title: HIV status does not influence outcome in patients with classical Hodgkin lymphoma treated with chemotherapy using doxorubicin, bleomycin, vinblastine, and dacarbazine in the highly active antiretroviral therapy era.
abstract: OBJECTIVE
  The prognosis of HIV-infected patients with non-Hodgkin lymphoma in the highly active antiretroviral therapy (HAART) era approaches that of the general population when they are treated with the same protocols. We analyzed the outcome of patients with Hodgkin lymphoma (HL) treated with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) in the HAART era according to HIV serostatus to establish whether this also holds true for HL.
  
  
  METHODS
  From 1997 to 2010, 224 patients newly diagnosed with HL, of whom 93 were HIV positive, were consecutively treated with ABVD chemotherapy. HIV-positive patients had more high-risk disease according to the International Prognostic Score (IPS) than HIV-negative patients (IPS≥3: 68% v 26%, respectively; P<.001). Forty-seven HIV-positive patients had a CD4 count less than 200/μL, and 92 patients received HAART during chemotherapy.
  
  
  RESULTS
  The complete response rate was 74% for HIV-positive patients and 79% for HIV-negative patients (P=not significant). After a median follow-up of 60 months (range, 8 to 174 months), 23 patients (16 HIV-negative and seven HIV-positive patients) have experienced relapse at a median time of 6 months (range, 1 to 106 months). Five-year event-free survival (EFS) was 59% (95% CI, 47% to 70%) for HIV-positive patients and 66% (95% CI, 57% to 74%) for HIV-negative patients (P=not significant). Five-year overall survival (OS) was 81% (95% CI, 69% to 89%) and 88% (95% CI, 80% to 93%) for HIV-positive and HIV-negative patients, respectively (P=not significant). HIV status did not predict OS or EFS on multivariate analysis including IPS and HIV status.
  
  
  CONCLUSIONS
  This mature study demonstrates that HIV-positive patients with HL have more extensive disease with more adverse prognostic factors than HIV-negative patients, but when treated with ABVD, HIV infection does not adversely affect OS or EFS.
authors.affiliation: Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, Chelsea and Westminster Hospital, 45 Little Britain, EC1A 7BE, London, United Kingdom. s.montoto@qmul.ac.uk
authors.forename: Silvia
authors.initials: S
authors.lastname: Montoto
authors.forename: Kate
authors.initials: K
authors.lastname: Shaw
authors.forename: Jessica
authors.initials: J
authors.lastname: Okosun
authors.forename: Shreyans
authors.initials: S
authors.lastname: Gandhi
authors.forename: Paul
authors.initials: P
authors.lastname: Fields
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilson
authors.forename: Milensu
authors.initials: M
authors.lastname: Shanyinde
authors.forename: Kate
authors.initials: K
authors.lastname: Cwynarski
authors.forename: Robert
authors.initials: R
authors.lastname: Marcus
authors.forename: Johannes
authors.initials: J
authors.lastname: de Vos
authors.forename: Anna Marie
authors.initials: AM
authors.lastname: Young
authors.forename: Melinda
authors.initials: M
authors.lastname: Tenant-Flowers
authors.forename: Chloe
authors.initials: C
authors.lastname: Orkin
authors.forename: Margaret
authors.initials: M
authors.lastname: Johnson
authors.forename: Daniella
authors.initials: D
authors.lastname: Chilton
authors.forename: John G
authors.initials: JG
authors.lastname: Gribben
authors.forename: Mark
authors.initials: M
authors.lastname: Bower
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects / Q000379:methods*; D001761:Bleomycin / Q000008:administration & dosage / Q000009:adverse effects; D003606:Dacarbazine / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000473:pathology / Q000821:virology*; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000188:drug therapy* / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage / Q000009:adverse effects; D055815:Young Adult
chemical_list: D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin