Nivolumab (nivo) is a salvage option in relapsed/refractory (r/r) Hodgkin lymphoma (HL) and non-Hodgkin lymphoma. Patients with HIV-related lymphoma may benefit not only anticancer activity of nivo, but also from its potential anti-HIV effect [1]. Just a few cases of HIV-related lymphoma treated with nivo were reported [2,3]. We describe a case series of r/r HIV-related lymphoma receiving nivo in First Pavlov State Medical University of Saint-Petersburg.
Six male patients with r/r HIV-related lymphoma were treated with nivo in 2017. The primary end point was response to therapy, secondary – toxicity, relapse incidence and overall survival (OS) at 12 months. CTCAE v4.03 for the toxicity and immune-related adverse effects have been used. LYRIC criteria for assessing FDG-PET/CT were applied.
The underlying diseases: HL n = 4 (66%) and diffuse large B-cell lymphoma (DLBCL) n = 2 (34%). Median number of prior lines of therapy was 2 (range, 2-3). Three patients received nivo as a bridge to auto-SCT (ASCT). Relapse after ASCT was treated in one patient, two patients didn’t proceed to ASCT. Two patients received nivo as mono, 4 patients in combi with bendamustine and gemcitabine. The median dose of nivo was 1 mg/kg (range, 0,5-1,5 mg/kg), number of nivo doses – 8,5 (range, 2-12). The median of CD4+ was 382 c/mcl (range, 45-490). One patient didn’t receive cART due acute renal failure. Only 5 patients were available for estimating response, one – died before PET/CT was performed. Overall response rate was 100%. Two – partial remission and three (60%) patients had complete metabolic responses. Toxicity according to CTCAE and an immune-related adverse effect was not registered. Relapse of the underlying disease was diagnosed in 2 patients, time to progression were 485 and 266 days. OS was 83,3%. Patient who didn’t receive cART died from undetermined cause. Summary of patients are outlined in the table. Pts – patients, Ds – diagnose, HL – Hodgkin lymphoma, DLBCL – diffuse large B-cell lymphoma, BeGeR – bendamustine, gemcitabine, rituximab, Nivo – nivolumab, CR – complete remission, PR – partial remission, auto-HSCT – hematopoietic stem cell transplantationPts Ds Age HIV load CD4+ cells/mcl cART Nivo N of nivo Response Followed therapy Outcome Follow up 1 HL 33 <40 140 + mono 10 CR Auto-HSCT Remission; Alive; 499 days 2 HL 41 <40 45 + BeGe 12 PR Continued Relapse; 485 days Alive; 506 days 3 HL 36 <40 362 + mono 10 PR Continued Remission; Alive; 528 days 4 HL 40 <40 490 + BeGe 7 CR Auto-HSCT Remission; Alive; 427 days 5 DLBCL 33 3381 410 - BeGe 2 - - - Died; 45 days 6 DLBCL 38 <40 473 + BeGeR 7 CR Auto-HSCT Relapse; 266 days Alive; 397 days
Overall response rate to nivo in patients with HIV-related lymphomas was 100%, one-year OS – 83,3%. Toxicity and immune-related adverse effects were not registered. Preliminary data provide that nivo is effective and safety treatment option for r/r HIV-related lymphoma.
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Raisa Gorbacheva Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation.
Has not received any funding.
All authors have declared no conflicts of interest.