title: 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.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Spectrum Health, Grand Rapids, MI, USA.
authors.forename: K C
authors.initials: KC
authors.lastname: Birendra
authors.affiliation: Department of Internal Medicine, Grand Rapids Medical Education Partners, Grand Rapdis, MI, USA.
authors.forename: Muhammad Zubair
authors.initials: MZ
authors.lastname: Afzal
authors.affiliation: Department of Internal Medicine, Grand Rapids Medical Education Partners, Grand Rapdis, MI, USA.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Wentland
authors.affiliation: Department of Internal Medicine, Grand Rapids Medical Education Partners, Grand Rapids, MI, USA.
authors.forename: Hamza
authors.initials: H
authors.lastname: Hashmi
authors.affiliation: Department of Cancer Immunodiagnostics, Van Andel Research Institute, Grand Rapids, MI, USA.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Singh
authors.affiliation: Spectrum Health, Grand Rapids, MI, USA.
authors.forename: Elena
authors.initials: E
authors.lastname: Ivan
authors.affiliation: Department of Hematology/Oncology, Cancer and Hematology Centers of Western Michigan, Grand Rapids, MI, USA.
authors.forename: Nehal
authors.initials: N
authors.lastname: Lakhani
mesh_terms: D001706:Biopsy; D006678:HIV; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007113:Immunity, Innate; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000175:diagnosis / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012075:Remission, Spontaneous; D014057:Tomography, X-Ray Computed