# Regional Oncology Research Center (Stimulate Research in HIV/AIDS Supplement)

> **NIH NIH P30** · JOHNS HOPKINS UNIVERSITY · 2024 · $207,357

## Abstract

PROJECT SUMMARY
Worldwide, Hodgkin lymphoma (HL) is treated with curative intent, regardless of HIV status. In South Africa, at
least 40% of people living with HIV (PWH) with HL and marrow involvement do not survive until diagnosis. For
those that survive long enough for a diagnosis to be pathologically confirmed, secondary hemophagocytic
lymphohistiocytosis (HLH) appears to be a significant contributor to the high mortality and a cause of
considerable morbidity resulting in poor outcomes. Strategies to improve the diagnosis of HL in this population
are desperately needed. In a cohort of HIV-associated HL in South Africa, a marked elevation of ferritin was seen
at time of diagnosis and was associated with known poor prognostic factors, raising the question as to whether
a marked elevation of ferritin could be useful in prioritizing HL diagnosis in this setting. While HL is not the only
trigger associated with HLH in Johannesburg (or an elevation in serum ferritin), it was associated with over 44%
of suspected HLH cases referred to Hematology. Co-infection with TB in PWH and HL is also a considerable
concern in South Africa, however one of the most widely used diagnostic tests for disseminated TB has only
modest sensitivity (~50%). Having a biomarker that can help identify patients early for prioritized HL diagnosis
could result in lives saved. Additionally, this biomarker could help identify patients at high risk for early mortality.
Several future clinical trials could be considered for this population including: 1) Empiric TB treatment if ferritin
is markedly elevated 2) Frontline clinical trial of immunotherapy to aid in the management of both HLH and HL
3) Incorporation of JAK-inhibitors (i.e. Ruxolitinib) into the upfront treatment regimen to help manage co-existing
HLH. We acknowledge the drawbacks of ferritin given that it is a non-specific marker of inflammation. The benefit
of serum ferritin is that it is readily available in low resource settings. In this proposal, by utilizing data from an
existing cohort of lymphoma patients and stored specimens from a pneumonia cohort study, we will better
understand the levels of ferritin elevation seen in other subtypes of lymphoma, other EBV-associated tumors,
PWH and disseminated TB and PWH admitted to the hospital with pneumonia. Our overarching goal is to show
that extreme elevations in ferritin, that do not respond to initial treatment regimens (i.e antibiotics or TB therapy),
should raise the suspicion of HL in PWH.

## Key facts

- **NIH application ID:** 11065115
- **Project number:** 3P30CA006973-61S2
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** WILLIAM George NELSON
- **Activity code:** P30 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $207,357
- **Award type:** 3
- **Project period:** 1997-05-07 → 2027-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11065115

## Citation

> US National Institutes of Health, RePORTER application 11065115, Regional Oncology Research Center (Stimulate Research in HIV/AIDS Supplement) (3P30CA006973-61S2). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/11065115. Licensed CC0.

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