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Hodgkin’s lymphoma: survival normalises to HIV negative rates despite more advanced disease at diagnosis




 

High levels of treatment response to chemotherapy for Hodgkin’s Lymphoma (HL) in the HAART era were reported in a combined analysis from five clinics, showing similar rates of event-free and overall survival compared to HIV negative controls.

Chloe Orkin and colleagues analysed all cases of HL diagnosed at five London teaching hospitals from 1997-2010 who were treated with 4-6 cycles of AVBD (adriamycin, bleomycin, viznblastine and dacarbazine). Of these, 97/237 were HIV positive and 90/97 were on HAART during HL treatment. HIV viral load was undetectable in 52/86 HIV positive patients with data and low (<6,000 c/mL) in others but 53% (47/97) had CD43.

HIV patients were older (median age: 41 vs 31 years, p<0.001), more likely to be male (88% vs 59%; p<0.001). They also had more advanced disease. This included higher rates of: mixed cellularity (54% vs 19%, p<0.001), stage 3/4 at diagnosis (80% vs 33%; p<0.001), B-symptoms (81% vs 36%; p<0.001), Hb <10.5 g/dL (46% vs 20%; p<0.001), albumin

Over median follow-up of 59 months (range 8-172), similar response rates (74% vs 81%), duration of response (33 vs 44 months), 5-year event-free survival (59% vs 65%) and 5-year overall survival (79% vs 88%) were seen in the HIV positive vs HIV negative groups respectively, see Table 1. In the combined group, 40 patients relapsed at a median time of 7 months (range: 1-106).

Table 1: Responses to ABVD chemotherapy in HIV positive vs HIV negative people
  HIV positiveHIV negativep-value
Complete response rate 74% 81% NS
Median duration of response 33 mo 48 mo NS
5-yr event-free survival 59%

(95%CI: 46– 69)

65%

(95%CI: 56–72)

NS
5-yr overall survival 79%

(95%CI: 67–87)

88%

(95%CI: 80–92)

p=0.06 (NS)

Comment

These results are important and impressive, despite including data from the early HAART era, and especially given the more advanced disease at HL diagnosis.

Reference:

Orkin C et al. HIV Status does not Impact on Outcome in Patients with Hodgkin Lymphoma Treated with ABVD Chemotherapy in the HAART Era. 18th BHIVA Conference, 18-20 April 2012, Birmingham. Oral abstract O13.

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Information in this article was accurate in June 4, 2012. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.