HIV-Associated Diffuse Large B-Cell Lymphoma Treated With Outpatient Pola-R-CHP Without Antiretroviral Therapy...

People living with HIV (PLWH) remain at increased risk of diffuse large B-cell lymphoma (DLBCL). Polatuzumab vedotin plus rituximab, cyclophosphamide, doxorubicin, and prednisone (Pola-R-CHP) has emerged as a standard first-line option for DLBCL in the general population, but the pivotal POLARIX trial excluded PLWH, leaving limited evidence on feasibility with contemporary antiretroviral therapy (ART).

A 61-year-old man presented with progressive anorexia and weight loss. With durable virologic suppression (plasma HIV-1 RNA below 20 copies/mL) and immune reconstitution (CD4+ T-cell count approximately 300 cells/µL) on bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF), he was diagnosed with nongerminal center B-cell DLBCL (Lugano stage II; International Prognostic Index score 2). Pola-R-CHP was administered every 21 days for six cycles (Cycle 1: inpatient and Cycles 2-6: outpatient), followed by two additional rituximab cycles, without ART modification. No grade 3-4 nonhematologic toxicity, febrile neutropenia, or serious infections occurred. HIV-1 RNA remained below 20 copies/mL throughout treatment, and CD4+ T-cell counts showed no clinically meaningful decline. End-of-treatment fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET-CT) demonstrated a partial metabolic response with two small residual FDG-avid foci (∼1 cm; SUVmax ∼4-5). At the last follow-up, the patient had no clinical or radiologic evidence of progression.

Outpatient-delivered Pola-R-CHP appeared feasible in PLWH with virologic suppression and immune reconstitution receiving BIC/FTC/TAF, without virologic breakthrough or unexpected toxicity. Prospective inclusion of PLWH in polatuzumab-containing frontline studies is warranted.