HIV Status Does Not Influence Outcome in Patients With Classical Hodgkin Lymphoma Treated With Chemotherapy Using Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine in the Highly Active Antiretroviral Therapy Era

Silvia Montoto; Kate Shaw; Jessica Okosun; Shreyans Gandhi; Paul Fields; Andrew Wilson; Milensu Shanyinde; Kate Cwynarski; Robert Marcus; Johannes de Vos; Anna Marie Young; Melinda Tenant-Flowers; Chloe Orkin; Margaret Johnson; Daniella Chilton; John G. Gribben; Mark Bower

doi:10.1200/JCO.2011.41.4193

HIV Status Does Not Influence Outcome in Patients With Classical Hodgkin Lymphoma Treated With Chemotherapy Using Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine in the Highly Active Antiretroviral Therapy Era

Silvia Montoto^*, Kate Shaw, Jessica Okosun, Shreyans Gandhi, Paul Fields, Andrew Wilson, Milensu Shanyinde, Kate Cwynarski, Robert Marcus, Johannes de Vos, Anna Marie Young, Melinda Tenant-Flowers, Chloe Orkin, Margaret Johnson, Daniella Chilton, John G. Gribben, Mark Bower

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

139 Citations (Scopus)

Abstract

Purpose

The prognosis of HIV-infected patients with non-Hodgkin lymphoma in the highly active antiretroviral therapy (HAART) era approaches that of the general population when they are treated with the same protocols. We analyzed the outcome of patients with Hodgkin lymphoma (HL) treated with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) in the HAART era according to HIV serostatus to establish whether this also holds true for HL.

Patients and Methods

From 1997 to 2010, 224 patients newly diagnosed with HL, of whom 93 were HIV positive, were consecutively treated with ABVD chemotherapy. HIV-positive patients had more high-risk disease according to the International Prognostic Score (IPS) than HIV-negative patients (IPS >= 3: 68% v 26%, respectively; P <.001). Forty-seven HIV-positive patients had a CD4 count less than 200/mu L, and 92 patients received HAART during chemotherapy.

Results

The complete response rate was 74% for HIV-positive patients and 79% for HIV-negative patients (P = not significant). After a median follow-up of 60 months (range, 8 to 174 months), 23 patients (16 HIV-negative and seven HIV-positive patients) have experienced relapse at a median time of 6 months (range, 1 to 106 months). Five-year event-free survival (EFS) was 59% (95% CI, 47% to 70%) for HIV-positive patients and 66% (95% CI, 57% to 74%) for HIV-negative patients (P = not significant). Five-year overall survival (OS) was 81% (95% CI, 69% to 89%) and 88% (95% CI, 80% to 93%) for HIV-positive and HIV-negative patients, respectively (P = not significant). HIV status did not predict OS or EFS on multivariate analysis including IPS and HIV status.

Conclusion

This mature study demonstrates that HIV-positive patients with HL have more extensive disease with more adverse prognostic factors than HIV-negative patients, but when treated with ABVD, HIV infection does not adversely affect OS or EFS.

Original language	English
Pages (from-to)	4111-4116
Number of pages	6
Journal	Journal of Clinical Oncology
Volume	30
Issue number	33
DOIs	https://doi.org/10.1200/JCO.2011.41.4193
Publication status	Published - 20 Nov 2012

Keywords

HUMAN-IMMUNODEFICIENCY-VIRUS
INFECTED PATIENTS
INTENSIVE CHEMOTHERAPY
ASSOCIATION GUIDELINES
RESPONSE CRITERIA
PROGNOSTIC SCORE
ADVANCED-STAGE
DISEASE
AIDS
REGIMEN

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Montoto, S., Shaw, K., Okosun, J., Gandhi, S., Fields, P., Wilson, A., Shanyinde, M., Cwynarski, K., Marcus, R., de Vos, J., Young, A. M., Tenant-Flowers, M., Orkin, C., Johnson, M., Chilton, D., Gribben, J. G., & Bower, M. (2012). HIV Status Does Not Influence Outcome in Patients With Classical Hodgkin Lymphoma Treated With Chemotherapy Using Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine in the Highly Active Antiretroviral Therapy Era. Journal of Clinical Oncology, 30(33), 4111-4116. https://doi.org/10.1200/JCO.2011.41.4193

