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 published from 1989 to 2020. Only articles or abstracts in English were considered for this Review Expert opinion In 2012, the International Agency for Research on Cancer -IARC- has considered the epidemiological and biological scientific evidence sufficient to establish that HIV induced immune deficiency is a cause of HL. Moreover, the risk of HL is substantially increased in people with iatrogenically acquired immune depression following organ transplantation. 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 favourably 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. In post-transplant-associated HL management is challenging because it must balance disease eradication with graft rejection, increased immunosuppression and life-threatening infections.