Spontaneous regression of stage IV advanced diffuse large B-cell lymphoma in an person living with HIV: a case report and literature review

Background HIV-associated diffuse large B-cell lymphoma (DLBCL) is an aggressive malignancy with poor outcomes despite combination antiretroviral therapy (cART). Spontaneous regression in advanced-stage disease is exceptionally rare. Case description A 66-year-old male with stage IV, non-germinal center DLBCL involving the liver achieved complete radiographic resolution of multifocal hepatic lesions without cytotoxic therapy following cART initiation. Remission has been sustained for over 36 months. Effective viral suppression and CD4+ T-cell recovery (from 200 to 571 cells/μL) were temporally correlated with tumor regression. Conclusion Spontaneous regression of stage IV diffuse large B−cell lymphoma (DLBCL) is exceedingly rare among individuals with HIV infection. This case underscores the critical role of immune reconstitution via cART in treating HIV−associated lymphoma. Therefore, it is recommended to initiate cART as early as possible in HIV−positive lymphoma patients to restore immune function, which can positively influence lymphoma management.