@article{a5f50c1ec5864f03b29f942b91f36535,

title = "HIV Status Does Not Influence Outcome in Patients With Classical Hodgkin Lymphoma Treated With Chemotherapy Using Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine in the Highly Active Antiretroviral Therapy Era",

abstract = "PurposeThe prognosis of HIV-infected patients with non-Hodgkin lymphoma in the highly active antiretroviral therapy (HAART) era approaches that of the general population when they are treated with the same protocols. We analyzed the outcome of patients with Hodgkin lymphoma (HL) treated with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) in the HAART era according to HIV serostatus to establish whether this also holds true for HL.Patients and MethodsFrom 1997 to 2010, 224 patients newly diagnosed with HL, of whom 93 were HIV positive, were consecutively treated with ABVD chemotherapy. HIV-positive patients had more high-risk disease according to the International Prognostic Score (IPS) than HIV-negative patients (IPS >= 3: 68% v 26%, respectively; P <.001). Forty-seven HIV-positive patients had a CD4 count less than 200/mu L, and 92 patients received HAART during chemotherapy.ResultsThe complete response rate was 74% for HIV-positive patients and 79% for HIV-negative patients (P = not significant). After a median follow-up of 60 months (range, 8 to 174 months), 23 patients (16 HIV-negative and seven HIV-positive patients) have experienced relapse at a median time of 6 months (range, 1 to 106 months). Five-year event-free survival (EFS) was 59% (95% CI, 47% to 70%) for HIV-positive patients and 66% (95% CI, 57% to 74%) for HIV-negative patients (P = not significant). Five-year overall survival (OS) was 81% (95% CI, 69% to 89%) and 88% (95% CI, 80% to 93%) for HIV-positive and HIV-negative patients, respectively (P = not significant). HIV status did not predict OS or EFS on multivariate analysis including IPS and HIV status.ConclusionThis mature study demonstrates that HIV-positive patients with HL have more extensive disease with more adverse prognostic factors than HIV-negative patients, but when treated with ABVD, HIV infection does not adversely affect OS or EFS.",

keywords = "HUMAN-IMMUNODEFICIENCY-VIRUS, INFECTED PATIENTS, INTENSIVE CHEMOTHERAPY, ASSOCIATION GUIDELINES, RESPONSE CRITERIA, PROGNOSTIC SCORE, ADVANCED-STAGE, DISEASE, AIDS, REGIMEN",

author = "Silvia Montoto and Kate Shaw and Jessica Okosun and Shreyans Gandhi and Paul Fields and Andrew Wilson and Milensu Shanyinde and Kate Cwynarski and Robert Marcus and {de Vos}, Johannes and Young, {Anna Marie} and Melinda Tenant-Flowers and Chloe Orkin and Margaret Johnson and Daniella Chilton and Gribben, {John G.} and Mark Bower",

year = "2012",

month = nov,

day = "20",

doi = "10.1200/JCO.2011.41.4193",

language = "English",

volume = "30",

pages = "4111--4116",

journal = "Journal of Clinical Oncology",

issn = "0732-183X",

publisher = "American Society of Clinical Oncology",

number = "33",

}

Montoto, S, Shaw, K, Okosun, J, Gandhi, S, Fields, P, Wilson, A, Shanyinde, M, Cwynarski, K, Marcus, R, de Vos, J, Young, AM, Tenant-Flowers, M, Orkin, C, Johnson, M, Chilton, D, Gribben, JG & Bower, M 2012, 'HIV Status Does Not Influence Outcome in Patients With Classical Hodgkin Lymphoma Treated With Chemotherapy Using Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine in the Highly Active Antiretroviral Therapy Era', Journal of Clinical Oncology, vol. 30, no. 33, pp. 4111-4116. https://doi.org/10.1200/JCO.2011.41.4193

HIV Status Does Not Influence Outcome in Patients With Classical Hodgkin Lymphoma Treated With Chemotherapy Using Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine in the Highly Active Antiretroviral Therapy Era. / Montoto, Silvia; Shaw, Kate; Okosun, Jessica et al.
In: Journal of Clinical Oncology, Vol. 30, No. 33, 20.11.2012, p. 4111-4116.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - HIV Status Does Not Influence Outcome in Patients With Classical Hodgkin Lymphoma Treated With Chemotherapy Using Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine in the Highly Active Antiretroviral Therapy Era

AU - Montoto, Silvia

AU - Shaw, Kate

AU - Okosun, Jessica

AU - Gandhi, Shreyans

AU - Fields, Paul

AU - Wilson, Andrew

AU - Shanyinde, Milensu

AU - Cwynarski, Kate

AU - Marcus, Robert

AU - de Vos, Johannes

AU - Young, Anna Marie

AU - Tenant-Flowers, Melinda

AU - Orkin, Chloe

AU - Johnson, Margaret

AU - Chilton, Daniella

AU - Gribben, John G.

