allowed consolidation with ASCT with continuous CR in most patients. The incidence of adverse events was higher than in other series. Considering the early response to pembro-GVD, patients should quickly proceed to ASCT consolidation after cycle 2 to minimize toxicity.
  • Francesca Pierdomenico Maciel
  • Carolina Freitas
  • Diana Viegas
  • Inês Coelho
  • Maria Inês Barbosa
  • Alina Ionita
  • Susana Carvalho
  • Maria Gomes da Silva
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T106 (T106)

Phase 1 PRIMAVERA Study of the PRMT5 Inhibitor AZD3470 in Patients with Relapsed/Refractory Classic Hodgkin Lymphoma

abstract talk Abstract Talk in Relapsed & Refractory HL (Monday, 05.10. 10:45)

Background: Protein arginine methyltransferase 5 (PRMT5) is critical for cell proliferation and differentiation and its dysregulation is associated with cancer development. Methylthioadenosine (MTA), an endogenous partial inhibitor of PRMT5, accumulates in cancer cells deficient in MTA phosphorylase (MTAP). In classic Hodgkin lymphoma (cHL), >80% of primary patient (pt) tumor samples are MTAP deficient (Urosevic J, ASH 2023). The MTA-cooperative PRMT5 inhibitor AZD3470 preferentially binds to MTA-bound PRMT5, increasing its target engagement to MTAP-deficient cancer cells. We present safety and preliminary efficacy of AZD3470 from a Phase 1 study in relapsed/refractory (r/r) cHL (NCT06137144). Methods: Eligibility: ≥18 years; r/r cHL; ≥3 prior lines of therapy (including brentuximab vedotin (BV) and anti-PD-1). Pts received oral AZD3470 monotherapy QD in ascending dose levels (DLs) using an mTPI-2 design. Primary endpoints: incidence and severity of treatment-emergent adverse events (TEAEs) and dose-limiting toxicity (DLT). Secondary endpoints: overall response rate (ORR) and complete response rate (CRR) (Lugano 2014 criteria). Results: As of 25/11/25, 39 pts (male, 62%; stage IV, 77%; median age, 42 [range 25–78] years; median prior lines of anticancer therapy, 6 [range 3–14]) had received AZD3470 at DL 1 to 8. All pts had had prior BV and anti-PD1 therapy; 20 (51%) and 5 (13%) pts had had prior autologous and allogeneic hematopoietic stem cell transplantation, respectively. All pts evaluable for MTAP protein expression were MTAP deficient. Median duration of exposure was 15 weeks (range 0.1–45.1), with treatment ongoing in 16 pts (41%). TEAEs occurred in 85% of pts, predominantly grades 1 or 2. The most common TEAEs (any grade) were anemia (28%) and nausea (15%). Grade ≥3 TEAEs occurred in 28% of pts, most commonly neutropenia (related) and hypokalemia (n=2 each). Serious TEAEs occurred in 5 pts (13%). Two pts had dose reductions due to TEAEs (grade 4 hypertriglyceridemia and grade 3 esophagitis). No DLTs, treatment discontinuations nor deaths due to TEAEs were reported. Of 31 evaluable pts, 14 had an objective response, with responses at ≥DL4. The highest response rate was observed at ≥DL7 (n=10) with ORR 80% and CRR 50%. Conclusions: AZD3470 monotherapy was well tolerated, with no DLTs and mainly low-grade AEs. Both ORR and CRR were dose-dependent and notably high in this heavily pretreated cHL population. Dose optimization is ongoing.
  • Pier Luigi Zinzani
  • Franck Morschhauser
  • Vincent Ribrag
  • Elizabeth H. Phillips
  • Herve Ghesquieres
  • Hun Ju Lee
  • Peter Borchmann
  • Paul J. Bröckelmann
  • Tae Min Kim
  • Katharine Lewis
  • Jakub Svoboda
  • Antonia Rodriguez Izquierdo
  • Won Seog Kim
  • Anna Sureda
  • Graham P. Collins
  • Kaitlyn Beyfuss
  • Cedric Dos Santos
  • Richard F. Olsson
  • Enrico Derenzini
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T107 (T107)

Treatment patterns and survival outcomes of patients relapsing after frontline Nivolumab-AVD in advanced stage classical Hodgkin lymphoma (cHL)

abstract talk Abstract Talk in Relapsed & Refractory HL (Monday, 05.10. 10:45)

