Use of pembrolizumab with or without pomalidomide in HIV-associated non-Hodgkin’s lymphoma
Background Non-Hodgkin’s lymphoma (NHL) is currently the most common malignancy among people living with HIV (PLWH) in the USA. NHL in PLWH is more frequently associated with oncogenic viruses than NHL in immunocompetent individuals and is generally associated with increased PD-1 expression and T ce...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2021-02-01
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| Series: | Journal for ImmunoTherapy of Cancer |
| Online Access: | https://jitc.bmj.com/content/9/2/e002097.full |
| _version_ | 1818642516989181952 |
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| author | Hao-Wei Wang Jomy George Kathryn Lurain Ramya Ramaswami Ralph Mangusan Anaida Widell Irene Ekwede Richard Ambinder Priscila H Goncalves Robert Yarchoan |
| author_facet | Hao-Wei Wang Jomy George Kathryn Lurain Ramya Ramaswami Ralph Mangusan Anaida Widell Irene Ekwede Richard Ambinder Priscila H Goncalves Robert Yarchoan |
| author_sort | Hao-Wei Wang |
| collection | DOAJ |
| description | Background Non-Hodgkin’s lymphoma (NHL) is currently the most common malignancy among people living with HIV (PLWH) in the USA. NHL in PLWH is more frequently associated with oncogenic viruses than NHL in immunocompetent individuals and is generally associated with increased PD-1 expression and T cell exhaustion. An effective immune-based second-line approach that is less immunosuppressive than chemotherapy may decrease infection risk, improve immune control of oncogenic viruses, and ultimately allow for better lymphoma control.Methods We conducted a retrospective study of patients with HIV-associated lymphomas treated with pembrolizumab±pomalidomide in the HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute.Results We identified 10 patients with stage IV relapsed and/or primary refractory HIV-associated NHL who were treated with pembrolizumab, an immune checkpoint inihibitor, with or without pomalidomide. Five patients had primary effusion lymphoma (PEL): one had germinal center B cell-like (GCB) diffuse large B cell lymphoma (DLBCL); two had non-GCB DLBCL; one had aggressive B cell lymphoma, not otherwise specified; and one had plasmablastic lymphoma. Six patients received pembrolizumab alone at 200 mg intravenously every 3 weeks, three received pembrolizumab 200 mg intravenously every 4 weeks plus pomalidomide 4 mg orally every day for days 1–21 of a 28-day cycle; and one sequentially received pembrolizumab alone and then pomalidomide alone. The response rate was 50% with particular benefit in gammaherpesvirus-associated tumors. The progression-free survival was 4.1 months (95% CI: 1.3 to 12.4) and overall survival was 14.7 months (95% CI: 2.96 to not reached). Three patients with PEL had leptomeningeal disease: one had a complete response and the other two had long-term disease control. There were four immune-related adverse events (irAEs), all CTCAEv5 grade 2–3; three of the four patients were able to continue receiving pembrolizumab. No irAEs occurred in patients receiving the combination of pembrolizumab and pomalidomide.Conclusions Treatment of HIV-associated NHL with pembrolizumab with or without pomalidomide elicited responses in several subtypes of HIV-associated NHL. This approach is worth further study in PLWH and NHL. |
| first_indexed | 2024-12-16T23:44:19Z |
| format | Article |
| id | doaj.art-6d8f5c5ee6c048a79a74b0603e352575 |
| institution | Directory Open Access Journal |
| issn | 2051-1426 |
| language | English |
| last_indexed | 2024-12-16T23:44:19Z |
| publishDate | 2021-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Journal for ImmunoTherapy of Cancer |
