HIV-associated Hodgkin’s lymphoma

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Patients with HIV-associated Hodgkin’s lymphoma had a similar prognosis to non-HIV infected Hodgkin’s lymphoma patients when treated with combined ART and doxorubicin, bleomycin, vinblastine and dacarbazine treatment, according to recently published data.

Healio reports that Dr Caroline Besson, division of cancer epidemiology and genetics at the National Cancer Institute, and colleagues prospectively enrolled 159 patients from the French National Agency for Research on AIDS and Viral Hepatitis ANRS-CO16 Lymphovir cohort who had newly diagnosed lymphoma between 2008 and 2014.

The researchers determined lymphoma staging using the Ann Arbor system. Patient evaluation for staging included routine laboratory and physical examination, as well as bone marrow biopsy, when clinically relevant, and positron emission tomography and CT when available. Patients were monitored every 6 months, with a planned follow-up of 5 years.

Among the patients newly diagnosed with HIV-associated lymphoma, 43% had Hodgkin’s lymphoma (HL). Of these, 76% were classified as Ann Arbor stage III/IV, and 96% were treated with doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD). At diagnosis of lymphoma, patients had a median CD4 T-cell count of 387 per µL. At baseline, 65 patients were currently receiving combined ART, and all but one patient previously had received combined ART.

Researchers recorded seven deaths at study outcome: two patients died from early progression, one patient died from sepsis, two patients died after relapse, and two additional patients died after relapsing during follow-up. The 2-year overall survival for patients was 94%, and progression-free survival was 89%. Age was the sole factor associated with death or progression (OR = 8.1; 95% CI, 1-67).

When compared with 336 patients who had HL but did not have HIV, patients with the infection had significantly higher risk factors for all prognostic indicators of HL. Besson and colleagues found the 2-year progression-free survival for HIV-positive patients, however, was 89% (95% CI; 82%-97%) compared with 86% (95% CI; 82%-90%) in the HIV-negative group.

“Altogether, the most striking observations drawn from the present study are the high frequency of (classical HL) among lymphomas in HIV-infected patients and the persistence of high risk features, namely (Epstein-Barr virus) association, (mixed cellularity) sub-type, and advanced clinical stage contrasting with the remarkable improvement of their prognosis in the modern (combined) ART era,” Besson and colleagues are quoted in the report as saying.

Abstract
Background.Human Immunodeficiency Virus (HIV) infection is associated with a high risk of classical Hodgkin’s lymphoma (cHL) in the combined antiretroviral therapy (cART) era.
Methods.We analyzed the characteristics and outcome of HIV-associated cHL diagnosed in the modern cART era. The French ANRS-CO16 Lymphovir cohort enrolled 159 HIV-positive patients with lymphoma, including 68 (43%) with cHL. HIV-HL patients were compared with a series of non HV-infected patients consecutively diagnosed with HL.
Results.Most patients (76%) had Ann-Arbor stages III-IV and 96% of patients were treated with ABVD. At diagnosis, median CD4 T-cell count was 387/μL and 94% of patients were treated with cART. All patients received cART after diagnosis. Five patients died from early progression (n=2), sepsis (1) or after relapse (2). Two additional patients relapsed during follow-up. Two-year overall and progression free survivals (PFS) were 94% [95%CI 89%, 100%] and 89% [82%, 97%], respectively. The only factor associated with progression or death was age with a relative risk of 8.1 [1.0; 67.0] above 45 years. The PFS of Lymphovir patients appeared similar to PFS of HIV-negative patients, 86% [82%, 90%], but patients with HIV infection displayed higher risk features than HIV-negative patients.
Conclusion.Although high risk features still predominate in HIV-HL, the prognosis of these patients, treated with cART and mainly ABVD, has markedly improved in the modern cART era and is now similar to non HIV-infected patients.

Full Healio report
Clinical Infectious Diseases abstract


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