HIV-related NK/T-cell lymphoma in the brain relapsed during intensive chemotherapy but regressed after chemotherapy discontinuation: the importance of maintaining cellular immunity

Abstract

This study reports a case of human immunodeficiency virus (HIV)-related natural killer/T-cell lymphoma with an unexpected clinical course. The lymphoma cells were positive for Epstein-Barr virus and the primary nodal lesions regressed after chemotherapy and combined antiretroviral therapy (c-ART); however, brain metastasis progressed along with a reduction in the CD8+ T-cell count. Chemotherapy was discontinued and the patient was treated with c-ART alone, resulting in regression of the brain lesions and recovery of the CD8+ T-cell count. This case highlights the importance of maintaining anti-tumor immunity in patients with HIV-related lymphoma.

Spontaneous Regression of Refractory Diffuse Large B-Cell Lymphoma with Improvement in Immune Status with ART in a Patient with HIV: A Case Report and Literature Review

“…The phenomenon of immune reconstitution leading to regression of malignancy is very well documented in this group of patients. A previous case of spontaneous regression of HIV-related NK/T-cell lymphoma in the brain relapsing during intensive chemotherapy but regressing after chemotherapy stopped while on ART alone highlights the important role played by T-cells in tumor regression [30]. …”

Nodal Epstein-Barr virus-positive T-cell/NK-cell lymphoma associated with immunodeficiency: a rare condition looking for recognition

“…HIV patients with lymphoma often present extranodal disease, most frequently involving the gastrointestinal tract, the central nervous system, the bone marrow, and the liver 15. There are very few reported cases of NK/T-cell lymphoma associated with EBV in an HIV patient 33 - 35. Canioni et al36 reported the first case of NKTCL in an HIV patient in 2001.…”

“…The majority of patients were men (median age of 42 years), with low CD4 counts (< 200/dL). The prognosis of NKTCL in HIV-related patients is very poor, usually with less than 1 month of survival 33 - 35…”