Human immunodeficiency and Hodgkin lymphoma

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dc.contributor.authorSissolak, Gerhard
dc.contributor.authorSissolak, Dagmar
dc.contributor.authorJacobs, Peter
dc.date.accessioned2011-09-28T08:13:56Z
dc.date.issued2010-04
dc.descriptionThe original publication is available at http://www.sciencedirect.comen_ZA
dc.description.abstractPresentation 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.en_ZA
dc.description.versionPublishers' Versionen_ZA
dc.format.extentp. 131–139
dc.identifier.citationSissolak, G., Sissolak, D., & Jacobs, P. 2010. Human immunodeficiency and Hodgkin lymphoma. Transfusion and apheresis science, 42(2), 131-139, doi:10.1016/j.transci.2010.01.008en_ZA
dc.identifier.issn1473-0502
dc.identifier.urihttp://hdl.handle.net/10019.1/16464
dc.language.isoen_ZAen_ZA
dc.publisherElsevieren_ZA
dc.rights.holderElsevieren_ZA
dc.subjectLymphomasen_ZA
dc.subjectHodgkin's diseaseen_ZA
dc.subjectImmunodeficiencyen_ZA
dc.titleHuman immunodeficiency and Hodgkin lymphomaen_ZA
dc.typeArticleen_ZA
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