Outcome of patients with Hodgkin's disease failing after primary MOPP-ABVD.

Presentation of Hodgkin lymphoma (HL) is distinctive in the infected individual being more advanced, accompanied by B symptoms and the presence of extranodal disease particularly lymphadenopathy of the head and neck. Bone marrow involvement may be found in over 50% of cases. Virtually all co express gamma-herpesvirus. Phenotypically there is prominence of the mixed-cellularity and lymphocyte depleted histopathologic subtypes that define an aggressive clinical course in comparison to other variants. Prior to the induction of cART, median survival was only 1-2 years. Notably the first chemotherapy trial using ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) in 21 patients, without treating the viral infection, resulted in a 43% complete remission rate accompanied by severe haematological toxicities but did not extend median survival with this being 1.5 years matching the negative cases.Significant change accompanied concomitant anti-retroviral therapy that could be given safely even with dose intensive regimens exemplified by BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) in 12 patients or the Stanford V regimen (doxorubicin, vinblastine, mechlorethamine, etoposide, vincristine, bleomycin, prednisone) coupled with involved-field radiation for bulky disease studied in 59 patients. BEACOPP extended overall survival (OS) to 83% at 2 years. A similar trend was seen 1 when using the Stanford V regimen with an OS rate of 51% at 3 years, disease-free survival (DFS) of 68% and freedom from progression (FFP) in 60%. Additional benefits accrued from supportive care with stimulatory peptides such as G-CSF and when combined with bacterial prophylaxis results approached that found in the uninfected reference group. Current consensus holds this particular lymphoma as still among the non-AIDS defining cancers being lung, stomach, liver or anal despite these having recently gained more attention as several of these neoplasms may be occurring more commonly in the era of cART.While the relative risk of developing a non-AIDS-defining neoplasm in HIV-infected persons on the average is 2-3 times, the risk for developing HL in HIV-infected cases impressively ranges between 5 and 25 times when compared to the general population. Based on the precedent in which Kaposi sarcoma and the non-Hodgkin lymphomas distinctively alter the course of this retroviral infection in a way indistinguishable from concurrent Hodgkin lymphoma we propose that this entity be similarly regarded and the hypothesis tested in large randomised prospective study.

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“…Recurrence reduces long-term disease-free survival with standard dose chemotherapy to below 20% [60] and [61]. Exception exists in two subgroups.…”

Section: Relapsementioning

confidence: 99%

Human immunodeficiency and Hodgkin lymphoma

Sissolak

Jacobs

2010

Transfusion and Apheresis Science

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“…Nevertheless, the prognosis of children who fail to attain complete remission or who relapse after conventional treatment is poor, particularly if relapse occurs after a short complete remission. 13 High-dose chemotherapy with stem cell rescue is considered a possible therapeutic option to cure some of these patients.…”

Section: Discussionmentioning

confidence: 99%

Autologous stem cell transplantation for advanced Hodgkin's disease in children

Verdeguer¹,

Pardo²,

Madero

et al. 2000

Bone Marrow Transplant

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“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Once patients relapse after initial therapy, however, conventionaldose chemotherapy regimens usually fail to provide durable complete remissions. [17][18][19][20][21][22][23][24] In the series with the longest follow-up, Longo and associates 17 reported that although 93% of relapsing patients could be re-induced into a second complete remission, only 17% of these remissions were durable. Other studies confirm that only a minority of patients experience prolonged disease-free survival with salvage chemotherapy.…”

mentioning

confidence: 99%

“…Other studies confirm that only a minority of patients experience prolonged disease-free survival with salvage chemotherapy. 19,20,[22][23][24] Consequently, high-dose therapy with autologous hematopoietic stem cell support (autotransplantation) is increasingly used to treat recurrent Hodgkin's disease. We analyzed results of autotransplantations reported to the Autologous Blood and Marrow Transplant Registry (ABMTR), performed in 414 people with Hodgkin's disease in first relapse or second complete remission.…”

mentioning

confidence: 99%

Autotransplants for Hodgkin's disease in first relapse or second remission: a report from the autologous blood and marrow transplant registry (ABMTR)

Lazarus

Loberiza

Zhang

et al. 2001

Bone Marrow Transplant

109

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Summary:Although patients with relapsed Hodgkin's disease have a poor prognosis with conventional therapies, high-dose chemotherapy and autologous hematopoietic stem cell transplantation (autotransplantation) may provide long-term progression-free survival. We reviewed data from the Autologous Blood and Marrow Transplant Registry (ABMTR) to determine relapse, disease-free survival, overall survival, and prognostic factors in this group of patients. Detailed records from the ABMTR on 414 patients with Hodgkin's disease in first relapse (n = 295) or second complete remission (CR) (n = 119) receiving an autotransplant from 1989 to 1995 were reviewed. Median age was 29 (range, 7-64) years. Median time from diagnosis to relapse was 18 (range, 6-219) months; median time from relapse to transplant was 5 (range, Ͻ1-215) months. Most patients received high-dose chemotherapy without total body irradiation for conditioning (n = 370). The most frequently used high-dose regimen was cyclophosphamide, BCNU, VP-16 (CBV) (n = 240). The graft consisted of bone marrow (n = 246), blood stem cells (n = 112), or both (n = 56).

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Outcome of patients with Hodgkin's disease failing after primary MOPP-ABVD.

Cited by 161 publications

References 23 publications

Human immunodeficiency and Hodgkin lymphoma

Human immunodeficiency and Hodgkin lymphoma

Autologous stem cell transplantation for advanced Hodgkin's disease in children

Autotransplants for Hodgkin's disease in first relapse or second remission: a report from the autologous blood and marrow transplant registry (ABMTR)

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