University of Maryland Greenebaum Comprehensive Cancer Center, University of Maryland Medical Center, Baltimore, Maryland, USA,
Department of Internal Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA.
Acta Haematol. 2020;143(2):184-188. doi: 10.1159/000500222. Epub 2019 Oct 9.
Patients with HIV-associated lymphocyte-depleted Hodgkin lymphoma (HIV-HL) often present with advanced, extranodal disease and aggressive clinical features, limiting definitive therapeutic intervention. Here we report two patients with HIV-HL who presented with multi-organ dysfunction as an initial manifestation of their malignancy. Both were initially treated with brentuximab vedotin (BV), which led only to a temporary partial response, highlighting the challenges of treatment. One patient was eventually started on nivolumab and responded very well to the immune checkpoint inhibitor. To our knowledge, this is the first case to describe successful use of nivolumab in a patient with relapsed lymphocyte-depleted HIV-HL. Prompt recognition of multi-organ dysfunction as an initial presentation of lymphocyte-depleted HIV-HL is essential to ensure rapid provision of therapy. While use of BV remains a reasonable option, earlier introduction of immunotherapy in the treatment of HL may provide an additional option in critically ill patients with lymphocyte-depleted HIV-HL.
HIV 相关淋巴细胞耗竭型霍奇金淋巴瘤（HIV-HL）患者常表现为晚期、结外疾病和侵袭性临床特征，限制了明确的治疗干预。本研究报告了两例以多器官功能障碍为首发表现的 HIV-HL 患者。两者最初均接受了 Brentuximab vedotin（BV）治疗，仅获得短暂的部分缓解，突出了治疗的挑战。其中一名患者最终开始接受nivolumab 治疗，对免疫检查点抑制剂反应良好。据我们所知，这是首例描述 nivolumab 在复发性淋巴细胞耗竭型 HIV-HL 患者中成功应用的病例。迅速认识到多器官功能障碍是淋巴细胞耗竭型 HIV-HL 的首发表现对于确保迅速提供治疗至关重要。虽然使用 BV 仍然是合理的选择，但在 HL 的治疗中更早地引入免疫疗法可能为淋巴细胞耗竭型 HIV-HL 的危重症患者提供另一种选择。
