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Real-World Multicenter Study of PD-1 Blockade in HIV-Associated Classical Hodgkin Lymphoma Across the United States
Kathryn Lurain1, Talal El Zarif2, Ramya Ramaswami1
1HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.
Insights
PD-1 blockade is safe and effective for HIV-associated classical Hodgkin lymphoma (HIV-cHL). This treatment increases CD4+ T-cell counts and shows high response rates, supporting its use in HIV-cHL patients.
Area of Science:
- Oncology
- Immunology
- Infectious Diseases
Background:
- People with HIV have an increased risk of classical Hodgkin lymphoma (cHL).
- PD-1 blockade is a proven treatment for cHL, but data in HIV-cHL are limited.
Purpose of the Study:
- To evaluate the safety and efficacy of PD-1 blockade in patients with HIV-associated cHL (HIV-cHL).
- To assess treatment outcomes, including response rates and immune-mediated adverse events (imAEs).
Main Methods:
- Retrospective analysis of 23 HIV-cHL patients from the CATCH-IT database treated with nivolumab or pembrolizumab.
- Data collected on demographics, disease characteristics, imAEs, and treatment outcomes.
- CD4+ T-cell counts and overall response rate (ORR) were assessed.
Main Results:
- Median CD4+ T-cell count increased from 155 to 310 cells/µL with treatment (P = .009).
- An 83% overall response rate (ORR) was observed, with a median response duration of 19.7 months.
- Median progression-free survival was 21.2 months; no difference based on baseline CD4+ count.
Conclusions:
- PD-1 blockade demonstrates significant efficacy and safety in HIV-cHL.
- Treatment with PD-1 inhibitors leads to improved CD4+ T-cell counts.
- The findings support using PD-1 blockade for HIV-cHL on the same indications as in the general cHL population.
Background:
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.
Results:
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).
Conclusion:
Our findings support the use of PD-1 blockade in HIV-cHL for the same indications as the general population with cHL.
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