The combination of body mass index and serum creatinine levels predicts survival in patients with Hodgkin lymphoma treated with nivolumab in the CheckMate 205 study.

Abstract

Patients with solid tumors and a higher body mass index (BMI) experience improved survival after receiving anti-PD1 antibodies. The predictive role of BMI in Hodgkin Lymphoma (HL), the most sensitive malignancy to PD1-blockade, remains unclear. We analyzed the association between BMI and survival outcomes in patients treated with the anti-PD-1 antibody nivolumab within the CheckMate 205 study. Patients with a lower BMI (<24.03 kg/m²) had a longer progression-free survival (PFS) (46.4% at three years) than those with a higher BMI (≥24.03 kg/m²;19.6%; p = 0.03). Combining the BMI cutoff with serum creatinine (sCr) levels generated a variable (BMCI) stratifying patients into distinct PFS risk groups. Patients with a BMCI^high (BMI ≥24.03 kg/m²/sCr <0.7 mg/dL) displayed a threefold increased PFS risk (95% CI,1.6-5.7; p < 0.001) than those with a BMCI^low (BMI <24.03 kg/m²/sCr ≥0.7 mg/dL). In a separate analysis of pretreated patients, those with a BMCI^high had a PFS risk 3.5-fold higher (95% CI,1.9-6.6; p < 0.001) than patients with a BMCI^low. The BMCI maintained its independent significance in a multivariable model including attenuating factors and predictive biomarkers. HL patients with reduced BMI but preserved lean body mass (BMCI^low) exhibit a more favorable response to nivolumab. Results highlight an unexpected side of the 'obesity paradox' in HL.