Background: Nivolumab (nivo) with AVD (NAVD) is standard-of-care for frontline (1L) treatment (tx) of advanced stage (AS) cHL in the U.S. There is a gap in data on patients (pts) relapsing after 1L NAVD and the utility of re-challenge with checkpoint inhibitors (CPI). Thus, we sought to evaluate tx patterns and outcomes of pts with cHL relapsing after 1L NAVD. Methods: Pts included had cHL treated with 1L NAVD between 2018 and 2025 at 23 US sites. Primary refractory disease was defined as less than a complete response (CR) at end of treatment (EOT) PET-CT. Second line (2L) tx was considered CPI-based if it included CPI with chemotherapy (chemo) or Brentuximab Vedotin (BV) and non-CPI based if BV +/- chemo. PFS was calculated from date of auto-SCT (ASCT). Results: Overall, 50 pts were included, 52% were male, 24 (48%) were primary refractory to 1L tx and 15 (30%) had relapse <12 months (mo) from EOT. 47 (94%) had biopsy proven relapse. The median age at relapse was 55 (17-84). At relapse, 78% had AS disease, 15% had B symptoms, and 42% had extranodal involvement. 49 pts (98%) received 2L tx; 23 pts (47%) received CPI-based tx and 26 pts (53%) received non-CPI based tx (Fig 1). Non-CPI tx included BV-bendamustine (benda) (n=13, 50%), BV-ICE (n=9, 35%), BV monotherapy (n=3), and ICE (n=1). CPI-based tx included CPI with chemo (n=16, 70%), BV+nivo (n=6, 26%) and nivo monotherapy (n=1). Among all response-evaluable pts (n=43/49), the ORR/CR rates were 86% and 65%, respectively. ORR (95% vs 78%) and CR rates (70% vs 61%) were numerically higher for CPI-based vs non-CPI based 2L tx. 71% (17/24) of primary refractory pts received non-CPI 2L tx. Among evaluable primary refractory pts (n=21/24), ORR was 76% and CRR was 57% (CPI-based vs non-CPI CRR was 50 vs 60%, respectively). 10 pts (20%) required third line tx. Of these, 8 pts had PD after 2L tx. The other 2 pts had inadequate response to 2L. With a median follow up (f/up) of 8.1 mo (0.1-60), there were 12 total events with 9 progressions and 3 deaths (1 cHL, 2 unknown during salvage). 31 patients (62%) proceeded to ASCT. Median f/up post ASCT was 5.3 mo (0.3-57.3). 6-month PFS/OS post ASCT was 100%, with 1 late relapse/death from cHL post-ASCT at 60 months. Two pts were ineligible for ASCT. Conclusions: Both CPI-based and non-CPI-based therapies remain effective at achieving disease control and bridging to ASCT post NAVD relapse. Outcomes after ASCT appear similar to prior literature with longer f/up needed.
  • Harsh Shah
  • Allison Bock
  • Peirong Hao
  • Xi Qiao
  • Robert Stuver
  • Swetha Thiruvengadam
  • Azra Borogovac
  • Reid Merryman
  • Nicole Araujo
  • Ayo Falade
  • Samin Houshyar
  • Daniel Reef
  • Gordon Smilnak
  • Kanithra Sekaran
  • Efrat Luttwak
  • Dahlia Sano
  • Ajay Major
  • Ritwick Mynam
  • Grace Baek
  • John Sharp
  • John Vaughn
  • Praveen Ramakrishnan Geethakumari
  • Sanjal Desai
  • Jessica Allen
  • Kelsey Baron
  • Tiffany Chang
  • Nivetha Ganesan
  • Vrutti Patel
  • Marisa Palmeri
  • Anuja Abhyankar
  • Drew Gerber
  • Madiha Iqbal
  • Hua-Jay Cherng
  • Alex Niu
  • Joanna Rhodes
  • Jakub Svoboda
  • Catherine Diefenbach
  • Timothy Voorhees
  • Mengyang Di
  • Priyanka Pophali
  • Yasmin Karimi
  • Reem Karmali
  • Krithika Shanmugasundaram
  • Natalie Grover
  • Urshila Durani
  • Ivana N. Micallef
  • Jonathan W. Friedberg
  • Tatyana Feldman
  • Matthew Mei
  • Pallawi Torka
  • Philippe Armand
  • Alison Moskowitz
  • Alex Herrera
  • Narendranath Epperla
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T108 (T108)

Primary Analysis of the GHSG Pembro-CORE Trial: PET-Adapted PD-1-Based Salvage Therapy Omitting High-Dose Chemotherapy in First-Relapsed Hodgkin Lymphoma

abstract talk Abstract Talk in Relapsed & Refractory HL (Monday, 05.10. 10:45)

