HIV Status Does Not Impact on Outcome in Patients with Hodgkin Lymphoma Treated with ABVD Chemotherapy in the HAART Era,

The prognosis of patients with HIV and non-Hodgkin lymphoma (NHL) has improved considerably since the advent of HAART, approaching that of patients with NHL in the general population when treated with the same chemotherapy regimens. However, it is not clear whether the same holds true for patients with Hodgkin lymphoma (HL). Aim: To analyze the outcome of patients diagnosed with HL treated with ABVD in the HAART era according to HIV status. Patients: From 1997 to 2010, 237 patients (92 with HIV infection) were newly diagnosed with HL at 5 university hospitals in London and consecutively treated with ABVD chemotherapy. Patients with HIV were older (median age: 41 years vs 31, p<0.001) and more were men (88% vs 59%, p<0.001). The histology subtype was more frequently mixed cellularity in HIV patients (54%) than in non-HIV (19%, p<0.001). In addition, HIV positive patients had more advanced stage at diagnosis (stage III-IV: 80% vs 33%, p<0.001), B-symptoms (81% vs 36%, p<0.001), lower Hb level (<10.5g/dL: 46% vs 20%, p<0.001) and lower albumin level (<4g/dL: 76% vs 35%, p<0.001). Patients with HIV infection had more frequently high risk disease according to the International Prognostic Score than HIV negative patients (IPS>3: 71% vs 22%, p<0.001). Amongst HIV patients, the HIV viral load (VL) was undetectable at the time of HL diagnosis in 52 of 86 patients with available data. The median VL for the remainder was 4,563 (range: 3,060–6,066). Forty-seven patients (53%) had a CD4 count <200/mL. All patients were treated with 4–6 cycles of ABVD chemotherapy with or without radiotherapy to residual/bulky areas according to local policies. Ninety patients with HIV infection received HAART concomitantly during chemotherapy. Results: The complete response (CR) rate in HIV positive and negative patients was 74% and 81%, respectively (p=NS). Fifty-one patients (21%) received consolidation radiotherapy. After a median follow-up of 59 months (range: 8–172 months), 40 patients relapsed at a median time of 7 months (range: 1–106). The median duration of response for HIV positive and negative patients was 33 months and 48 months, respectively (p=NS). Thirty-three patients have died: in 25 cases of HL; 2 patients due to toxicity and 5 patients due to other causes. Five-year event-free survival (EFS) was 59% (95%CI: 46–69) for HIV patients and 65% (95%CI: 56–72) for the remainder (p=NS). Five-year overall survival (OS) was 79% (95%CI: 67–87) and 88% (95%CI: 80–92) for HIV positive and negative patients respectively (p=0.06). HIV status did not predict OS or EFS on multivariate analysis including all variables comprising the IPS and HIV status. Conclusions: This long follow-up study demonstrates that patients diagnosed with HL in the setting of HIV infection have a more extensive disease with adverse prognostic factors. However, when treated with ABVD chemotherapy HIV positive status does not adversely affect OS or EFS.

Montoto:Roche: Honoraria; Genentech: Research Funding. Orkin:Janssen: Honoraria; Gilead: Honoraria; BMS: Honoraria; BI: Honoraria; MSD: Honoraria; GSK: Honoraria; Viiv: Honoraria. Gribben:Roche: Honoraria; Celgene: Honoraria; GSK: Honoraria; Mundipharma: Honoraria; Gilead: Honoraria; Pharmacyclics: Honoraria.