PS1282 INFECTIOUS COMPLICATIONS OF NIVOLUMAB THERAPY IN RELAPSED/REFRACTORY HODGKIN'S LYMPHOMA

Background: The clinical development of checkpoint inhibitor‐based immunotherapy has ushered in an exciting era of anticancer therapy. Despite of many reports on anti PD‐1 antibody therapy for the treatment of Hodgkin's lymphoma (HL), risk of infection among patients receiving nivolumab is still unknown. We are the first to present the real‐life data on infection complications in large cohort of r/r HL after nivolumab (nivo) therapy. Aims: Our aim was to study the epidemiology of infection complications in r/r HL adult patients during one year of salvage therapy with nivo in CIC 725. Methods: Between 2016 and 2018 years 112 patients with r/r HL were observed and treated with nivolumab (3 mg/kg) in CIC 725. The median age was 31 y.o. (13–62 years). The median number of nivolumab courses received was 20 (range, 1–30). 18 patients underwent allo‐HSCT after therapy of nivolumab. The median follow‐up period was 1,4 years (1 month‐2,6 year). Outcome analysis considered events at one year after first nivolumab administration and were censored at the date of allo‐HSCT or auto‐HSCT. Infections were identified by reviewing patient clinical, laboratory data and imaging studies. All patients had a standard anti‐infective prophylaxis and treatment according to the international guidelines. Results: During salvage treatment with nivolumab of r/r HL in 11 (10%) patients were documented infection episodes (n = 16): bacterial infections – 37,5% (n = 6), invasive fungal diseases (IFD) – 25% (n = 4) and viral infections – 37,5% (n = 6). The median time to infection episodes was 98 days (12–365) after first nivolumab administration. Incidence of bacterial infections in study cohort was 5,3% (n = 6). Two patients developed pneumonia, others met in one: sinusitis, meningitis cause by Listeria meningitis, colitis and gonitis. Incidence of viral infections was 5,3% (n = 6): pneumonia associated with HHP‐6 and CMV in 50% and generalized infections in 50% caused by HSV‐1,2 and HHV‐6 . Invasive fungal diseases were diagnosed in 3,6% patients (n = 4). The main etiology agent was Aspergillus spp. in 50%. Primary chemoresistant disease before nivolumab therapy was the only risk factor of infection complications during treatment of r/r HL (p = 0,029). Overall survival (OS) at 1 year after first nivolumab administration in study cohort was 96,5%. The only one death was attributed to infection, patient died due to sepsis unknown etiology. Summary/Conclusion: Incidence of infectious complications in r/r HL treated with nivolumab was 10% with the median time of onset – 98 days. Etiology of infectious complications presented by bacterial infections –37,5%, invasive fungal diseases – 25% and viral infections – 37,5%. Primary chemoresistance was a risk factor for infection complications. Wherewith infections could be managed successfully and carry favorable prognosis.