Background: Standard therapy for relapsed/refractory classical Hodgkin lymphoma (r/r cHL) consists of salvage chemotherapy followed by high-dose chemotherapy (HDCT) and autologous stem-cell transplantation (ASCT). Although effective, this approach is associated with substantial acute and long-term toxicity, and a major unmet need for HDCT-free strategies remains. Anti-PD1-based salvage combinations have shown high complete metabolic response rates (CMR) and may allow selected patients to avoid HDCT/ASCT. Methods: Pembro-CORE is a prospective, open-label, multicenter phase II trial conducted at four German sites. Transplant-eligible patients aged 18–65 years with first relapsed or primary refractory cHL received 1x pembrolizumab followed by chemoimmunotherapy adapted by interim PET after 1x pembrolizumab and 2x P-ICE. PET-negative patients received 2 additional P-ICE, whereas PET-positive patients switched to 4x P-DHAP. Patients achieving PET negativity received 8x pembrolizumab maintenance. Stem-cell apheresis was mandatory; patients with persistent PET positivity were recommended to undergo off-trial HDCT/ASCT. The primary endpoint was centrally reviewed CMR after completion of 4x chemoimmunotherapy. Results: 29 patients were enrolled (median age 38 years; 59% male; 52% advanced-stage at initial diagnosis; 93% BEACOPP-like-pretreated; 14% primary refractory). At the primary endpoint restaging CMR was achieved in 26/29 patients (90%). After 2 cycles of chemoimmunotherapy, the CMR rate was 57%. Only 5/29 patients (17%) subsequently underwent HDCT/ASCT. With a median follow-up of 13.2 months, 9 patients (31%) experienced progression/relapse, including 7 patients who had achieved CMR at the primary endpoint assessment. No deaths occurred. All patients experienced at least one adverse event. Serious adverse events occurred in 10/29 (34%), mainly infections (n=5), while one patient developed autoimmune colitis (all events resolved). Conclusions: PET-adapted pembrolizumab-chemotherapy induces a high CMR rate of 90% in first r/r cHL. However, the substantial relapse rate despite short follow-up, including relapses among patients who achieved PET-negativity at the primary endpoint restaging indicates that Deauville score-based stratification alone appears insufficient to identify patients who can safely omit HDCT. Further studies exploring HDCT-free strategies, tailored by biologically defined patient subgroups and dynamic response assessment, are warranted.
  • Hishan Tharmaseelan
  • Ina Bühnen
  • Helen Kaul
  • Sarah Gillessen
  • Carsten Kobe
  • Karin G. Schrenk
  • Philipp Ernst
  • Max S. Topp
  • Ulf Schnetzke
  • Nico Freund
  • Stephanie Sasse
  • Wolfram Klapper
  • Michael Fuchs
  • Sven Borchmann
  • Paul J. Bröckelmann
  • Peter Borchmann
  • Bastian von Tresckow

Resource constrained setting

Posters

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    P139 (P139) Implementation of BrECADD According to HD21 Standards in a Middle-Income Country: Barriers and Feasibility in Mexican Public Hospitals

    • Laura Nayeli Tecayehuatl Negrete
    • Luis Felipe Rubalcava Lara
    • Gerardo Santiago Jiménez
    • Alonso Hernández Company
    • Perla Rocío Colunga Pedraza
    • Bogar Pineda Terreros
    • Martín Jacobo Pacheco
    • María Eugenia Mejía Chávez
    • Karina Angelica Arzate Ramírez
    • María Catalina López Aparicio
    • Ramón Alberto Barreda González
    • Ana Xochitl Muñoz Gutierrez
    • Juan Rangel Patiño
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P139 (P139)

Implementation of BrECADD According to HD21 Standards in a Middle-Income Country: Barriers and Feasibility in Mexican Public Hospitals

