Epidemiology and results of the first line therapy of HIV-related Hodgkin Lymphoma: Russian retrospective multicenter study
Patients with HIV infection have a significantly higher risk of developing cancer comparing to general population. Hodgkin lymphoma (HL) is one of the most common non-AIDS-defining malignancies. Currently, there is no unified approach to the treatment of HIV-related HL, and data on its epidemiology in the Russian Federation is limited. The ART allows treating HIV-infected patients with lymphomas with standard chemotherapy protocols.
To study epidemiology and evaluate results of the first-line therapy of HIV-related HL.
Patients and Methods:
This multicenter retrospective study included 46 patients with HIV-related HL who received treatment in 9 Russian centers from 2006 to 2022. The median follow-up was 15 months (1-129). Overall survival (OS) and progression-free survival (PFS) were analyzed using the Kaplan-Meier method.
The median age was 37years (25-66), men - 25 (54%), women - 21 (46%). Histological variants of HL in most cases were represented by nodular sclerosis (60%) and mixed-cell subtype (37%). The advanced stage of the disease was observed in 74% of patients, B-symptoms at the onset of the disease - 65%, extranodal involvement-52%. All patients were on ART at the start of HL therapy. The median number of CD4+ cells/μl at the onset of HL was 354 (50-727). ECOG status at the start of therapy was 0-1 in 39 (84.8%), ECOG≥2 in 7 (15.2%). As the first line of therapy, patients with early stages of HL received ABVD (79,4%) and BEACOPP therapy (20,6%), with advanced stages - ABVD (58.7%) and BEACOPP-like (41.3%). The median number of first-line therapy cycles was 4 (1-10). Radiation therapy in first-line therapy was performed on 6 patients. The structure of response to first-line therapy: complete response - 81.6%, partial response - 26.3%, disease stabilization - 2.6%, disease progression – 17.9%. 2-years OS in the study group was 85%, PFS - 49% (median PFS – 23.2 months). The level of CD4+ cells at the onset of HL less than 266.5/μl was associated with a significant worsening of 2-year OS (57% vs 100%, p=0.019). Also, ECOG-status ≥2 significantly worsened 2-year OS (71% vs 88%, p=0.033). Factors such as gender, age, stage of the disease, the presence of B-symptoms and extranodal involvement at the onset of the disease, as well as the treatment regimen did not significantly affected the results of first-line therapy.
The multicenter study allowed characterization of HIV-related HL and evaluation of the efficacy.