Immunodeficiency-associated Hodgkin lymphoma

ABSTRACT

Introduction: Hodgkin lymphoma (HL) can occur in different host conditions, i.e. in the general population and immunocompromised individuals, either during HIV infection or solid organ/hematopoietic transplantation and immunosuppressive drug treatment.

Areas covered: Areas covered include multidimensional characteristics of tumor cells and cellular composition of tumor microenvironment of HL. Current conventional treatments and new treatment strategies for HL in immunosuppressed patients, especially in persons living with HIV (PLWH), are also discussed.

PubMed and MEDLINE were used for database searches to identify articles in English published from 1989 to 2020.

Expert opinion: For people with post-transplant HL or for those with HIV/AIDS-associated HL, standard treatments mirror those in the general population. In the last decade, the combination of cART with anti-neoplastic treatments, alongside with current anti-rejection therapies, has increased long-term survival of people with HL and acquired immune deficiencies. High-dose chemotherapy and autologous stem cell transplantation have been favorably proven as salvage therapy in PLWH with relapsed and refractory HL. Immune checkpoint inhibitors emerged as an area of clinical investigation for relapsed and refractory HL in the general population. Pembrolizumab, an anti-programmed cell death protein 1 (PD-1) drug, resulted safe in PLWH indicating that PD-1 ligand assessment should be advisable in HIV-associated HL.

KEYWORDS:

• Hodgkin lymphoma
• immunodeficiency-associated Hodgkin lymphoma
• HIV-associated Hodgkin lymphoma
• post-transplant-associated Hodgkin lymphoma
• tumor microenvironment
• management

Article highlights

• In the present cART era, treatment for persons living with HIV (PLWH) with Hodgkin lymphoma mirrors that for Hodgkin lymphoma in the general population. cART combined with anti-neoplastic treatments has lead to improvement of long-term survival.

• The search for effective treatment in Hodgkin lymphoma patients, both responsive to conventional therapies and in refractory disease, is still necessary either in the general population or in immunocompromised individuals.

• In PLWH, high-dose chemotherapy and autologous stem cell transplantation have been successfully adopted as salvage therapy.

• Novel therapeutics in primary and second-line Hodgkin lymphoma therapy is an area of clinical investigation.

Acknowledgments

The authors thanks Elettra Gislon and Luigina Mei for English editing of the manuscript.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was supported in part by an Institutional grant from Centro di Riferimento Oncologico, Aviano for an Intramural Project ‘Agenti infettivi e Tumori’ to A.Carbone and E.Vaccher and by the Italian Ministry of Health (5×1000 Funds–2015), through Institutional Grant [BRI2018] ‘Progetto 6 — Visualizing immunomodulatory molecules in individual human cancer cells using in situ bright field multiplexing methods and an innovative proximity detection assay’ to A.Gloghini.