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.

Prognostic factors for advanced‐stage human immunodeficiency virus‐associated classical Hodgkin lymphoma treated with doxorubicin, bleomycin, vinblastine, and dacarbazine plus combined antiretroviral therapy: A multi‐institutional retrospective study

“…In the study by Spina et al, 21 patients experienced 3-year freedom from progression and OS rates of 60% and 51%, respectively, and the study by Montoto et al produced 5-year event-free survival and OS rates of 59% and 88%, respectively. 5 Our results are similar those reported by Xicoy et al, with estimated 5-year PFS and OS rates of 71% and 76%, respectively. 11 The results reported by Hentrich et al were also encouraging, with 2-year PFS and OS rates of 92% and 91%, respectively.…”

“…A study by Montoto and colleagues included 93 HIVpositive patients with HL and reported a CR rate of 74%, which was not statistically different from the rate in HIVnegative patients (79%). 5 However, in that study, no specific factors were independently associated with CR. A Spanish study in 62 patients who received ABVD produced a CR rate of 87%.…”

“…Patients with a diagnosis of nodular lymphocyte-predominant HL, stage I or II disease, other concurrent malignancy, or clinical suspicion, but not laboratory confirmation, of HIV infection were excluded. Portions of the data sets from previous studies 5,10,11 are included in this report.…”

“…3,4 A recent study demonstrated an improvement in the outcome of patients with HIV-associated HL compared with their immunocompetent counterparts when treated with standard regimens. 5,6 However, a standard of care in HIV-positive individuals has not been established, because, in general, HIVpositive patients are excluded from clinical trials, and data on their outcomes are rather scant.…”

HIV Infection and Survival of Lymphoma Patients in the Era of Highly Active Antiretroviral Therapy

“…However, a few studies directly compared HIV-infected and HIV-uninfected patients with lymphoma and found inconsistent results. Two studies from Europe found no difference (25,26), one study from the United States found that HIV infection was still negatively associated with NHL survival in the HAART era (27), and another recent study from England found that patients with diffuse large B-cell lymphoma (DLBCL, the most common NHL subtype) with HIV infection had a significantly longer survival (28). Thus, the evidence for an association between HIV infection and lymphoma survival remains elusive, likely due to limitations of previous studies, which include the lack of a well-matched control group, a small sample size, highly selected cases, and short follow-up.…”