Abstract P044

HIV-associated Hodgkin lymphoma: real-world treatment outcomes and infectious complications – a multicentre study by the Polish Lymphoma Research Group

Background: HIV-associated Hodgkin lymphoma (HL) is uncommon and remains clinically challenging despite the availability of antiretroviral therapy (ART). Contemporary cohorts suggest favourable outcomes with standard HL treatment and effective HIV care, but real-world data from Central and Eastern Europe are limited.

Methods: We retrospectively analysed 12 adults with HIV-associated HL treated in 10 Polish haematological centres between 2007 and 2026, representing 12.2% of the Polish Lymphoma Research Group HIV-positive lymphoma cohort (12/98).

Results: All patients were male; median age was 39.5 years. HIV and HL were diagnosed concurrently in 1 patient; 11/12 had known HIV infection and were receiving ART before HL diagnosis. CD4 count and HIV RNA at HL diagnosis were available in 6/12; median CD4 count was 296 cells/μL. Advanced disease (Lugano III–IV) was present in 11/12 and bone marrow involvement in 3/12. Importantly, 6/12 patients had clinically significant infectious complications before HL treatment, including CMV reactivation, oesophageal candidiasis, Pneumocystis jirovecii pneumonia and pulmonary tuberculosis. First-line treatment consisted of ABVD in 11/12 patients and BV-AVD in 1/12. Infections and/or severe neutropenia complicated treatment, leading to dose reduction in 1 patient, prolonged intervals in 3 and hospitalisation in 3. Complete remission (CR) was achieved in 9/12; 4 of these patients relapsed, while 3/12 had primary refractory disease. Overall, 7/12 required second-line therapy and 1 underwent high-dose chemotherapy followed by autologous stem cell transplantation. Median time to relapse was 17.7 months. Additional events illustrated diagnostic and immune-related complexity: syphilis mimicked PET-positive nodal relapse in one patient in CR on the end of treatment, while immune thrombocytopenia developed after first-line therapy in another patient and preceded subsequent HL relapse. During a median follow-up of 41 months, 4/12 patients died (33.3%), mainly due to lymphoma progression, including hemophagocytic lymphohistiocytosis and CSN relapse.

Conclusions: Despite favourable outcomes reported in ART-era cohorts, this real-world series shows that HIV-associated HL may still follow a clinically challenging course. Infectious and immune-related events may complicate PET-based assessment and follow-up. These findings underscore the need for clinical vigilance, HIV/immunological assessment and standardised infection prophylaxis.