Efficacy of nivolumab as checkpoint inhibitor drug on survival rate of patients with relapsed/refractory classical Hodgkin lymphoma: a meta-analysis of prospective clinical study

  • A. Amraee
  • M. R. Evazi
  • M. Shakeri
  • N. Roozbeh
  • M. Ghazanfarpour
  • M. Ghorbani
  • J. Ansari
  • L. DarvishEmail author
Research Article



The primary standard treatment for classic Hodgkin's lymphoma (cHL) is chemotherapy and radiation therapy. However, some patients get relapsed, or their diseases become resistant. PD1 blocking antibodies have been used to increase the response of treatment in solid tumors, and led to potentially stable responses that are acceptable. Our purpose in this study is to investigate the effect of nivolumab as a PD1 blocking antibody on the survival rate of patients with Hodgkin's cancer.


Databases were found in International Medical Sciences, Web of Science, Medline, Scopus, Index Copernicus, PubMed, DOAJ, Google Scholar, EBSCO-CINAHL, and Persian databases containing SID and Magiran using keywords such as: “checkpoint inhibitor”, “nivolumab”, “Hodgkin lymphoma”, and “PD1 Blockade”. The risk of bias was determined by two external observers using the Cochrane checklists. After the search, the data provided in 51 documents was independently evaluated. Duplicate papers were excluded. Assessing the full texts of the remaining papers, 7 papers were approved.


Pooled data of these seven studies revealed that the overall objective response rate was 68% (CI 64.1% to 72.1%; heterogeneity; I2 = 40.19%; p = 0.123) with partial remission (52%; CI 46.5% to 57.6%; heterogeneity; I2 = 28.36%; p = 0.212). In the pooled analysis, complete remission was 16.8 (CI 11.1% to 26.4%). Pooled data of six studies showed that stable disease was averaged to 19% (CI 16% to 23%; heterogeneity; I2 = 30%; p = 0.209; fixed-effect model).


The results of the study indicate that nivolumab as a PD1 pathway inhibitor can be effective in treating relapsed and refractory cHL patients compared to other therapies, and lead to more effective treatment over the long term. Furthermore, the adverse effects of nivolumab are controllable and have a good safety profile.


Checkpoint inhibitor Nivolumab Hodgkin lymphoma PD1 blockade 



We would like to thank to Dr. Ramin Sadeghi from Mashhad University Department of Nuclear Medicine for his advice in the meta-analysis.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval (research involving human participants and/or animals)

This work has no human or animal participants.

Informed consent

There is no consent for this work.


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Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2019

Authors and Affiliations

  1. 1.Department of Medical Physics, Faculty of Medicine, School of MedicineIran University of Medical SciencesTehranIran
  2. 2.Hematologist and Medical OncologistHormozgan University of Medical ScienceBandar AbbasIran
  3. 3.Department of Radiology and Radiotherapy, Allied Medical Sciences SchoolTehran University of Medical SciencesTehranIran
  4. 4.Mother and Child Welfare Research CenterHormozgan University of Medical SciencesBandar AbbasIran
  5. 5.Department of Midwifery, Razi School of Nursing and MidwiferyKerman University of Medical SciencesKermanIran
  6. 6.Biomedical Engineering and Medical Physics Department, Faculty of MedicineShahid Beheshti University of Medical SciencesTehranIran
  7. 7.Department of Radiotherapy & OncologyArak University of Medical SciencesArakIran
  8. 8.Department of Radiology, Faculty of ParamedicineHormozgan University of Medical SciencesBandar AbbasIran

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