Age 16 or over
Primary refractory classical Hodgkin lymphoma or classical Hodgkin lymphoma in firstrelapse
About to receive, receiving or within 14 days of first 2 cycles of first or second line salvage therapy (4 cycles if receiving treatment with brentuximab vedotin)
Fit for autologous stem cell transplantation
Written informed consent
Willing to comply with the contraceptive requirements of the trial
Exclusion criteria for registration
Nodular lymphocyte predominant Hodgkin lymphoma
Women who are pregnant or breastfeeding
History of colitis, inflammatory bowel disease or pneumonitis
Patients with autoimmune disorders excluding patients with vitiligo, diabetes mellitustype 1, hypo- and hyperthyroidism not requiring immunosuppressive therapy
Known active hepatitis B or C infection
Known HIV infection
History of allergy (including severe/life threatening skin reaction) to monoclonalantibodies, anaphylaxis or uncontrolled allergy
Major surgery within 4 weeks prior to registration
Myocardial infarction, unstable angina, coronary artery bypass graft, cerebrovascular accident or transient ischaemic attack within the past 6 months
Non-haematological malignancy within the past 3 years (some exceptions apply – see trial protocol)
Inclusion criteria – trial treatment
Has received 2 cycles of first line or second line salvage chemotherapy (4 cycles ifbeing treated with brentuximab vedotin)
PET positive (Deauville score 4 or 5) after 2 cycles of first or second line salvage chemotherapy (4 cycles if being treated with brentuximab vedotin)
Fit for further salvage chemotherapy
ECOG performance status 0-1
Creatinine clearance >30ml/min calculated by Cockroft-Gault formula
Bilirubin
Adequate bone marrow function (Hb >80g/l, Platelets >50 x 109/l,neutrophils >1.0 x 109/l
Exclusion criteria for trial treatment
Deauville score 1-3 after 2 cycles of first or second line salvage chemotherapy (4 cycles if being treated with brentuximab vedotin)
Positive serology for hepatitis B or C (some exceptions apply – see trial protocol)
Active infection requiring systemic therapy
Ongoing immunosuppressive therapy, apart from inhaled, intranasal, topical corticosteroids or systemic corticosteroids at low doses (≤10mg prednisolone or equivalent per day).
Chemo-or radiotherapy or corticosteroids at a dose of more than 10mg/day prednisolone or equivalent within 14 days prior to response PET-CT. NOTE: corticosteroids can be used AFTER a positive PET-CT scan for symptomatic disease but must be weaned to a dose of prednisolone ≤10mg/day or less (or equivalent) at least 7 days prior to starting nivolumab.
Treatment with any investigational agent within 28 days prior to planned start of nivolumab
Ongoing grade 2-4 non-haematological toxicities related to prior Hodgkin lymphoma treatments, with the exception of alopecia and grade 2 fatigue
Pregnant or breastfeeding women