ABCL-385 CD4 Counts and Viral Loads for Screening of HIV-Associated Lymphoma.

Lymphoma is a leading cause of death in HIV patients, with up to 400-fold increased incidence compared to HIV-negative individuals. There tends to be a downtrend in CD4 lymphocyte counts noted at the diagnosis of lymphoma in HIV patients, despite virologic control. Some reports have described a preceding downtrend of CD4 counts almost a year prior to lymphoma diagnosis. The pathophysiology of this CD4 decline remains largely unknown, and the implications of this finding on prognosis, infection risk, or response to therapy are unclear. To date, there are no significant interventions suggested in response to this finding. Further characterization of this decline may provide clinical utility for identifying high-risk patients and intervening earlier, both by way of treatment and prophylaxis. We performed a retrospective chart review of patients with HIV-associated lymphoma treated at the UTMB oncology clinic between 2020 to 2021. We identified 3 patients with HIV-associated lymphoma, all notably with diffuse large B-cell lymphoma (DLBCL). We analyzed their CD4 counts and HIV viral loads from the time of diagnosis to 1 year after treatment completion, their rates of infectious complications, and lymphoma treatment outcomes. Hematology and Oncology Clinic Results: All patients had CD4 counts <100 with undetectable HIV on quantitative PCR at lymphoma diagnosis. All received chemo-immunotherapy, predominantly the R-EPOCH regimen, and standard infection prophylaxis according to guidelines. Two patients presented with a significant rise in absolute CD4 levels throughout the treatment course, whereas 1 had minimally rising levels initially that then declined. All patients achieved complete responses to systemic therapy with no infectious complications and no significant relapses. There is a lack of clear explanation for CD4 lymphopenia decline prior to and at the time of HIV-associated lymphoma diagnosis, despite optimal HIV control. Lymphocyte recruitment to lymphomagenesis sites may contribute to the low CD4 count in peripheral blood, which may explain their preceding decline. Screening such patients for lymphoma diagnosis might help with early-stage diagnosis and prognosis improvement. Large-scale studies are needed to better evaluate the implications of our findings and make potential changes to the management algorithm of HIV-associated lymphoma. Copyright © 2022 Elsevier Inc. All rights reserved.

Citation

Pooja Bhakta, Sindusha Gudipally, Zachary Hunzeker, J Patrik Hornak, Tejo Musunuru. ABCL-385 CD4 Counts and Viral Loads for Screening of HIV-Associated Lymphoma. Clinical lymphoma, myeloma & leukemia. 2022 Oct;22 Suppl 2:S374-S375

Mesh Tags

PMID: 36164081

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