Real-world multicenter study of PD-1 blockade in HIV-associated classical Hodgkin lymphoma across the United States

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=0.009). 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=0.95). Conclusion Our findings support the use of PD-1 blockade in HIV-cHL for the same indications as the general population with cHL. Microabstract There are limited data on PD-1 blockade in HIV-associated classical Hodgkin lymphoma (HIV-cHL). We retrospectively identified 23 patients with HIV-cHL safely treated with PD-1 blockade with a response rate of 83% that did not differ by CD4+ T-cell count. Our data support the use of PD-1 blockade in HIV-cHL for the same indications as the general population with cHL.