Nivolumab treatment in patients with relapsed/refractory HIV-related lymphomas

Abstract

Background: 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. Methods: 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. Results: The underlying diseases: HL n ¼ 4 (66%) and diffuse large B-cell lymphoma (DLBCL) n ¼ 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 CD4þ 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.