Background: BrECADD has emerged as a new standard of care for advanced-stage classical Hodgkin lymphoma (cHL). However, little is known about its implementation outside clinical trials. We evaluated the feasibility of delivering BrECADD in Mexico. Methods: We conducted a multicenter retrospective study of consecutive patients with newly diagnosed cHL treated with BrECADD across four Mexican public institutions. Feasibility was assessed using a predefined HD21-inspired adherence measure, defined by the availability of baseline and interim PET-CT, completion of planned treatment, and the absence of dose reductions or treatment delays >14 days. Potential implementation barriers were evaluated across four predefined domains: diagnostic infrastructure, treatment delivery, supportive care, and safety. Results: Twenty patients were included. Median age was 33 years (IQR 22–42); 65% had nodular sclerosis subtype and 90% advanced-stage disease. B symptoms were present in 90%, bulky disease in 55%, and ECOG 0–1 in 75%. Baseline and interim PET-CT assessments were available in 65% and 50% of patients, respectively. Treatment was administered in the outpatient setting in 75% of cases, while mesna was used in 30%. Thirty percent received four cycles and 70% six cycles of BrECADD. Ninety percent completed treatment without dose modifications and only 10% experienced delays >14 days due to toxicity or logistical reasons. All patients received primary G-CSF prophylaxis; 70% received Pneumocystis and antifungal prophylaxis. Febrile neutropenia occurred in 10%, intensive care admission in 5%, and transfusion support in 10%. No treatment-related deaths were observed. The overall response rate was 95%, including 70% complete responses. Radiotherapy consolidation was administered in 30%. Four patients (20%) required subsequent systemic therapy; 12-month progression-free survival was 74.5%, and overall survival was 100%. All patients completed planned treatment; however, full HD21 adherence was achieved in only 7 of 20 patients (35%). Conclusions: BrECADD can be safely delivered in Mexican public hospitals, with low rates of severe toxicity. Despite a 100% treatment completion rate, full implementation of the HD21 strategy was achieved in only 35% of patients. Barriers were predominantly identified within the diagnostic infrastructure domain, particularly limited access to baseline and interim PET-CT.
  • Laura Nayeli Tecayehuatl Negrete
  • Luis Felipe Rubalcava Lara
  • Gerardo Santiago Jiménez
  • Alonso Hernández Company
  • Perla Rocío Colunga Pedraza
  • Bogar Pineda Terreros
  • Martín Jacobo Pacheco
  • María Eugenia Mejía Chávez
  • Karina Angelica Arzate Ramírez
  • María Catalina López Aparicio
  • Ramón Alberto Barreda González
  • Ana Xochitl Muñoz Gutierrez
  • Juan Rangel Patiño

General Information

Conference Office

Gürzenich Cologne Martinstraße 29-37 50677 Cologne During the Conference the Secretariat can be contacted at Phone: +49 (0) 173 939 07 30 Email: info@tca-hanke.de

Opening Hours of the Conference Secretariat

Saturday, October 03, 2026 11:00–18:00 Sunday, October 04, 2026 08:00–18:00 Monday, October 05, 2026 08:00–13:00

Accomodation

For accomodation support, please contact the conference management: Phone: +49 (0) 2102 . 669 36 Email: info@tca-hanke.de

Name Badge

Please make sure to always wear your badge at the conference. If you lose your badge, we will have to charge you a replacement fee.

Catering

During the breaks, complimentary coffee, fruit and refreshments will be available.

Cloakroom

The cloakroom is located in the basement.

Conference Language

The conference language is English.

Continuing Medical Education

The 14th International Symposium on Hodgkin Lymphoma is certified by the European Board for Accreditation in Hematology with 16 EBAH credit points. Please collect your certificates before departure at the registration desk (in the entrance hall of the Gürzenich)

Insurance

The meeting organizers cannot accept liability for personal injuries sustained to Conference participants or for loss or damage of their personal belongings, neither during nor as a result of the meeting.

Internet

There will be free wifi at the Gürzenich Conference Center. Further details and access codes will be provided on site. You can also use the two on-site internet terminals for web browsing and web-based email access.

Prayer Room

A nondenominational prayer room will be available in the conference center. For further details, please contact the Conference Secretariat.

Registration

Pre-registration will close on October 1, 2026. All registrations re- ceived on or after October 2 will be considered as on-site registrations and will be charged the on-site fee. Full registration will include access to the scientific sessions and exhibition, a copy of the program, the welcome reception on Saturday (October 03) and all refreshment breaks. You will also receive a name tag; please wear this name tag at all conference events including the scientific symposia. No refunds will be given.

Speakers Ready Room

The Speakers Ready Room is located next to the registration desk on the ground floor of the Gürzenich Conference Center. Speakers are requested to hand in their PowerPoint presentations in 16:9 format saved on a stick at least 3 hours before their session or the day before if the session starts early in the morning. We can only accept Microsoft PowerPoint files for upload to the conference system. It is not permit- ted to use your own laptops or other devices for uploading the files

Non-Smoking

Please note that there will be a strict non-smoking policy at all conference facilities.

