Hodgkin’s lymphoma: survival normalises to HIV negative rates despite more advanced disease at diagnosis

High levels of treatment response to chemotherapy for Hodgkin’s Lymphoma (HL) in the HAART era were reported in a combined analysis from five clinics, showing similar rates of event-free and overall survival compared to HIV negative controls.

Chloe Orkin and colleagues analysed all cases of HL diagnosed at five London teaching hospitals from 1997-2010 who were treated with 4-6 cycles of AVBD (adriamycin, bleomycin, viznblastine and dacarbazine). Of these, 97/237 were HIV positive and 90/97 were on HAART during HL treatment. HIV viral load was undetectable in 52/86 HIV positive patients with data and low (<6,000 c/mL) in others but 53% (47/97) had CD4 <200 cells/mm3.

HIV patients were older (median age: 41 vs 31 years, p<0.001), more likely to be male (88% vs 59%; p<0.001). They also had more advanced disease. This included higher rates of: mixed cellularity (54% vs 19%, p<0.001), stage 3/4 at diagnosis (80% vs 33%; p<0.001), B-symptoms (81% vs 36%; p<0.001), Hb <10.5 g/dL (46% vs 20%; p<0.001), albumin <4 g/dL (76% vs 35%, p<0.001) and a higher International Prognostic Score (IPS 3 in 71% vs 22%; p<0.001).

Over median follow-up of 59 months (range 8-172), similar response rates (74% vs 81%), duration of response (33 vs 44 months), 5-year event-free survival (59% vs 65%) and 5-year overall survival (79% vs 88%) were seen in the HIV positive vs HIV negative groups respectively, see Table 1. In the combined group, 40 patients relapsed at a median time of 7 months (range: 1-106).

Table 1: Responses to ABVD chemotherapy in HIV positive vs HIV negative people
	HIV positive	HIV negative	p-value
Complete response rate	74%	81%	NS
Median duration of response	33 mo	48 mo	NS
5-yr event-free survival	59%(95%CI: 46– 69)	65%(95%CI: 56–72)	NS
5-yr overall survival	79%(95%CI: 67–87)	88%(95%CI: 80–92)	p=0.06 (NS)

Table 1: Responses to ABVD chemotherapy in HIV positive vs HIV negative people

HIV positive

HIV negative

p-value

Complete response rate

74%

81%

Median duration of response

33 mo

48 mo

5-yr event-free survival

59%(95%CI: 46– 69)

65%(95%CI: 56–72)

5-yr overall survival

79%(95%CI: 67–87)

88%(95%CI: 80–92)

p=0.06 (NS)

comment

These results are important and impressive, despite including data from the early HAART era, and especially given the more advanced disease at HL diagnosis.

Orkin C et al. HIV Status does not Impact on Outcome in Patients with Hodgkin Lymphoma Treated with ABVD Chemotherapy in the HAART Era. 18th BHIVA Conference, 18-20 April 2012, Birmingham. Oral abstract O13.