HIV status does not influence outcome in patients with classical Hodgkin lymphoma treated with chemotherapy using doxorubicin, bleomycin, vinblastine, and dacarbazine in the highly active antiretroviral therapy era.

Abstract

PURPOSE:

The prognosis of HIV-infected patients with non-Hodgkin lymphoma in the highly active antiretroviral therapy (HAART) era approaches that of the general population when they are treated with the same protocols. We analyzed the outcome of patients with Hodgkin lymphoma (HL) treated with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) in the HAART era according to HIV serostatus to establish whether this also holds true for HL.

PATIENTS AND METHODS:

From 1997 to 2010, 224 patients newly diagnosed with HL, of whom 93 were HIV positive, were consecutively treated with ABVD chemotherapy. HIV-positive patients had more high-risk disease according to the International Prognostic Score (IPS) than HIV-negative patients (IPS≥3: 68% v 26%, respectively; P<.001). Forty-seven HIV-positive patients had a CD4 count less than 200/μL, and 92 patients received HAART during chemotherapy.

RESULTS:

The complete response rate was 74% for HIV-positive patients and 79% for HIV-negative patients (P=not significant). After a median follow-up of 60 months (range, 8 to 174 months), 23 patients (16 HIV-negative and seven HIV-positive patients) have experienced relapse at a median time of 6 months (range, 1 to 106 months). Five-year event-free survival (EFS) was 59% (95% CI, 47% to 70%) for HIV-positive patients and 66% (95% CI, 57% to 74%) for HIV-negative patients (P=not significant). Five-year overall survival (OS) was 81% (95% CI, 69% to 89%) and 88% (95% CI, 80% to 93%) for HIV-positive and HIV-negative patients, respectively (P=not significant). HIV status did not predict OS or EFS on multivariate analysis including IPS and HIV status.

CONCLUSION:

This mature study demonstrates that HIV-positive patients with HL have more extensive disease with more adverse prognostic factors than HIV-negative patients, but when treated with ABVD, HIV infection does not adversely affect OS or EFS.

• Authors: Silvia Montoto, Kate Shaw, Jessica Okosun, Shreyans Gandhi, Paul Fields, Andrew Wilson, Milensu Shanyinde, Kate Cwynarski, Robert Marcus, Johannes de Vos, Anna Marie Young, Melinda Tenant-Flowers, Chloe Orkin, Margaret Johnson, Daniella Chilton, John G Gribben, Mark Bower
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 30 Issue 33 Pg. 4111-6 (Nov 20 2012) ISSN: 1527-7755 [Electronic] United States
• PMID: 23045581 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Bleomycin
• Vinblastine
• Dacarbazine
• Doxorubicin

Topics

• Adolescent
• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, adverse effects, therapeutic use)
• Antiretroviral Therapy, Highly Active (adverse effects, methods)
• Bleomycin (administration & dosage, adverse effects)
• Dacarbazine (administration & dosage, adverse effects)
• Disease-Free Survival
• Doxorubicin (administration & dosage, adverse effects)
• Female
• HIV Infections (complications, drug therapy)
• Hodgkin Disease (drug therapy, pathology, virology)
• Humans
• Lymphoma, AIDS-Related (drug therapy, pathology, virology)
• Male
• Middle Aged
• Neoplasm Staging
• Prognosis
• Retrospective Studies
• Treatment Outcome
• Vinblastine (administration & dosage, adverse effects)
• Young Adult