Improved survival in HIV-related Hodgkin's lymphoma since the introduction of highly active antiretroviral therapy.
OBJECTIVE
To evaluate the evolving characteristics of HIV-related Hodgkin's lymphoma (HL) and survival of affected patients since the introduction of highly active antiretroviral therapy (HAART).


METHODS
A retrospective single-institution study was performed over a 15-year follow-up period. For statistical analysis, patients were categorized into a pre-HAART period (1987-1996, n = 61) and a post-HAART period (1997-2001, n = 47).


RESULTS
HL characteristics were similar in both groups. The chemotherapy regimens used did not differ significantly, although the MOPP/ABV regimen (mechlorethamine, vincristine, procarbazine substituted by cyclophosphamide since 2000, and prednisone /adriamycin, bleomycin, vinblastin) has progressively replaced the ABVD regimen (adriamycin, bleomycin, vinblastin, dacarbazine). A slight increase in the complete response rate was noted in the post-HAART population (74.5%) versus the pre-HAART population (64.5%), and the probability to relapse was not different between the two groups. Patients diagnosed since 1997 had a higher probability for prolonged survival with a median survival time not reached versus 19 months in the pre-HAART period. The estimate 2-year survival probability was 45% [95% confidence interval (CI), 32.3-57.8% in the pre-HAART period, and 62% (95% CI, 46.7-77.1%) in the post-HAART period ( P= 0.03). This decreased mortality was associated with a decrease in AIDS-associated deaths. In the post-HAART period, 12 patients were naive to any antiretroviral therapy and 31 were already on HAART at the time of HL diagnosis. Twenty of them had a plasma HIV-RNA below 500 copies/ml. The response rate and the overall survival were not statistically different in these patients.


CONCLUSIONS
HL still occurs in patients with HAART-induced HIV suppression. However, overall survival has significantly improved since the introduction of HAART.
Gérard
Laurence
L
Service d'Immuno-Hématologie and Laboratoire d'Anatomopathologie, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, Paris, France.
Galicier
Lionel
L
Boulanger
Emmanuelle
E
Quint
Laurent
L
Lebrette
Marie-Giselle
MG
Mortier
Emmanuel
E
Meignin
Véronique
V
Oksenhendler
Eric
E
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000188:drug therapy* / Q000821:virology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D019562:Viral Load