Immune checkpoint inhibitors (ICIs) are a new option for salvage therapy in relapsed/refractory (r/r) Hodgkin lymphoma (HL) and non-Hodgkin lymphoma. Patients with HIV-related lymphoma may benefit not only from the anticancer activity of ICIs, but also from its potential anti-HIV effect. The publications on ICIs in HIV-related lymphomas is limited by a few case reports.
Nine patients with r/r HIV-related lymphoma were treated with nivolumab (nivo) between 2017-2019. Median follow-up time was 397 days [45-889]. The end points were response to therapy, immune-related adverse effects (IRAE) and overall survival (OS) at 12 months. LYRIC criteria for assessing FDG-PET/CT were applied.
The main characteristics of the study population and outcomes are presented in the table. Median number of prior lines of therapy was 3 (range, 2-4). Four patients received low dose of nivo as monotherapy [NCT03343665] with median of 12 courses 12 (7-12), 5 patients in combination with bendamustine and gemcitabine [NCT03259529] with median of 4 courses 4 (3-11). The median of CD4+ was 382 c/mcl (range, 45-560). The only one patient who did not receive cART due to acute renal failure died early from undetermined cause. Overall response rate (ORR) was 89% with the median time 104 days (73-517); complete remission (CR) was 67% with the median time 107 days (75-265). IRAE were not registered. OS at 12 months was 88.9%. Table: 61P Pts – patients, Ds – diagnose, HL – Hodgkin lymphoma, DLBCL – diffuse large B-cell lymphoma, BeGeR – bendamustine, gemcitabine, rituximab, Nivo/N – nivolumab, CR – complete remission, PR – partial remission, PD – progression disease, 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 40 [1] BeGeN 5 CR Auto-HSCT Remission; 882 days 2 HL 41 <40 45 + BeGeN 12 PR Continued [GeN] Relapse; 485 days 889 days 3 HL 36 <40 362 + mono N 40 [1] 10 CR Auto-HSCT Remission; 222 days 4 HL 40 <40 490 + BeGeN 7 CR Auto-HSCT Remission; 427 days 5 HL 37 <40 568 + mono N 40 [1] 6 PR Continued Partial remission; 161 days 6 HL 34 <40 482 + mono N 40 [1] 14 PR Continued Remission; 591 days 7 DLBCL 33 3381 410 + BeGeRN [2] 2 PD - Progression; Died; 45 days 8 DLBCL 38 <40 473 + BeGeRN [2] 7 CR Auto-HSCT Relapse; 266 days 397 days 9 Plasmoblastic Ly 38 <40 174 + mono N 40 [1] 12 CR Continued Remission; 186 days
Overall response rate to nivo in patients with HIV-related lymphomas was 89%, one-year OS – 88.9%. Immune-related adverse effects were not registered. Preliminary data suggest that nivo seems to be an effective and safety treatment option for r/r HIV-related lymphoma.
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