Transportation

The airports closest to Cologne City are Cologne Bonn Airport (CGN; 15 km) and Düsseldorf Airport (DUS; 45 km). From Cologne Bonn Airport you can reach Cologne central station by regional rail in about 30 minutes; from Frankfurt Airport to Cologne it takes only an hour by InterCity Express (ICE) and from Düsseldorf Airport about 45 minutes. Cologne central station is within walking distance (about 10 minutes) from the Gürzenich Conference Center and the Dorint Hotel. You can also take bus no. 132 and get off at “Gürzenichstraße”. The other hotels recommended by the Conference Organization can easily be reached by public transport. Cologne has an efficient public trans- port system, but the recommended hotels, the venue as well as other places of interest are within a comfortable walking distance from each other. For those who are traveling by car, we recommend to use the parking ground “Heumarkt” (about 3 minutes walking distance from the Gürzenich)

Welcome Reception

On Saturday evening, the conference will be opened officially. After the Opening Ceremony, all participants are warmly invited to join the poster session which is accompanied by a Get Together event at the Gürzenich Conference Center. This event is a great opportunity to meet and chat with many colleagues involved in Hodgkin Lymphoma research and treatment. Drinks and snacks will be provided.

Sponsors

Legal Info

International Symposium on Hodgkin Lymphoma

Prof. Peter Borchmann, MD. German Hodgkin Study Group (GHSG) Gleueler Str. 269-273 50935 Köln Phone: +49 (0)221-478 5933 Fax: +49 (0)221-478 3778

Responsible for Content Provided

In accordance with the German Act for Telemedia Services (TMG), § 55 Abs. 2 RStV (section 55, subsection 2 broadcast services state treaty): Prof. Peter Borchmann, MD.

Obligatory Information

Legal Entitiy: The University Hospital of Cologne is a Public Law Institution. Legal Representation: The University Hospital of Cologne is represented by the Board of Directors, in turn represented by: Prof. Dr. Edgar Schömig, CEO and medical director Günter Zwilling, Director of finance Kerpener Str. 62 D-50937 Köln

Scientific Organisation

Peter Borchmann, MD, Symposium and GHSG Chairman Sven Borchmann, MD, PhD, Symposium Co-Chair Paul J. Bröckelmann, MD, Symposium Co-Chair Dennis A. Eichenauer, MD, Symposium Co-Chair German Hodgkin Study Group Department I for Internal Medicine University Hospital of Cologne Kerpener Straße 62, D-50924 Cologne Phone: +49 (0) 221 . 478-5933 Fax: +49 (0) 221 . 478-3778 Email: info@hodgkinsymposium.org Further Information: www.hodgkinsymposium.org

Conducting Organisation

KARO – KML Academic Research Organisation GmbH Gleueler Str. 176-178, D–50935 Köln Phone +49 221 560 779-43 Fax: +49 221 560 779-44 CEO: Dr. Birgit Fath, Michael Fuchs

Conference Management & Industrial Exhibition Secretariat

Gabriele Hanke Travel & Congress Activities Marienburger Str. 8; D-40883 Ratingen Phone: +49 (0) 2102 . 669 36 Fax: +49 (0) 2102 . 9648 29 Email: info@tca-hanke.de

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Awards

Karl Musshoff Prize: Best Clinical Abstract

Judith Trotmann

Karl Musshoff Prize: Best Preclinical Abstract

Wolfram Klapper

Scientific Committee

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Ranjana Advani
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Marc André
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Stephen Ansell
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Philippe Armand
Photo of { mem.first_name }} Baiocchi
Otavio Baiocchi
Photo of { mem.first_name }} Baues
Christian Baues
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Peter Borchmann
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Paul J. Bröckelmann
Photo of { mem.first_name }} Collins
Graham Collins
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Catherine Diefenbach
Photo of { mem.first_name }} Diehl
Volker Diehl
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Hans Theodor Eich
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Dennis Eichenauer
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Andrew Evens
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Justin Ferdinandus
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Alexander Fosså
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Jonathan Friedberg
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Herve Ghesquieres
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Sylvia Hartmann
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Alex Herrera
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Mark Hertzberg
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Richard Hoppe
Photo of { mem.first_name }} Hutchings
Martin Hutchings
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Wolfram Klapper
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Carsten Kobe
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Ralf Küppers
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Sirpa Leppä
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Christine Mauz-Körholz
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Alison Moskowitz
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Craig H. Moskowitz
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Peter Omondi Oyiro
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Wouter Plattel
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John Radford
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Andreas Rosenwald
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Margaret Shipp
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Yuqin Song
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Lena Specht
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Christian Steidl
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Anna Sureda
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Flora van Leeuwen
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Bastian von Tresckow
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Joachim Yahalom
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Josée Zijlstra
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Pier Luigi Zinzani

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