SWOG Scores in Switzerland

The world’s most important meeting on lymphoid neoplasms – the International Conference on Malignant Lymphoma (ICML), held biannually in Lugano, Switzerland – wraps up tomorrow morning. SWOG lymphoma research and lymphoma researchers have been well represented.

Drs. Jonathan Friedberg and Sonali Smith, chair and vice chair, respectively, of our lymphoma committee, serve on the conference’s scientific advisory board. And a scan through the meeting’s programme (this is Europe – note the sophisticated British spelling, please) finds them listed as chairs of several sessions, as is SWOG’s Dr. Alex Herrera.

You’ll also find SWOG involvement listed in “The Big Debate,” a special symposium addressing controversies in the management of B-cell lymphoma, presented in the format of “wars of words” on three key questions.

Our S1826 study in Hodgkin lymphoma has been the subject of three oral presentations and one poster at ICML 2025:

• Impact of EBV status and histology on outcomes with nivolumab-AVD versus Bv-AVD in patients enrolled on SWOG S1826 – Abstract 020
  
  Patients with classic Hodgkin lymphoma who are positive for Epstein-Barr virus (EBV) generally have worse survival outcomes than patients who are EBV-negative. 
  
  Dr. Sairah Ahmed reported that on S1826, treatment with the investigational nivolumab-AVD combination largely eliminated the poorer outcomes seen historically in patients who are EBV-positive. On the N-AVD arm, 2-year progression-free survival (PFS) rates for EBV-positive patients were similar to those for EBV-negative patients, and both were better than rates on the Bv-AVD control arm. 

• Prognostic value of circulating tumor DNA in patients with advanced stage classic Hodgkin lymphoma treated on SWOG S1826 – Abstract 021
  
  Dr. Alex Herrera presented results of a pre-planned analysis from S1826, reporting that on both arms, higher baseline circulating tumor DNA (ctDNA) levels were associated with lower 2-year PFS, as was the presence of ctDNA at the start of treatment cycle 3 or at the end of treatment. 
  
  The researchers also found that the degree of change in molecular tumor burden from baseline to treatment cycle 3 was prognostic. They suggest that quantifying changes in patient ctDNA levels from baseline to treatment cycle 3 can let us identify low-risk vs. high-risk groups, raising the possibility this measure could be used as an integral biomarker in response-adapted trials.

• Health-related quality of life (HRQoL) endpoints of the phase III intergroup S1826 advanced-stage, classic Hodgkin lymphoma (cHL) trial – Abstract 127
  
  Dr. Kelly Davison presented on S1826 health-related quality of life measures – specifically fatigue and neuropathy.
  
  On S1826’s N-AVD arm, fatigue scores at treatment cycle 3 were slightly worse than those reported on the Bv-AVD arm, although that difference did not meet the pre-specified threshold to be considered clinically meaningful.
  
  There was, however, a clinically meaningful difference in neuropathy scores – compared to patients on the N-AVD arm, patients treated with Bv-AVD experienced significantly worse neuropathy at the end of treatment and at one year after randomization.

• The association of social disadvantage with outcomes in patients with advanced-stage, classic Hodgkin lymphoma (cHL) enrolled in the phase 3 intergroup trial S1826 – Abstract 368
  
  Dr. Kara M. Kelly presented an analysis of whether S1826’s N-AVD arm treatment benefits applied equally to groups of patients who were potentially socioeconomically vulnerable.
  
  Across race/ethnicity, rural vs. urban setting, area-level socioeconomic deprivation, and insurance status, the team found no evidence that the benefit of N-AVD was significantly reduced for patients based on factors related to social disadvantage.

Actually, it’s been quite a week for S1826. In addition to the Lugano presentations, a report on that trial’s outcomes in patients 60 and older was published Monday in the Journal of Clinical Oncology, concluding that the N-AVD treatment was better tolerated and more effective and is a new standard of care for older patients.

But S1826 is not the only SWOG lymphoma trial reported on in Lugano.

Dr. Paul Barr presented on the results of SWOG S1608, which he chairs:

• S1608: Randomized phase II trial comparing lenalidomide/obinutuzumab and umbralisib/obinutuzumab with chemoimmunotherapy in early progressing follicular lymphoma (POD24) – Abstract 233
  
  S1608 was the first prospective trial in patients with follicular lymphoma who experience disease relapse within two years of starting chemoimmunotherapy, a group who typically face a poor prognosis.
  
  S1608 randomized 76 of these patients to one of three regimens, two pairing a targeted agent with obinutuzumab and the third pairing chemotherapy with obinutuzumab. The trial found no differences across arms in rates of complete remission or PFS, although patients on the lenalidomide plus obinutuzumab arm appeared to demonstrate a longer response duration.
  
  The authors conclude that these results “establish a standard for comparison in future trials with this high‐risk population.”

If you ever get a chance, visit Lugano. The scenery is spectacular. And for a week in June every two years, so is the lymphoma research.