PerspectiveIn the Journals

HIV-associated Hodgkin’s lymphoma patients benefit from cART, ABVD

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August 13, 2015

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.

Caroline Besson, MD, PhD, 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] subtype, and advanced clinical stage contrasting with the remarkable improvement of their prognosis in the modern [combined] ART era,” Besson and colleagues wrote. – by Jeff Craven

Disclosure: The researchers report no relevant financial disclosures.

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Nina Clark

Nina Clark

While AIDS-defining malignancies, including non-Hodgkin’s lymphoma, have been declining in frequency with the introduction of combination ART (cART), non-AIDS–defining malignancies such as HL are increasing in prevalence. HL is one of the most common non-AIDS–defining cancers, occurring at a several-fold increased rate in HIV-infected persons compared with the general population. 

Older literature had found that survival from HL was significantly worse in HIV-infected persons compared with those without HIV, but this was prior to the advent of potent cART, and lower-dose chemotherapy was sometimes used due to baseline immunodeficiency. Besson and colleagues now provide encouraging outcomes data with respect to treatment of classic HL, demonstrating a high rate of overall (94%) and progression-free (89%) survival at 2 years in a French cohort of HIV-infected persons, with most receiving standard ABVD therapy. Outcomes were similar to a comparison group of HIV-negative classic HL patients, despite more ominous risk features in the HIV-infected cohort (eg, histologic type, Epstein-Barr virus infection and International Prognostic Index). The vast majority of the group with HIV were receiving cART, undoubtedly a factor in the good outcomes. Only a limited analysis of prognostic factors could be performed given that there were few adverse outcomes, but age was associated with death and disease progression, without an effect of CD4 count.

This study joins others demonstrating leaps in survival among those diagnosed with AIDS or certain AIDS-related opportunistic processes in the era of cART compared with those diagnosed in earlier eras. It remains to be seen whether novel agents under study for HL will have further beneficial impact on survival and less toxicity, particularly in older patients. In addition, identifying accurate outcome predictors are of great interest to help guide therapy.

Nina Clark, MD
Associate professor of infectious disease Loyola University Chicago Stritch School of Medicine

Disclosure: Clark reports no relevant financial disclosures.