Stage‐adapted treatment of HIV‐associated Hodgkin lymphoma: Long‐term results of a prospective, multicenter study

Abstract

Abstract Results of a prospective study of stage‐adapted treatment of human immunodeficiency virus (HIV)‐associated Hodgkin lymphoma (HIV‐HL) showed a 2‐year overall survival (OS) of 90.7% with no significant difference between early favorable (EF), early unfavorable (EU), and advanced HL. Patients with EF HIV‐HL received two to four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) + 30 Gy involved field (IF) radiation, those with EU HIV‐HL received four cycles of ABVD or BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) baseline + 30 Gy IF, and six to eight cycles of BEACOPP baseline were administered in advanced disease. The objective of the present analysis is to determine long‐term outcomes of HIV‐HL. Of 108 patients, 23 (21%) had EF HL, 14 (13%) had EU HL, and 71 (66%) had advanced‐stage HL. After a median follow‐up of 9.14 (range, 0–12.9) years, there were five primary refractory HL patients (5%) and 11 relapses (10%), of which seven were late relapses (>2 years). A second primary malignancy (SPM) occurred in 10 patients after a median of 7.3 years (range, 1.5–10.7) from HL diagnosis. The 10‐year OS for patients with EF, EU, and advanced HL was 95.7%, 84.6%, and 76.1%, respectively. By multivariate analysis, Center for Disease Control and Prevention category C (hazard ratio [HR] 3.00, 95% confidence interval [CI]: 1.16–7.74, p = 0.023) and achievement of complete remission were significant for OS (HR 0.03, 95% CI: 0.01–0.08, p = 2.45 × 10−9). In conclusion, a stage‐adapted treatment approach for HIV‐HL is highly effective with long‐term survival rates similar to those reported in HIV‐uninfected HL. However, the risk for late relapse and SPM is significant.