HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.
Yale University School of Medicine, New Haven, CT.
Clin Lymphoma Myeloma Leuk. 2024 Aug;24(8):523-530. doi: 10.1016/j.clml.2024.03.011. Epub 2024 Apr 5.
Despite a higher risk of classical Hodgkin lymphoma (cHL) in people with HIV and the demonstrated safety and efficacy of PD-1 blockade in cHL, there are limited data on the use of these agents in HIV-associated cHL (HIV-cHL).
PATIENTS/METHODS: We retrospectively identified patients with HIV-cHL from the "Cancer Therapy using Checkpoint inhibitors in People with HIV-International (CATCH-IT)" database who received nivolumab or pembrolizumab, alone or in combination with other agents, and reviewed records for demographics, disease characteristics, immune-mediated adverse events (imAEs), and treatment outcomes. Changes in CD4 T-cell counts with treatment were measured via Wilcoxon signed-rank tests. Overall response rate (ORR) was defined as the proportion of patients with partial or complete response (PR/CR) per 2014 Lugano classification.
We identified 23 patients with HIV-cHL who received a median of 6 cycles of PD-1 blockade: 1 as 1st-line, 6 as 2nd-line, and 16 as ≥3rd-line therapy. Seventeen (74%) patients received monotherapy, 5 (22%) received nivolumab plus brentuximab vedotin, and 1 received nivolumab plus ifosfamide, carboplatin, and etoposide. The median baseline CD4 T-cell count was 155 cells/µL, which increased to 310 cells/µL at end-of-treatment (P = .009). Three patients had grade 3 imAEs; none required treatment discontinuation. The ORR was 83% with median duration of response of 19.7 months. The median progression-free survival was 21.2 months and did not differ between patients with <200 versus ≥200 CD4 cells/µL (P = .95).
Our findings support the use of PD-1 blockade in HIV-cHL for the same indications as the general population with cHL.
尽管 HIV 感染者发生经典型霍奇金淋巴瘤（cHL）的风险更高，且 PD-1 阻断在 cHL 中的安全性和有效性已得到证实，但有关这些药物在 HIV 相关 cHL（HIV-cHL）中的应用的数据有限。
患者/方法：我们从“使用免疫检查点抑制剂治疗 HIV 感染者的癌症-国际（CATCH-IT）”数据库中回顾性地确定了接受纳武利尤单抗或帕博利珠单抗单药或联合其他药物治疗的 HIV-cHL 患者，并对其人口统计学特征、疾病特征、免疫介导的不良反应（imAE）和治疗结果进行了审查。采用 Wilcoxon 符号秩检验来衡量治疗过程中 CD4 T 细胞计数的变化。根据 2014 年卢加诺分类，按照部分缓解（PR）或完全缓解（CR）患者比例定义总体缓解率（ORR）。
我们确定了 23 例接受 PD-1 阻断治疗的 HIV-cHL 患者，中位接受了 6 个周期的 PD-1 阻断治疗：1 例为一线治疗，6 例为二线治疗，16 例为≥三线治疗。17 例（74%）患者接受单药治疗，5 例（22%）患者接受纳武利尤单抗联合 Brentuximab vedotin 治疗，1 例患者接受纳武利尤单抗联合异环磷酰胺、卡铂和依托泊苷治疗。中位基线 CD4 T 细胞计数为 155 个/µL，治疗结束时增至 310 个/µL（P =.009）。3 例患者发生 3 级 imAE，均无需停药。ORR 为 83%，中位缓解持续时间为 19.7 个月。中位无进展生存期为 21.2 个月，<200 个/µL 与≥200 个/µL CD4 细胞的患者之间无差异（P =.95）。
我们的研究结果支持在 HIV-cHL 中应用 PD-1 阻断治疗，适应证与 cHL 一般人群相同。
