Background: 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.
Aim: 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.
Results: 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.
Conclusion: The multicenter study allowed characterization of HIV-related HL and evaluation of the efficacy.
Andrey Chekalov, Marina Popova, Ivan Tsygankov, Yuliya Rogacheva, Nikita Volkov, Anastasia Beynarovich, Kirill Lepik, Marina Demchenkova, Marina Grigorieva, Tatiana Schneider, Yuliya Kopeikina, Natalia Medvedeva, Ilya Zyuzgin, Elena Pavlyuchenko, Alexander Levanov, Alexander Myasnikov, Natalia Mikhailova, Vadim Baykov, Alexander Kulagin