Nivolumab treatment in patients with relapsed/refractory HIV-related lymphomas
Authors: Y. Rogacheva, M. Popova, A. Nekrasova, I. Tsygankov, K. Lepik, L. Stelmah, I. Moiseev, S. Bondarenko, N. Mikhaylova, V. Baykov, B. Afanasyev
Journal: Annals of Oncology (2018)

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 = 4 (66%) and diffuse large B-cell lymphoma (DLBCL) n = 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 CD4+ 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. Summary of patients are outlined in the table.Table59PPtsDsAgeHIV loadCD4+ cells/mclcARTNivoN of nivoResponseFollowed therapyOutcomeFollow up1HL33<40140+mono10CRAuto-HSCTRemission;Alive; 499 days2HL41<4045+BeGe12PRContinuedRelapse; 485 daysAlive; 506 days3HL36<40362+mono10PRContinuedRemission;Alive; 528 days4HL40<40490+BeGe7CRAuto-HSCTRemission;Alive; 427 days5DLBCL333381410-BeGe2---Died; 45 days6DLBCL38<40473+BeGeR7CRAuto-HSCTRelapse; 266 daysAlive; 397 daysPts – patients, Ds – diagnose, HL – Hodgkin lymphoma, DLBCL – diffuse large B-cell lymphoma, BeGeR – bendamustine, gemcitabine, rituximab, Nivo – nivolumab, CR – complete remission, PR – partial remission, auto-HSCT – hematopoietic stem cell transplantation Open table in a new tab Pts – patients, Ds – diagnose, HL – Hodgkin lymphoma, DLBCL – diffuse large B-cell lymphoma, BeGeR – bendamustine, gemcitabine, rituximab, Nivo – nivolumab, CR – complete remission, PR – partial remission, auto-HSCT – hematopoietic stem cell transplantation Conclusions: Overall response rate to nivo in patients with HIV-related lymphomas was 100%, one-year OS – 83,3%. Toxicity and immune-related adverse effects were not registered. Preliminary data provide that nivo is effective and safety treatment option for r/r HIV-related lymphoma. Legal entity responsible for the study: Raisa Gorbacheva Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.