AU - Bower, Mark

PY - 2012/11/20

Y1 - 2012/11/20

N2 - PurposeThe prognosis of HIV-infected patients with non-Hodgkin lymphoma in the highly active antiretroviral therapy (HAART) era approaches that of the general population when they are treated with the same protocols. We analyzed the outcome of patients with Hodgkin lymphoma (HL) treated with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) in the HAART era according to HIV serostatus to establish whether this also holds true for HL.Patients and MethodsFrom 1997 to 2010, 224 patients newly diagnosed with HL, of whom 93 were HIV positive, were consecutively treated with ABVD chemotherapy. HIV-positive patients had more high-risk disease according to the International Prognostic Score (IPS) than HIV-negative patients (IPS >= 3: 68% v 26%, respectively; P <.001). Forty-seven HIV-positive patients had a CD4 count less than 200/mu L, and 92 patients received HAART during chemotherapy.ResultsThe complete response rate was 74% for HIV-positive patients and 79% for HIV-negative patients (P = not significant). After a median follow-up of 60 months (range, 8 to 174 months), 23 patients (16 HIV-negative and seven HIV-positive patients) have experienced relapse at a median time of 6 months (range, 1 to 106 months). Five-year event-free survival (EFS) was 59% (95% CI, 47% to 70%) for HIV-positive patients and 66% (95% CI, 57% to 74%) for HIV-negative patients (P = not significant). Five-year overall survival (OS) was 81% (95% CI, 69% to 89%) and 88% (95% CI, 80% to 93%) for HIV-positive and HIV-negative patients, respectively (P = not significant). HIV status did not predict OS or EFS on multivariate analysis including IPS and HIV status.ConclusionThis mature study demonstrates that HIV-positive patients with HL have more extensive disease with more adverse prognostic factors than HIV-negative patients, but when treated with ABVD, HIV infection does not adversely affect OS or EFS.

AB - PurposeThe prognosis of HIV-infected patients with non-Hodgkin lymphoma in the highly active antiretroviral therapy (HAART) era approaches that of the general population when they are treated with the same protocols. We analyzed the outcome of patients with Hodgkin lymphoma (HL) treated with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) in the HAART era according to HIV serostatus to establish whether this also holds true for HL.Patients and MethodsFrom 1997 to 2010, 224 patients newly diagnosed with HL, of whom 93 were HIV positive, were consecutively treated with ABVD chemotherapy. HIV-positive patients had more high-risk disease according to the International Prognostic Score (IPS) than HIV-negative patients (IPS >= 3: 68% v 26%, respectively; P <.001). Forty-seven HIV-positive patients had a CD4 count less than 200/mu L, and 92 patients received HAART during chemotherapy.ResultsThe complete response rate was 74% for HIV-positive patients and 79% for HIV-negative patients (P = not significant). After a median follow-up of 60 months (range, 8 to 174 months), 23 patients (16 HIV-negative and seven HIV-positive patients) have experienced relapse at a median time of 6 months (range, 1 to 106 months). Five-year event-free survival (EFS) was 59% (95% CI, 47% to 70%) for HIV-positive patients and 66% (95% CI, 57% to 74%) for HIV-negative patients (P = not significant). Five-year overall survival (OS) was 81% (95% CI, 69% to 89%) and 88% (95% CI, 80% to 93%) for HIV-positive and HIV-negative patients, respectively (P = not significant). HIV status did not predict OS or EFS on multivariate analysis including IPS and HIV status.ConclusionThis mature study demonstrates that HIV-positive patients with HL have more extensive disease with more adverse prognostic factors than HIV-negative patients, but when treated with ABVD, HIV infection does not adversely affect OS or EFS.

KW - HUMAN-IMMUNODEFICIENCY-VIRUS

KW - INFECTED PATIENTS

KW - INTENSIVE CHEMOTHERAPY

KW - ASSOCIATION GUIDELINES

KW - RESPONSE CRITERIA

KW - PROGNOSTIC SCORE

KW - ADVANCED-STAGE

KW - DISEASE

KW - AIDS

KW - REGIMEN

U2 - 10.1200/JCO.2011.41.4193

DO - 10.1200/JCO.2011.41.4193

M3 - Article

SN - 0732-183X

VL - 30

SP - 4111

EP - 4116

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

IS - 33

ER -

Montoto S, Shaw K, Okosun J, Gandhi S, Fields P, Wilson A et al. HIV Status Does Not Influence Outcome in Patients With Classical Hodgkin Lymphoma Treated With Chemotherapy Using Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine in the Highly Active Antiretroviral Therapy Era. Journal of Clinical Oncology. 2012 Nov 20;30(33):4111-4116. doi: 10.1200/JCO.2011.41.4193