title: Results of treatment with doxorubicin, bleomycin, vinblastine and dacarbazine and highly active antiretroviral therapy in advanced stage, human immunodeficiency virus-related Hodgkin's lymphoma.
abstract: OBJECTIVE
  Although doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) is considered the standard chemotherapy regimen for Hodgkin's lymphoma (HL), information on the results of this therapy in human immunodeficiency (HIV)-related HL is scarce. We analyzed the results of the ABVD regimen and highly active antiretroviral therapy (HAART) in patients with advanced stage, HIV-related HL.
  
  
  METHODS
  From January 1996 to December 2005, 62 HIV-infected patients with newly diagnosed HL were treated in 15 Spanish hospitals. Six to eight cycles of ABVD and HAART were planned. Response to chemotherapy, overall survival (OS) and event-free survival (EFS) were recorded.
  
  
  RESULTS
  The median age of the patients was 37 years (range, 24-61) and 29 (47%) had a previously known diagnosis of acquired immunodeficiency syndrome. The median CD4 lymphocyte count at diagnosis was 129/muL (range 5-1,209). The histologic subtype of HL was nodular sclerosis in 17 patients (27%), mixed cellularity in 25 (41%), lymphocyte depletion in 10 (16%) and non-specified in the remaining 10 (16%). Twenty-one (34%) patients were in stage III and 41 (66%) in stage IV. The scheduled six to eight ABVD cycles were completed in 82% of cases. Six patients died during induction, 54 (87%) achieved a complete response (CR) and two were resistant. After a median follow-up of 39 and 47 months, 5-year EFS and OS probabilities were 71% (47-95) and 76% (65-87), respectively. An immunological response was observed in 24 out of 43 patients (56%) and a virological response in 27 out of 40 (68%). The immunological response to HAART had a positive impact on OS and EFS (p=0.002 and p=0.001, respectively).
  
  
  CONCLUSIONS
  In patients with advanced stage, HIV-related HL, treatment with ABVD together with HAART is feasible and effective. This supports the concept that patients with HIV-related HL should be treated in the same way as immunocompetent patients if HAART, adequate supportive therapy and anti-infectious prophylaxis are given concomitantly. An immunological response to HAART has a positive impact on OS and EFS.
authors.affiliation: Institut Català d' Oncologia-Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
authors.forename: Blanca
authors.initials: B
authors.lastname: Xicoy
authors.forename: Josep-María
authors.initials: JM
authors.lastname: Ribera
authors.forename: Pilar
authors.initials: P
authors.lastname: Miralles
authors.forename: Juan
authors.initials: J
authors.lastname: Berenguer
authors.forename: Rafael
authors.initials: R
authors.lastname: Rubio
authors.forename: Beatriz
authors.initials: B
authors.lastname: Mahillo
authors.forename: María-Eulalia
authors.initials: ME
authors.lastname: Valencia
authors.forename: Eugenia
authors.initials: E
authors.lastname: Abella
authors.forename: Armando
authors.initials: A
authors.lastname: López-Guillermo
authors.forename: Ana
authors.initials: A
authors.lastname: Sureda
authors.forename: Mireia
authors.initials: M
authors.lastname: Morgades
authors.forename: José-Tomás
authors.initials: JT
authors.lastname: Navarro
authors.forename: Herminia
authors.initials: H
authors.lastname: Esteban
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001761:Bleomycin / Q000008:administration & dosage; D015496:CD4-Positive T-Lymphocytes / Q000378:metabolism; D003606:Dacarbazine / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000188:drug therapy* / Q000821:virology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage
chemical_list: D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin