Important note: Information in this article was accurate in 1994. The state of the art may have changed since the publication date.
Epidemiological, virological and clinicopathological data from 114 patients (pts) with Hodgkin's disease and HIV infection (HD-HIV) evidence of significant relation to Epstein-Barr virus (EBV), increase of mixed cellularity (MC) and lymphocyte depletion (LD) subtypes and feasibility of combined treatment with chemotherapy (CT) and zidovudine (AZT) (Meeting abstract).
Proc Annu Meet Am Soc Clin Oncol; 13:A22 1994. Unique Identifier : AIDSLINE ICDB/94600019 Errante D; Tirelli U; Serraino D; Boiocchi M; Carbone A; Italian Cooperative Study Group on AIDS and Tumors (GICAT),; C.R.O. Aviano, Italy
Abstract:
Since November 1986, 114 cases (103 m, 11 f) of HD-HIV have been collected by the GICAT. The median age was 29 years (19-57), 80% were IVDU in accordance to the overall epidemiology of HIV infection in Italy. At the diagnosis of HD, 17% of pts had AIDS, 22% ARC, 29% PGL and 34% were asymptomatic; median CD4+ cell count was 275/mm3 (9-1100). Lymphocyte predominance (LP) was observed in 4%, nodular sclerosis (NS) in 30%, MC in 44% and LD in 21% of pts. In comparison with 125 Italian HD pts not infected with HIV, observed in the same period of time at our Institution and with a comparable median age, a 4-fold higher frequency of the MC and an approx 12-fold higher frequency of the LD subtypes were detected among pts with HD-HIV. To determine whether EBV may play a role in HD-HIV we characterized EBV (latent membrane protein, LMP-1) in HD samples from 18 pts with HD-HIV as well as from a control population of 104 pts with HD. EBV was detected in 14/18 (78%) HD samples from the former group, but only in 27/104 (25%) HD samples from the latter group (p less than 0.001) indicating that EBV may be more pathogenetically involved in HD-HIV, as previously reported for HIV-associated NHLs. 31/108 (28%) and 56/108 (51%) pts were Stage III and IV respectively; 78% of pts had B symptoms. These figures were significantly different from those observed in pts with HD of the general population. Twelve pts received no treatment, 7 pts radiotherapy (RT) alone, 53 pts were treated with standard CT (MOPP, MOPP-/ ABVD +/- RT) and obtained 45% complete remission (CR) and 34% partial remission (PR). Twenty-six pts were treated prospectively with EBV +/- P (epirubicin, bleomycin, vinblastine +/- prednisone) + AZT +/- G-CSF and obtained 58% CR and 27% PR. The median survival of all pts was 15.3 mo. Pts with CD4+ lymphocytes less than or equal to 250/mm3 at onset of HD had a median survival or 11.5 months, while those with CD4+ greater than 250/mm3 a median of 38 mo (p = 0.002). The median survival of pts without and with Aids at onset of HD was 27 mo and 9 mo, respectively, (p less than 0.001) and for pts achieving or not CR was 11 mo and 58 mo, respectively, (p less than 0.001). Pts without B symptoms survived significantly longer than pts with B symptoms (43 vs 12 mo, p less than 0.001). Age more or less than 30 yr, sex, risk group (IVDU vs other groups), stage (I + II vs III + IV), extranodal involvement, were not factors influencing survival. The median survival of 26 pts treated with EBV +/- P + AZT +/- G-CSF was not different (13 mo) from that of pts treated with standard CT (17 mo) but a statistically significant lower rate of opportunistic infections (OI) occurred in the first group (32% vs 74%, p = 0.003) during or after treatment. In conclusion, in comparison to HIV-negative HD there is evidence of a significant increase of: (1) MC and LD subtypes, (2) EBV expression in tumor tissue. Moreover, there is evidence of feasibility or antiretroviral therapy and CT with a significant reduction of OI.
Keywords: Adult Antineoplastic Agents, Combined/ADVERSE EFFECTS/*THERAPEUTIC USE Female Follow-Up Studies Herpesviridae Infections/*DRUG THERAPY/MORTALITY/PATHOLOGY *Herpesvirus 4, Human Hodgkin's Disease/*DRUG THERAPY/MORTALITY/PATHOLOGY Human HIV Infections/*DRUG THERAPY/MORTALITY/PATHOLOGY Italy/EPIDEMIOLOGY Leukocyte Count/DRUG EFFECTS Lymphoma, AIDS-Related/*DRUG THERAPY/MORTALITY/PATHOLOGY Male Neoplasm Staging Survival Rate Tumor Virus Infections/*DRUG THERAPY/MORTALITY/PATHOLOGY Zidovudine/ADVERSE EFFECTS/*THERAPEUTIC USE ABSTRACT
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Important note: Information in this article was accurate in 1994. The state of the art may have changed since the publication date.
