Complete remission of refractory Hodgkin's lymphoma in a patient with AIDS after single dose checkpoint inhibitor therapy

Aswanth Reddy, Joerg Rathmann
2020 Journal of Case Reports and Images in Oncology  
Hodgkin's lymphoma (HL) is a hematopoietic neoplasm that arises from the preapoptotic germinal or postgerminal center B cells. It is characterized by the neoplastic Reed- Sternberg cell, of which they are few in number relative to surrounding dense inflammatory infiltrate elicited by the neoplastic B cell. The incidence of HL is higher in patients with human immunodeficiency virus (HIV) and the risk of developing HL increases 10-fold in patients with CD4 cell count <100 cells/mm. Case Report: A
more » ... 65-year-old man with HIV presented with recurrent classical HL. His initial diagnosis was in 2010 when he was treated with adriamycin, bleomycin, vinblastine, dacarbazine (ABVD) and first recurrence in 2017 when he received brentuximab. At this recurrence, he had extensive disease, poorly controlled HIV, and elevated liver function tests. He was started on nivolumab but after one dose he deteriorated clinically with worsening bilirubin. He was transitioned to best supportive care and when eventually seen in the outpatient clinic he had complete recovery of liver dysfunction which coincided with complete remission of his HL, confirmed by a repeat positron emission tomography/computed tomography (PET/CT). Conclusion: Nivolumab is currently approved for treatment of relapsed or refractory HL after brentuximab and autologous stem cell transplant. The paucity of data regarding the efficacy of nivolumab in HIV-related HL is attributable in part to the exclusion of HIV positive patients from registration trials. We conclude that immune checkpoint inhibitor therapy should be considered for patients with HIV-related HL if they are transplant ineligible, irrespective of their CD4 count and tumor burden.
doi:10.5348/100064z10ar2020cr fatcat:qin4oaqmajek5j3zvc6czwa4n4