Good outcomes for people living with HIV diagnosed with Hodgkin's lymphoma in France

People living with HIV who are diagnosed with Hodgkin’s lymphoma now have excellent outcomes, French investigators report in the online edition of Clinical Infectious Diseases. Two-year overall and progression-free survival rates were 94% and 89%, respectively, outcomes which are at least as good as those seen in HIV-negative individuals.

“We confirm, in the setting of an observational cohort prospective study, the striking improvement in the prognosis of…[Hodgkin’s] lymphomas in the modern cART [combination antiretroviral therapy] era,” comment the investigators. “When comparing the prognosis of HIV-infected patients with a prospective series of HIV-negative patients recruited in France during the same period, we did not see any difference in outcome.”

Infection with HIV has been associated with an increased risk of lymphomas. Although incidence of non-Hodgkin’s lymphoma has declined since the introduction of effective antiretroviral therapy, rates of Hodgkin’s lymphoma have remained stable. Indeed, it’s been estimated that incidence of Hodgkin’s lymphoma is 19-times higher in patients with HIV compared to their HIV-negative peers. Moreover, there is concern that new diagnoses of this type of cancer will increase as the population of people living with HIV ages.

Glossary

lymphoma

A type of cancer that starts in the tissues of the lymphatic system, including the lymph nodes, spleen, and bone marrow. In people who have HIV, certain lymphomas, such as Burkitt lymphoma, are AIDS-defining conditions.

prospective study

A type of longitudinal study in which people join the study and information is then collected on them for several weeks, months or years. 

toxicity

Side-effects.

prognosis

The prospect of survival and/or recovery from a disease as anticipated from the usual course of that disease or indicated by the characteristics of the patient.

sepsis

Sepsis is a potentially life-threatening condition caused by the body's response to an infection. The body normally releases chemicals into the bloodstream to fight an infection. Sepsis occurs when the body's response to these chemicals is out of balance, triggering changes that can damage multiple organ systems. Also known as septicemia.

 

HIV infection had been associated with poorer outcomes in patients with Hodgkin’s lymphoma. But recent studies conducted in Britain and Germany have shown that survival rates among patients living with HIV with Hodgkin’s lymphoma are now approaching those seen in HIV-uninfected individuals.

Investigators from the French LYMPHOVIR cohort wanted to establish a clearer understanding of rates of the overall and progression-free survival rates among people who have HIV and Hodgkin’s lymphoma in the modern antiretroviral treatment era. They therefore designed a prospective study involving 68 patients who have HIV who were newly diagnosed with Hodgkin’s lymphoma between 2008 and 2014. As well as determining two-year survival rates, the authors also analysed the factors associated with survival and compared the characteristics and outcomes of patients who have HIV with 336 HIV-negative patients diagnosed with this cancer at approximately the same time.

The patients who have HIV had a median age of 44 years and 87% were male. Median CD4 count at the time of cancer diagnosis was 387 cells/mm3. Most (94%) individuals were taking HIV therapy when Hodgkin’s lymphoma was detected. All patients received antiretrovirals when under cancer therapy.

Factors associated with poorer disease outcomes were prevalent: 93% of tested individuals had EBV present in tumour tissue and 76% had advanced disease (Ann-Arbor stages III-IV).

In terms of cancer therapy, patients with less advanced disease (stages I-II) were treated with three to four cycles of ABVD followed by radiotherapy. The majority of individuals with advanced stage III-IV disease received an ABVD/ABVD-like regimen. Two individuals were treated with BEACOPP. The most common side effects were neuropathy (n = 7), sepsis (n = 7), pulmonary toxicity (n = 4) and cardiac failure (n = 1).

Median follow-up was for 38 months. Five patients died, two due to early progression, two following relapse and one from sepsis.

Two-year overall and progression-free survival rates were 94% and 89%, respectively.

The low number of clinical events meant that analysis of prognostic factors was limited to progression free survival. The only factor associated with disease progression or death was age over 45 years (OR = 8.1; 95% CI, 1.0-67.0).

“Most patients were treated with the combination of cART and ABVD which have been found to offer very good outcomes with limited toxicity,” write the authors. “Therefore, our data are in line with the recently published recommendations concluding that ABVD should be the treatment of choice in patients with HIV-Hodgkin’s-lymphoma.”

Progression-free survival rates over two years were comparable between the people living with HIV and HIV-negative patients (89% vs. 86%, respectively). This was despite the HIV-positive patients having a higher prevalence of risk factors – demographic, pathological, clinical and biological – associated with poor outcomes.

“The outcomes of Hodgkin’s lymphoma in HIV-infected patients in the recent cART era do not differ from those of non HIV-infected patients,” conclude the investigators.”

References

Besson C et al. High risk features contrast with favorable outcomes in HIV-associated Hodgkin Lymphoma in the modern cART era, ANRS CO16 LYMPHOVIR  cohort. Clin Infect Dis, online edition, 2015.