Azacytidine Plus PD-1 Therapy in Relapsed or Refractory Hodgkin Lymphoma

Background: The treatment of relapsed or refractory (R/R) Hodgkin lymphoma (HL) remains challenging. Azacitidine has been demonstrated enhancing PD-1 expression in vivo. The aim of this study is to evaluate the safety and efficacy of azacitidine when given together with PD-1 therapy(AP) in treating patients with relapsed/refractory classic Hodgkin lymphoma.

Methods: Adult patients with R/R HL who had progressed after at least 1 prior line of therapy were enrolled to receive Azacytidine(75 mg/m2 qd on days 1-7) plus PD-1 therapy(200mg qd on day 8). Treatment continued until disease progression or unacceptable toxicity occurred post CR. Patients discontinue treatment after 2 years of sustained CR (NCT06190067).

Results: 2 patients with R/R HL were enrolled. Patient 1 received complete remission after two cycles of ABVD, but relapsed after six cycles of ABVD. Patient 1 then received complete remission again after four cycles of DP（Decitabine pus PD-1 therapy）, but relapsed again after six cycles of DP. Then, the patient received complete remission the third time after 3 cycles of AP and received AP maintenance therapy. The patient is still in complete remission until now (8 months). Patient 2 received partial remission after two cycles of ABVD，but progressed after four cycles of ABVD. Patient 2 received complete remission after 3 cycles of AP and received AP maintenance therapy. The patient is still in complete remission until now (9 months).

Conclusion: This study found that the AP regimen was effective and safe in patients with R/R HL after multiline therapy. Surprisingly, in the patient who relapsed after demethylated drug decitabine plus PD-1 therapy, AP regimen also showed a better response. More R/R HL patients need to be enrolled and further prospective studies were warranted.

No relevant conflicts of interest to declare.