 |
Case Report
Complete remission of refractory Hodgkin’s lymphoma in a patient with AIDS after single dose checkpoint inhibitor therapy
1 University of Connecticut Health, Farmington, Connecticut, USA
2 Hartford Healthcare Cancer Institute, Hartford, Connecticut, USA
Address correspondence to:
Aswanth Reddy
MD, Hematology-Oncology Fellow, Department of Hematology/Oncology, Neag Comprehensive Cancer Center, University of Connecticut Health, 263 Farmington Ave, Farmington, Connecticut 06030,
USA
Message to Corresponding Author
Article ID: 100064Z10AR2020
Access full text article on other devices
Access PDF of article on other devices
How to cite this article
Reddy A, Luke A, Rathmann J. Complete remission of refractory Hodgkin’s lymphoma in a patient with AIDS after single dose checkpoint inhibitor therapy. J Case Rep Images Oncology 2020;6:100064Z10AR2020.ABSTRACT
Introduction: 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 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.
Keywords: CD4, Hodgkin’s, Human immunodeficiency virus, Nivolumab
SUPPORTING INFORMATION
Author Contributions
Aswanth Reddy - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Abigael Luke - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Joerg Rathmann - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2020 Aswanth Reddy et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
