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How Experts Treat HIV-associated Lymphomas · EHA Unplugged

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  Why is it important to have specific practical guidelines on
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  HIV lymphomas? Yeah, as I say, the incidence is
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  decreasing, but the incidence is 4/24 higher than in general
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  lymphoma population. And what is also important that
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  the most frequent type of cancer in people living with HIV.
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  The the lymphomas and lymphomas contribute to a significant
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  morbidity and mortality to for this patient and the mortality
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  rate for for lymphomas is higher than for opportunistic,
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  opportunistic infections. And so there's a good reason to
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  take care of these patients. Welcome to EHA Unplugged, the
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  official podcast channel of the European Hematology Association.
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  EHA. I am your host Isabella Rivera.
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  We're here today with Professor Kai Hubel.
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  Can you please introduce yourself?
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  Yeah, my name is Kai Hubel. I'm a hematologist and
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  oncologist from the University Hospital of Cologne in Germany.
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  I'm practicing now since more than 30 years, my scientific
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  interests focusing on lymphoid neoplasia, including HIV
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  associated lymphomas. And I'm also sharing the
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  European Network for HIV Associate Associated Lymphomas,
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  which was founded last year. It is part of the EHA Lymphoma
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  working Party. And we are now, we have now
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  around 25 members, which is really great.
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  We're here to discuss the EHA ESMO clinical practice
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  guidelines on HIV associated lymphomas.
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  So can you explain first what's your involvement on these
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  guidelines was I'd? Let me say it was a great
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  experience to develop such a guideline.
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  I never thought that it needs more than two or 2 1/2 years
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  from the very beginning and to getting on the guideline
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  published. The first challenge was to to
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  gather a group of very experienced investigators from
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  different European countries. And the second challenge was to
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  find a contents on the guide because I really learned that
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  HIV lymphomas are treated differently in different
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  European countries and we have to find a consent.
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  But finally we got it published, I think it was since the summer
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  last year, so. Why is it important to have
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  specific practical guidelines on HIV lymphomas?
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  Yeah, if you see the incidence of HIV associated lymphomas, the
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  incidence is decreasing since the beginning of the century,
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  mainly because of the introduction of the modern or
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  combined antiretroviral therapy C ART.
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  So this is a good question. Why do we need a guideline?
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  But there are several reasons. First, the outcome of HIV
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  associated lymphomas is different or it's worse than for
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  non HIV associated lymphomas. For example, if you have a blood
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  lymphoma, you can treat patients with a very intensive protocol.
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  But if the patient has has Ava bloody lymphoma, then there's a
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  high rate of fatalities of around 10%.
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  So we need different treatment approaches.
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  Another reason is that the con cumin therapies are different
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  between HIV and non HIV associated lymphomas.
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  Another reason is that there are rare lymphomas more or less
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  exclusively developing in people living with HIV.
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  For example, it's a primary funeral lymphomas and we need
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  guidelines recommendations for these patients.
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  And finally, we have a lot of modern treatment approaches like
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  the T set directed therapies and of course we need a
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  recommendation. Can we use these therapies in
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  HIV infected patients? You touched a bit on this, but
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  how prevalent are HIV associated lymphomas?
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  Yeah, as I said before, the incidence is decreasing, but the
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  incidence is 4/24 higher than in general lymphoma population.
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  And what is also important that the most frequent type of cancer
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  in people living with HIV is the RV lymphomas and lymphomas
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  contribute to a significant morbidity and mortality to for
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  this patient. And the mortality rate for for
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  lymphomas is higher than for opportunistic, opportunistic
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  infections. And so there's a good reason to
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  take care of these patients. Which are the most common
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  histological types of HIV associated lymphomas?
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  The most frequent HIV HIV associated lymphomas are other
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  diffuse large B cell lymphomas that accounts for about 20, 36
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  or 37%, followed by the Hodgkins lymphomas with with a rate of
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  26% and the Burger lymphomas with a rate of 20%.
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  Is the prevalence the same as informers that are not
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  associated to HIV? It's nearly the same for the
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  diffuse slash B cell lymphoma but it but it's not the same for
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  the burger lymphoma is more frequent and what we've rarely
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  seen in HIV affected patients is the Internet lymphomas and we
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  only see rare CNS lymphomas mainly because of the CRT.
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  What are the main challenges in diagnosing HIV associated
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  lymphomas? How do you combine the
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  procedures for the diagnosis of lymphomas with the procedures to
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  assess HIV? Let me say in general we can use
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  the same diagnostic procedures as the use in non HIV associated
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  lymphomas. But for example, there's an
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  ongoing discussion about the PET CT scan, because if you use a
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  PET CT in patients with HIV infections, then you may have a
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  high rate of false positive results, mainly due to
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  overlapping infections or due to immune disregulations, which
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  should lead to an hyperplasia of the lymph nodes.
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  So be careful if you use a CT scan, a PET CT scan.
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  And we often use a situation that the diagnosis of the HIV
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  infection is a diagnosis of the lymphomas.
