Elif Yilmaz

Summary: Brentuximab vedotin (BV)‐doxorubicin, vinblastine and dacarbazine (AVD) and nivolumab (N)‐AVD have transformed the frontline treatment of advanced‐stage Hodgkin lymphoma (HL), yet real‐world comparative data remain limited. In this multicentre retrospective study across 17 US centres, 646 patients treated between September 2011 and April 2025 were included; 509 (78.8%) received BV‐AVD and 137 (21.2%) received N‐AVD. Dose reductions or omissions were more common with BV‐AVD (35.8% vs. 14.4%, p < 0.0001). N‐AVD was associated with higher rates of neutropenia (any grade 77.2% vs. 43.9%, p < 0.0001; grade ≥3 58.1% vs. 34.0%, p < 0.0001) and infections (31.9% vs. 19.7%, p = 0.004), while grade ≥3 infections and febrile neutropenia were comparable. Neuropathy was significantly more frequent with BV‐AVD (57.2% vs. 20.6%, p < 0.0001). End‐of‐therapy complete response rates were numerically higher with N‐AVD (86.2% vs. 79.3%, p = 0.11). With a median follow‐up of 26.8 months, 2‐year overall survival (OS) was 97% for BV‐AVD and 100% for N‐AVD ( p = 0.08) and 2‐year progression‐free survival (PFS) was 84% vs. 88% ( p = 0.06). Survival outcomes were consistent in a 1:1 propensity score‐matched cohort. These real‐world data demonstrate comparable survival between regimens, with numerically improved PFS supporting N‐AVD as a frontline standard for advanced‐stage HL; however, higher rates of neutropenia and infections warrant careful monitoring and consideration of growth factor prophylaxis.

PURPOSE: To study the influence of the Affordable Care Act (ACA) policy and its Medicaid expansion on insurance status and survival in patients with HIV with aggressive lymphoma. METHODS: We used the National Cancer Database, a hospital-based national registry, to identify adults age 18-64 years with HIV-associated aggressive B-cell non-Hodgkin lymphomas (HIV-a-B-NHLs), diagnosed during 2007 to 2016. Survival analysis was performed on a subset of patients with HIV-a-B-NHL for whom location data were available who resided in Medicaid expansion–adopted and nonadopted states. Using a quasi-experimental difference-in-difference model, the difference in adjusted 2-year survival rates obtained with a flexible parametric Weibull model was compared for states that adopted the Medicaid expansion of ACA against those that did not adopt the expansion. RESULTS: We identified 8,231 patients with HIV-a-B-NHL and 50,650 non-HIV patients with a-B-NHL. We found that a lower proportion of individuals were uninsured at diagnosis in the expansion states compared with nonexpansion states. We also found that the ACA policy adoption led to a reduction in the proportion of uninsured individuals with HIV-a-B-NHL in expansion states of 34.9%, compared with 15.9% in non–expansion-adopted states. There was a statistically significant improvement in the 2-year survival rate among patients with HIV-a-B-NHL in the expansion compared with nonexpansion states with the adoption of ACA (7.17% v 1.58%, P = .02). CONCLUSION: Using a novel quasi-experimental model, we found that the ACA policy corresponded with a greater survival improvement in patients with HIV-a-B-NHL within Medicaid expansion–adopted states compared with nonexpansion states. We believe that this evidence should be taken into consideration in future policy making.

Splenic diffuse red pulp small B-cell lymphoma (SDRPL) is a rare disease, representing <1% of all non-Hodgkin lymphomas (NHL). The most common clinical manifestations include splenomegaly, lymphocytosis, and hemocytopenia. A diagnosis of SDRPL can be challenging, as it shares multiple clinical and laboratory features with splenic marginal zone lymphoma (SMZL), hairy cell leukemia (HCL), and HCL variant (HCL-v). Obtaining splenic tissue remains the gold standard for diagnosis. In the cases where splenic tissue is not available, diagnosis can be established by a review of peripheral blood and bone marrow studies. SDRPL is characterized by a diffuse involvement of the splenic red pulp by monomorphous small-to-medium sized mature B lymphocytes effacing the white pulp. The characteristic immunophenotype is positive for CD20, DBA.44 (20 to 90%), and IgG, and typically negative for CD5, CD10, CD23, cyclin D1, CD43, annexin A1, CD11c, CD25, CD123, and CD138. The Ki-67 proliferative index is characteristically low. Cyclin D3 is expressed in the majority of SDRPL in contrast with other types of small B-cell lymphomas, thus facilitating the recognition of this disease. There is no standard treatment regimen for SDRPL. Initial treatment options include splenectomy, rituximab monotherapy, or a combination of both. Chemoimmunotherapy should be considered in patients with advanced disease at baseline or progression.