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Spontaneous Regression of Refractory Diffuse Large B-Cell Lymphoma with Improvement in Immune Status with ART in a Patient with HIV: A Case Report and Literature Review

Birendra K.C., Muhammad Zubair Afzal, Katherine A. Wentland, Hamza Hashmi, Sudhir Singh, Elena Ivan, Nehal Lakhani

(Spectrum Health, Grand Rapids, MI, USA)

Am J Case Rep 2015; 16:347-352

DOI: 10.12659/AJCR.892883

Published: 2015-06-05

BACKGROUND: Diffuse large B-cell lymphoma accounts for the large majority of AIDS-related non-Hodgkin lymphoma. Traditionally, this lymphoma has been treated with CHOP-like regimens with the recent addition of rituximab. We report a unique case where an HIV-infected patient with diffuse large B-cell lymphoma had complete regression of the lymphoma with continued antiretroviral therapy (ART) after chemotherapy was stopped.
CASE REPORT: A 55-year-old man who presented with fatigue and weight loss had initial CT findings of bilateral renal masses during his workup. Biopsy revealed diffuse large B-cell lymphoma and subsequently he was also diagnosed with HIV. He completed 6 cycles of CHOP-like (4 cycles of EPOCH-R and 2 cycles of R-CHOP) first-line therapy with significant dose delays and dose reductions due to severe adverse effects. Chemotherapy was stopped due to physical deconditioning and intolerable adverse effects. He had a FDG-PET/CT showing progression of his disease 8 weeks after completing chemotherapy. He was maintained only on ART after finishing 6 cycles of chemotherapy. With this therapy alone and with improvement in his immune status, his lymphoma regressed completely.
CONCLUSIONS: There are very few reported cases in which lymphoma has regressed with treatment of HIV alone, as is regression of diffuse large B-cell lymphoma. This case emphasizes that ART can lead to immune reconstitution of HIV-infected patients and can establish the anti-tumor effect, causing regression of the lymphoma.

Keywords: HIV Infections - complications, HIV, Biopsy, Humans, Immunity, Innate, Lymphoma, Large B-Cell, Diffuse - immunology, Male, Middle Aged, Remission, Spontaneous, Tomography, X-Ray Computed