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  It's the same time. And in this situation, you have
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  to follow for the HIV infections recommendation for newly
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  diagnosed HIV infections. How do you combine the
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  antiretroviral treatment for HIV with the lymphoma treatments?
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  This is a very important question and there was content
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  in the guideline that is no reason to stop the CRC entero
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  retroviral therapy during the lymphoma treatment.
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  Sometimes investigators are a little bit uncertain to continue
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  the CR during lymphoma treatment because of maybe interactions,
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  but there's no reason to stop it.
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  Also if you use a high dose chemotherapy or not only
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  transmutation or a Carkeesa therapy, does this mean that
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  there is no interaction? No, there could be an
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  interaction between the retroviral therapy and
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  cellophoma treatment. So if you are not you are
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  unfamiliar with this, you have to ask a HIV specialist or you
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  can visit websites who may have you.
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  But again, no reason to stop the anti retroviral therapy.
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  It's dangerous to stop. It it's a very important part of
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  the lymphoma therapy. We know that since we have the
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  modern angioedral viral therapy available, it's a prognosis.
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  It's much better for the patients.
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  How do you manage the increased risk of infections on HIV
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  lymphoma patients? Well, if the patient has a good
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  immune system that let me say in 64 cell count of more than 200,
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  you can for the same recommendation As for the HIV
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  negative patients. However, if the cell count is
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  less than 200, we recommend a general PCP prophylaxis and we
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  also recommend an antiviral prophylaxis, especially if the
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  patient has a history of a viral infection.
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  And if the patient has the CD 4's hair count less than 100, we
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  recommend the CMB monitoring and also we'll cause it and
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  candidias as prophylaxis. So this is a little bit
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  different from the HIV negative lymphomas.
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  It depends a little bit on the CD 4's hair counts.
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  This is about. So what are the key differences
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  for you in treating an HIV positive versus an HIV negative
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  lymphoma? So let me say in most situations
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  we can use the same therapies for the HIV positive and HIV
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  negative lymphomas, but there are some differences.
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  I will give you some examples. First, the use of rituximab.
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  Rituximab significantly improves the overall outcome of patients
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  with B cell lymphomas and this was also shown for the HIV
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  associated lymphomas. However, we know from randomized
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  trials that if the patient has ACD 4 cell count less than 50
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  and you use rituximab and you have a higher rate of fatal
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  infections. So there's a general
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  recommendation to be careful with the use of rituximab if the
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  CD 4 cell count is less than 50. Another point, CAR T cells, I
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  know in different European countries CAR T cells are not
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  allowed in HIV lymphomas if it data are rare, but we know from
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  several case reports and we know from one clinical trial
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  including nearly 30 patients, CAR T cells are visible in HIV
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  lymphomas. So we gave the recommendation if
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  the patient has ACT 4 cell count of more than 200, then you can
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  use the CAR T cells if it's in label.
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  And I will briefly focus on the Burger lymphoma.
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  I said at the very beginning that we have a higher fatality
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  rate if you use an intensive regimen in HIV burger lymphoma.
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  So if the patient is in a good condition, you may use of course
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  an intensive protocol like the German female protocol or the M
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  Codex IVAC protocol. However, if the patient has
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  comorbidities, then you should not use these intensive
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  protocols. We recommend to use something
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  like those adjusted epoch R. The results are great for HIV
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  burger lymphomas, but, and this is also important only if the
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  patient has no CNS involvement and has no POMERA involvement.
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  And you also give, as I said this, as I said at the
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  beginning, give recommendations for rare lymphomas like the
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  plasmoblastic lymphomas or the primary fusion lymphomas.
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  So we would like to highlight that in this HA guidelines,
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  there are specific and detailed recommendations for DLBCL, for
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  Birkett's lymphoma, for plasma plastic lymphoma, for primary
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  fusion lymphoma, for CNS lymphoma, primary and
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  secondaries, for Hodgkin's lymphoma and more.
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  We cannot summarize everything in this podcast, of course, so
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  please check the full details in the paper in hemisphere.
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  The the full link will be in the description.
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  Is there anything else that we haven't touched on that you
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  would like to add for the audience about these guidelines?
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  I would like to to close this interview with a call because
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  it's so important that we get more data on HIV lymphoma.
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  So it is very important to open clinical trials for HIV, for
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  patients with HIV lymphomas. It's general.
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  In general, it's an exclusive criterion to have an IGV
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  infection. So I don't know understand why
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  please open clinical trials for HIV lymphomas.
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  And 2nd, to get more data, it is necessary to have a registry and
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  we have a European registry which is chaired by my colleague
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  Marco Sandrich Munich. And so if you treat patients
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  with HIV, inform us, please send us an e-mail or call us, and we
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  will try to include your patients in the registry.
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  Thank you very much, Professor Huwen, for being with us today
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  It. Was my pleasure.
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  And thank you to the audience for listening.
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  And if you enjoyed this episode, please like it and subscribe to
• 11:05
  our channel. Stay tuned for more episodes of
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  EH Unplugged.