Human immunodeficiency and Hodgkin lymphoma
Date
2010-04
Authors
Sissolak, Gerhard
Sissolak, Dagmar
Jacobs, Peter
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier
Abstract
Presentation of Hodgkin lymphoma (HL) is distinctive in the infected individual being more
advanced, accompanied by B symptoms and the presence of extranodal disease particularly
lymphadenopathy of the head and neck. Bone marrow involvement may be found in over
50% of cases. Virtually all co express gamma-herpesvirus. Phenotypically there is prominence
of the mixed-cellularity and lymphocyte depleted histopathologic subtypes that
define an aggressive clinical course in comparison to other variants.
Prior to the induction of cART, median survival was only 1–2 years. Notably the first chemotherapy
trial using ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) in 21
patients, without treating the viral infection, resulted in a 43% complete remission rate
accompanied by severe haematological toxicities but did not extend median survival with
this being 1.5 years matching the negative cases.
Significant change accompanied concomitant anti-retroviral therapy that could be given
safely even with dose intensive regimens exemplified by BEACOPP (bleomycin, etoposide,
doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) in 12 patients
or the Stanford V regimen (doxorubicin, vinblastine, mechlorethamine, etoposide, vincristine,
bleomycin, prednisone) coupled with involved-field radiation for bulky disease studied
in 59 patients. BEACOPP extended overall survival (OS) to 83% at 2 years. A similar
trend was seen when using the Stanford V regimen with an OS rate of 51% at 3 years, disease-
free survival (DFS) of 68% and freedom from progression (FFP) in 60%. Additional benefits
accrued from supportive care with stimulatory peptides such as G-CSF and when
combined with bacterial prophylaxis results approached that found in the uninfected reference
group.
Current consensus holds this particular lymphoma as still among the non-AIDS defining
cancers being lung, stomach, liver or anal despite these having recently gained more attention
as several of these neoplasms may be occurring more commonly in the era of cART.
While the relative risk of developing a non-AIDS-defining neoplasm in HIV-infected persons
on the average is 2–3 times, the risk for developing HL in HIV-infected cases impressively
ranges between 5 and 25 times when compared to the general population. Based on
the precedent in which Kaposi sarcoma and the non-Hodgkin lymphomas distinctively
alter the course of this retroviral infection in a way indistinguishable from concurrent
Hodgkin lymphoma we propose that this entity be similarly regarded and the hypothesis
tested in large randomised prospective study.
Description
The original publication is available at http://www.sciencedirect.com
Keywords
Lymphomas, Hodgkin's disease, Immunodeficiency
Citation
Sissolak, G., Sissolak, D., & Jacobs, P. 2010. Human immunodeficiency and Hodgkin lymphoma. Transfusion and apheresis science, 42(2), 131-139, doi:10.1016/j.transci.2010.01.008