Results of treatment with doxorubicin, bleomycin, vinblastine and dacarbazine and highly active antiretroviral therapy in advanced stage, human immunodeficiency virus-related Hodgkin's lymphoma

Abstract

Although doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) is considered the standard chemotherapy regimen for Hodgkin's lymphoma (HL), information on the results of this therapy in human immunodeficiency (HIV)-related HL is scarce. We analyzed the results of the ABVD regimen and highly active antiretroviral therapy (HAART) in patients with advanced stage, HIV-related HL. Design and MethodsFrom January 1996 to December 2005, 62 HIV-infected patients with newly diagnosed HL were treated in 15 Spanish hospitals. Six to eight cycles of ABVD and HAART were planned. Response to chemotherapy, overall survival (OS) and event-free survival (EFS) were recorded. ResultsThe median age of the patients was 37 years (range, 24-61) and 29 (47%) had a previously known diagnosis of acquired immunodeficiency syndrome. The median CD4 lymphocyte count at diagnosis was 129/µL (range 5-1,209). The histologic subtype of HL was nodular sclerosis in 17 patients (27%), mixed cellularity in 25 (41%), lymphocyte depletion in 10 (16%) and non-specified in the remaining 10 (16%). Twentyone (34%) patients were in stage III and 41 (66%) in stage IV. The scheduled six to eight ABVD cycles were completed in 82% of cases. Six patients died during induction, 54 (87%) achieved a complete response (CR) and two were resistant. After a median follow-up of 39 and 47 months, 5-year EFS and OS probabilities were 71% (47-95) and 76% (65-87), respectively. An immunological response was observed in 24 out of 43 patients (56%) and a virological response in 27 out of 40 (68%). The immunological response to HAART had a positive impact on OS and EFS (p=0.002 and p=0.001, respectively). Interpretation and ConclusionsIn patients with advanced stage, HIV-related HL, treatment with ABVD together with HAART is feasible and effective. This supports the concept that patients with HIVrelated HL should be treated in the same way as immunocompetent patients if HAART, adequate supportive therapy and anti-infectious prophylaxis are given concomitantly. An immunological response to HAART has a positive impact on OS and EFS.Key words: Hodgkin's lymphoma, HIV-related, advanced stage, ABVD, HAART. Haematologica 2007; 92:191-198 ©2007 Ferrata Storti Foundation 1 Its aggressive behavior includes unfavorable histological subtypes, advanced stage and extranodal involvement at diagnosis. 2-6Although in the era of highly active antiretroviral therapy (HAART) the incidence of non-Hodgkin's lymphoma (NHL) has declined according to several studies, this does not seem to be the case for HL. In recent years improvements have been observed in the survival of both patients with HIV-related NHL and those with HL.7-9 There are several possible reasons for these improvements. First, HAART increases CD4 lymphocyte counts and, concomitantly, reduces the risk of opportunistic infections; second, an improvement in the immunodeficiency status could prevent relapse of the lymphoma; and third, improvements in supportive therapy, e.g. the use of granulocyte colony-stimulating factor (G-...

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

“…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. 20 Most of the studies on HIV-associated HL, however, are hampered by short follow-up periods, which might lead to overestimation of survival rates.…”

“…A Spanish study in 62 patients who received ABVD produced a CR rate of 87%. 11 Finally, a prospective study by Spina and colleagues in 59 patients with HIV-associated HL who received the Stanford V regimen (doxorubicin, vinblastine, mechlorethamine, vincristine, bleomycin, etoposide, and prednisone) and cART produced a CR rate of 81%. 21 The IPS was significantly associated with obtaining a CR.…”

“…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.…”

Human immunodeficiency and Hodgkin lymphoma

“…Those who responded by increasing CD4 cell count of 100/ul or a RNA level below 500 copies/ml had an overall survival rate of 89% at 2 years compared with 44% for those who did not meet this criterion or were over 45 years of age [106]. Interestingly, limited data on the treatment with ABVD combined with cART in HIV-related HL, the standard in the non-immunosuppressed population, are available [106], [108] and [109].…”

“…For example the Spanish GESIDA/GELCAB Group [108] analysed outcome in advanced stage where 87% achieved CR: at median follow-up of 39 and 47 months, 5-year EFS and OS probabilities were 71% and 76%, respectively. An immunological response was observed in 56% and this was also virological in 68% of all treated patients leading to the conclusion that this regimen is effective and tolerated well.…”