| spelling | doaj.art-6d8f5c5ee6c048a79a74b0603e3525752022-12-21T22:11:33ZengBMJ Publishing GroupJournal for ImmunoTherapy of Cancer2051-14262021-02-019210.1136/jitc-2020-002097Use of pembrolizumab with or without pomalidomide in HIV-associated non-Hodgkin’s lymphomaHao-Wei Wang0Jomy George1Kathryn Lurain2Ramya Ramaswami3Ralph Mangusan4Anaida Widell5Irene Ekwede6Richard Ambinder7Priscila H Goncalves8Robert Yarchoan9Laboratory of Pathology, National Cancer Institute, Bethesda, Maryland, USA7 Clinical Pharmacokinetics Research Unit, Pharmacy Department, National Institutes of Health Clinical Center, Bethesda, Maryland, USA HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USAHIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USAHIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USAHIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USAHIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USADepartment of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USAHIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USAHIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USABackground Non-Hodgkin’s lymphoma (NHL) is currently the most common malignancy among people living with HIV (PLWH) in the USA. NHL in PLWH is more frequently associated with oncogenic viruses than NHL in immunocompetent individuals and is generally associated with increased PD-1 expression and T cell exhaustion. An effective immune-based second-line approach that is less immunosuppressive than chemotherapy may decrease infection risk, improve immune control of oncogenic viruses, and ultimately allow for better lymphoma control.Methods We conducted a retrospective study of patients with HIV-associated lymphomas treated with pembrolizumab±pomalidomide in the HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute.Results We identified 10 patients with stage IV relapsed and/or primary refractory HIV-associated NHL who were treated with pembrolizumab, an immune checkpoint inihibitor, with or without pomalidomide. Five patients had primary effusion lymphoma (PEL): one had germinal center B cell-like (GCB) diffuse large B cell lymphoma (DLBCL); two had non-GCB DLBCL; one had aggressive B cell lymphoma, not otherwise specified; and one had plasmablastic lymphoma. Six patients received pembrolizumab alone at 200 mg intravenously every 3 weeks, three received pembrolizumab 200 mg intravenously every 4 weeks plus pomalidomide 4 mg orally every day for days 1–21 of a 28-day cycle; and one sequentially received pembrolizumab alone and then pomalidomide alone. The response rate was 50% with particular benefit in gammaherpesvirus-associated tumors. The progression-free survival was 4.1 months (95% CI: 1.3 to 12.4) and overall survival was 14.7 months (95% CI: 2.96 to not reached). Three patients with PEL had leptomeningeal disease: one had a complete response and the other two had long-term disease control. There were four immune-related adverse events (irAEs), all CTCAEv5 grade 2–3; three of the four patients were able to continue receiving pembrolizumab. No irAEs occurred in patients receiving the combination of pembrolizumab and pomalidomide.Conclusions Treatment of HIV-associated NHL with pembrolizumab with or without pomalidomide elicited responses in several subtypes of HIV-associated NHL. This approach is worth further study in PLWH and NHL.https://jitc.bmj.com/content/9/2/e002097.full |
| spellingShingle | Hao-Wei Wang Jomy George Kathryn Lurain Ramya Ramaswami Ralph Mangusan Anaida Widell Irene Ekwede Richard Ambinder Priscila H Goncalves Robert Yarchoan Use of pembrolizumab with or without pomalidomide in HIV-associated non-Hodgkin’s lymphoma Journal for ImmunoTherapy of Cancer |
| title | Use of pembrolizumab with or without pomalidomide in HIV-associated non-Hodgkin’s lymphoma |
| title_full | Use of pembrolizumab with or without pomalidomide in HIV-associated non-Hodgkin’s lymphoma |
| title_fullStr | Use of pembrolizumab with or without pomalidomide in HIV-associated non-Hodgkin’s lymphoma |
| title_full_unstemmed | Use of pembrolizumab with or without pomalidomide in HIV-associated non-Hodgkin’s lymphoma |
| title_short | Use of pembrolizumab with or without pomalidomide in HIV-associated non-Hodgkin’s lymphoma |
| title_sort | use of pembrolizumab with or without pomalidomide in hiv associated non hodgkin s lymphoma |
| url | https://jitc.bmj.com/content/9/2/e002097.full |
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