Caroline Besson1, Remi Lancar2, Sophie Prevot3, Pauline Brice4, Marie-Caroline Meyohas5, Bruno Marchou6, Jean Gabarre7, Fabrice Bonnet8, Cécile Goujard1, Olivier Lambotte1, François Boué9, Nicolas Mounier10, Marialuisa Partisani11, Francois Raffi12, Régis Costello13, Houria Hendel-Chavez14, Michele Algarte-Genin2, Selma Trabelsi2, Lucie Marchand15, Martine Raphael14, Yassine Taoufik16, Dominique Costagliola2. 1. Université Paris Sud, Faculté de médecine Paris Sud, Le Kremlin-Bicêtre AP-HP, Hôpitaux Paris Sud, Service d'hématologie, Le Kremlin-Bicêtre. 2. Sorbonne Universités, UPMC Univ Paris 06 INSERM, UMR_S 1136, Institut Pierre Louis d'épidémiologie et de Santé Publique, Paris. 3. Université Paris Sud, Faculté de médecine Paris Sud, Le Kremlin-Bicêtre AP-HP, Hôpitaux Paris Sud Site Béclère, Service d'anatomo-pathologie, Clamart. 4. Department of Hemato-oncology, Hôpital Saint-Louis, AP-HP. 5. AP-HP CHU Saint-Antoine, Service de maladies infectieuses, Paris. 6. CHU Toulouse, Service de maladies infectieuses. 7. AP-HP, CHU Pitié-Salpétrière, Service d'hématologie, Paris. 8. CHU Bordeaux, Service de Médecine Interne et Maladies Infectieuses, and INSERM U593, Université de Bordeaux. 9. Université Paris Sud, Faculté de médecine Paris Sud, Le Kremlin-Bicêtre AP-HP, Hôpitaux Paris Sud Site Béclère, Service d'immunologie clinique, Clamart. 10. Department of Onco-Hematology, Archet Hospital, Nice. 11. Hôpitaux Universitaires, Centre de soins de l'infection VIH, Strasbourg. 12. CMIT, Paris. 13. Department of Hematology, Hôpital La Conception, Marseille. 14. Université Paris Sud, Faculté de médecine Paris Sud, Le Kremlin-Bicêtre. 15. ANRS, Paris. 16. Université Paris Sud, Faculté de médecine Paris Sud, Le Kremlin-Bicêtre AP-HP, Hôpitaux Paris Sud, Service d'imunologie biologique, Le Kremlin-Bicêtre, France.
Abstract
BACKGROUND: Human immunodeficiency virus (HIV) infection is associated with a high risk of classical Hodgkin's lymphoma (cHL) in the combined antiretroviral therapy (cART) era. METHODS: We analyzed the characteristics and outcome of HIV-associated cHL diagnosed in the modern cART era. The French ANRS-CO16 Lymphovir cohort enrolled 159 HIV-positive patients with lymphoma, including 68 (43%) with cHL. HIV-HL patients were compared with a series of non-HV-infected patients consecutively diagnosed with HL. RESULTS: Most patients (76%) had Ann-Arbor stages III-IV and 96% of patients were treated with ABVD. At diagnosis, median CD4 T-cell count was 387/µL and 94% of patients were treated with cART. All patients received cART after diagnosis. Five patients died from early progression (n = 2), sepsis (1) or after relapse (2). Two additional patients relapsed during follow-up. Two-year overall and progression free survivals (PFS) were 94% [95% CI, 89%, 100%] and 89% [82%, 97%], respectively. The only factor associated with progression or death was age with a relative risk of 8.1 [1.0; 67.0] above 45 years. The PFS of Lymphovir patients appeared similar to PFS of HIV-negative patients, 86% [82%, 90%], but patients with HIV infection displayed higher risk features than HIV-negative patients. CONCLUSIONS: Although high-risk features still predominate in HIV-HL, the prognosis of these patients, treated with cART and mainly ABVD, has markedly improved in the modern cART era and is now similar to non-HIV-infected patients.
BACKGROUND: Human immunodeficiency virus (HIV) infection is associated with a high risk of classical Hodgkin's lymphoma (cHL) in the combined antiretroviral therapy (cART) era. METHODS: We analyzed the characteristics and outcome of HIV-associated cHL diagnosed in the modern cART era. The French ANRS-CO16 Lymphovir cohort enrolled 159 HIV-positivepatients with lymphoma, including 68 (43%) with cHL. HIV-HLpatients were compared with a series of non-HV-infectedpatients consecutively diagnosed with HL. RESULTS: Most patients (76%) had Ann-Arbor stages III-IV and 96% of patients were treated with ABVD. At diagnosis, median CD4 T-cell count was 387/µL and 94% of patients were treated with cART. All patients received cART after diagnosis. Five patients died from early progression (n = 2), sepsis (1) or after relapse (2). Two additional patients relapsed during follow-up. Two-year overall and progression free survivals (PFS) were 94% [95% CI, 89%, 100%] and 89% [82%, 97%], respectively. The only factor associated with progression or death was age with a relative risk of 8.1 [1.0; 67.0] above 45 years. The PFS of Lymphovir patients appeared similar to PFS of HIV-negative patients, 86% [82%, 90%], but patients with HIV infection displayed higher risk features than HIV-negative patients. CONCLUSIONS: Although high-risk features still predominate in HIV-HL, the prognosis of these patients, treated with cART and mainly ABVD, has markedly improved in the modern cART era and is now similar to non-HIV-infectedpatients.
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