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

Abstract

Patient: Male, 55Final Diagnosis: Diffuse large B-cell lymphoma • HIVSymptoms: Fatigue • weight lossMedication: —Clinical Procedure: Renal biopsySpecialty: OncologyObjective:Unusual or unexpected effect of treatmentBackground:Diffuse large B-cell lymphoma accounts for the large majority of AIDS-related non-Hodgkin lymphoma. Traditionally, this lymphoma has been treated with CHOP-like regimens with the recent addition of rituximab. We report a unique case where an HIV-infected patient with diffuse large B-cell lymphoma had complete regression of the lymphoma with continued antiretroviral therapy (ART) after chemotherapy was stopped.Case Report:A 55-year-old man who presented with fatigue and weight loss had initial CT findings of bilateral renal masses during his workup. Biopsy revealed diffuse large B-cell lymphoma and subsequently he was also diagnosed with HIV. He completed 6 cycles of CHOP-like (4 cycles of EPOCH-R and 2 cycles of R-CHOP) first-line therapy with significant dose delays and dose reductions due to severe adverse effects. Chemotherapy was stopped due to physical deconditioning and intolerable adverse effects. He had a FDG-PET/CT showing progression of his disease 8 weeks after completing chemotherapy. He was maintained only on ART after finishing 6 cycles of chemotherapy. With this therapy alone and with improvement in his immune status, his lymphoma regressed completely.Conclusions:There are very few reported cases in which lymphoma has regressed with treatment of HIV alone, as is regression of diffuse large B-cell lymphoma. This case emphasizes that ART can lead to immune reconstitution of HIV-infected patients and can establish the anti-tumor effect, causing regression of the lymphoma.

Spontaneous Regression of FDG/PET Positive Lung Adenocarcinoma in an Elderly Man

“…All of them concerned patients with hematological malignancies [11][12][13] except for one patient with lung cancer [10]. In this lung cancer patient, squamous cell carcinoma was confirmed pathologically by surgical resection performed several months after PET/CT scan [10].…”

“…There have been some reports on spontaneous regression of FDG/PET positive tumors [10][11][12][13]. All of them concerned patients with hematological malignancies [11][12][13] except for one patient with lung cancer [10].…”

Fast-Growing Subcutaneous Tumors with Lower-Extremity Edema and Rib Lesions: A Case of Non-Hodgkin’s Lymphoma in an HIV-1-Infected Patient

“…DLBCL accounts for the large majority of AIDS-related NHL [ 3 ]. Even among non-HIV infected people, about one-third of newly diagnosed NHL is DLBCL in the United States [ 4 ].…”

“…Since the introduction of combined antiretroviral therapy (cART), HIV-related lymphomas have increased as a percentage of first AIDS-defining illness, in particular diffuse large B-cell lymphoma (DLBCL) [ 1 ]. Immunosuppression is the primary culprit leading to lymphomas [ 2 ], and immune reconstitution with cART is considered to be an important factor in maintaining long-term lymphoma remission [ 3 ]. It is well known that swollen painless lymph nodes are the most common symptoms of systemic lymphoma.…”

Diffuse large B‑cell lymphoma with pulmonary and cerebral involvement: A case report

“…High-grade non-Hodgkin lymphoma (NHL) is considered to represent one of three acquired immune deficiency syndrome (AIDS)-defining malignancies ( 1 ), among which diffuse large B-cell lymphoma (DLBCL) is the most common, accounting for 31% of all NHL cases ( 2 , 3 ). However, primary non-Hodgkin lymphoma of the lung is uncommon and accounts for only 0.4% of all malignant lymphomas ( 4 ).…”