title: Stage-adapted treatment of HIV-associated Hodgkin lymphoma: results of a prospective multicenter study.
abstract: OBJECTIVE
  Although the outcome of patients with HIV-related Hodgkin lymphoma (HIV-HL) has markedly improved since the introduction of combined antiretroviral therapy, standard therapy is still poorly defined. This prospective study investigates a stage- and risk-adapted treatment strategy in patients with HIV-HL.
  
  
  METHODS
  Patients with early favorable HIV-HL received two to four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by 30 Gy of involved-field (IF) radiation. In patients with early unfavorable HIV-HL, four cycles of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP baseline) or four cycles of ABVD + 30 Gy of IF radiation were administered. Six to eight cycles of BEACOPP baseline were given in patients with advanced-stage HIV-HL. In patients with advanced HIV infection, BEACOPP was replaced with ABVD.
  
  
  RESULTS
  Of 108 patients (including eight female patients) included in the study, 23 (21%) had early favorable HL, 14 (13%) had early unfavorable HL, and 71 (66%) had advanced-stage HL. The median CD4 count at HL diagnosis was 240/μL. The complete remission rates for patients with early favorable, early unfavorable, and advanced-stage HL were 96%, 100%, and 86%, respectively. The 2-year progression-free survival of the entire study population was 91.7%. Eleven patients (11%) have died, and treatment-related mortality was 5.6%. The 2-year overall survival rate was 90.7% with no significant difference between early favorable (95.7%), early unfavorable (100%), and advanced-stage HL (86.8%).
  
  
  CONCLUSIONS
  In patients with HIV-HL, stage- and risk-adapted treatment is feasible and effective. The prognosis for patients with HIV-HL may approach that of HIV-negative patients with HL.
authors.affiliation: Department of Hematology, Oncology and Palliative Care, Harlaching Hospital, Academic Teaching Hospital of the University of Munich, Sanatoriumsplatz 2, 81545 Munich, Germany. marcus.hentrich@klinikum-muenchen.de
authors.forename: Marcus
authors.initials: M
authors.lastname: Hentrich
authors.forename: Marcel
authors.initials: M
authors.lastname: Berger
authors.forename: Christoph
authors.initials: C
authors.lastname: Wyen
authors.forename: Jan
authors.initials: J
authors.lastname: Siehl
authors.forename: Jürgen K
authors.initials: JK
authors.lastname: Rockstroh
authors.forename: Markus
authors.initials: M
authors.lastname: Müller
authors.forename: Gerd
authors.initials: G
authors.lastname: Fätkenheuer
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Seidel
authors.forename: Maike
authors.initials: M
authors.lastname: Nickelsen
authors.forename: Timo
authors.initials: T
authors.lastname: Wolf
authors.forename: Ansgar
authors.initials: A
authors.lastname: Rieke
authors.forename: Dirk
authors.initials: D
authors.lastname: Schürmann
authors.forename: Ralf
authors.initials: R
authors.lastname: Schmidmaier
authors.forename: Manfred
authors.initials: M
authors.lastname: Planker
authors.forename: Jürgen
authors.initials: J
authors.lastname: Alt
authors.forename: Franz
authors.initials: F
authors.lastname: Mosthaf
authors.forename: Andreas
authors.initials: A
authors.lastname: Engert
authors.forename: Keikawus
authors.initials: K
authors.lastname: Arasteh
authors.forename: Christian
authors.initials: C
authors.lastname: Hoffmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / 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; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D011344:Procarbazine / Q000008:administration & dosage / Q000009:adverse effects; D011379:Prognosis; D011446:Prospective Studies; D012074:Remission Induction; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage / Q000009:adverse effects; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects; D055815:Young Adult
chemical_list: D001761:Bleomycin; D011344:Procarbazine; D014750:Vincristine; D014747:Vinblastine; D005047:Etoposide; D003606:Dacarbazine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone