Prognostic Factors in Patients with HIV-Associated Hodgkin Lymphoma: An Analysis of 199 Cases

Autor: Kate Cwynarski, Joseph M. Connors, Minh-Li Nguyen, Jeremy S. Abramson, Julie M. Vose, Paula Y. Tanaka, Mark Bower, Michael Furman, Josep-Maria Ribera, Jorge J. Castillo, Jaime A. Collins, Brady E Beltran, Michele Bibas
Rok vydání: 2012
Předmět:
Zdroj: Blood. 120:1528-1528
ISSN: 1528-0020
0006-4971
Popis: Abstract 1528 Background: Hodgkin Lymphoma (HL) accounts for approximately 15% of all lymphomas. The incidence of HL is increased in HIV infection. The International Prognostic Score (IPS) is the most commonly used tool to risk-stratify patients with advanced HL but it has not been validated in HIV-associated HL (HIV-HL). We conducted a retrospective study to describe characteristics and evaluate the IPS and other prognostic factors for survival in HIV-HL. Methods: Institutions in the United States (US) and internationally submitted clinical and pathological patient-level data on HIV-positive individuals with a pathological diagnosis of HL who were treated concurrently with doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) and highly-active antiretroviral therapy (HAART). Continuous and categorical variables are presented using descriptive statistics. Univariate and multivariate analyses were performed for progression-free survival (PFS) and overall survival (OS). P-values Results: Data on 199 patients were obtained from 12 institutions; 148 cases (74%) were from Europe, 28 (14%) from North America (US, Canada), and 23 (12%) from South America. All patients were diagnosed between 1996 and 2010. The most common subtype was mixed cellularity (51%). Median age at diagnosis of HL was 42 years (range: 22–73 years), and 87% (n=184) were men. Median CD4+ count was 245 cells/mm3 (range: 4–1209 cells/mm3), and 51% (n=98) had a CD4+ count 15,000 cells/mm3, 26% (n=44) had lymphocyte count 3. All patients received concurrent HAART and ABVD chemotherapy, opportunistic infection prophylaxis was used in 89% (n=146), and 71% (n=128) received G-CSF therapy. Complete response (CR) was obtained in 82% (n=159) of patients. After a median follow-up of 5 years, the 5-year PFS and OS were 75% and 78%, respectively. In univariate analyses, adverse prognostic factors for PFS included albumin 3 was significant for a worse PFS (p=0.04) and had a trend towards significance for a worse OS (p=0.06). When compared side-to-side, CD4+ count 3 for PFS and OS. Conclusions: HIV-HL commonly presents with high-risk features such as advanced stage, B symptoms and hypoalbuminemia. Despite high-risk presentations, we demonstrate an encouraging prognosis when these patients are treated with ABVD and concurrent HAART. Low CD4+ count was the strongest adverse predictor of prognosis in this population. Disclosures: No relevant conflicts of interest to declare.
Databáze: OpenAIRE
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