L. C. Ammoni1, C. Fasola1, D. De Francesco2, V. Micheli3, G. Bombonati1, M. T. Cattaneo1, B. De Troia1, S. Ferrario1, V. Filipazzi1, A. R. Gambaro1, L. Isabella1, L. Somma1, N. Tosca1, D. Dalu1
1 Oncology Unit, Luigi Sacco Hospital, University of Milan, Milan, Italy, 2 Institute for Global Health, UCL, London, UK, 3 Clinical Microbiology Unit, Luigi Sacco Hospital, University of Milan, Milan, Italy
Background: The introduction of highly active antiretroviral therapy (HAART) since 1997 has completely changed the prognosis of HIV-positive patients (pts), decreasing the risk of developing myeloproliferative disorders.
Unexpectedly incidence of HIV related Hodgkin lymphoma (HL) has not been declining.
Recent clinical studies show that HIV-positive HL pts treated with concomitant HAART achieve encouraging results, as those seen in the general population.
Our aim was to compare the characteristics, the response to treatment and the survival of the HL treated with first line chemoteraphy between HIV-positive (HIV+) on HAART and HIV-negative (HIV-) pts.
Methods: This is a single institution retrospective cohort study conducted in Ospedale Luigi Sacco Milan, Italy. We selected pts aged >18 years with histopatologic diagnosis of HL from April 2008 to January 2018. We included HIV+ on HAART and HIV- pts both treated with ABVD.
Differences between HIV+ and HIV- pts were assessed using Chi-square, Fisher's exact or Wilcoxon Rank-sum test. Overall survival (OS), progression-free survival (PFS) and response rate (RR) were compared across groups defined by HIV-status, HAART treatment prior to HL diagnosis (yes vs no), IPS (0–2 vs ≥3) and stage (early vs advanced) using the log-rank test.
Results: We included 45 pts, 20 HIV+ and 25 HIV-. The HIV+ pts were on average older (49 vs 39ys p = 0.18), they were more likely to be male (95% vs 60% p = 0.01), at an advanced stage at diagnosis (90% vs 72% p = 0.26), they had ≥1 extranodal site involved (80% vs 40% p = 0.01), EBV infection (78.6% vs 36.8% p = 0.03), a worst performance status (PS ECOG ≥2 35% vs 8% p = 0,06), a higher prognostic index score (IPS ≥3 75% vs 13% p < 0.001).
During ABVD chemotherapy, HIV+ pts developed more frequently myelotoxicity (anemia G3–4 23.6% vs 0% p = 0.02).
During a median (IQR) follow-up of 33 months in HIV+ and 43 months in HIV- pts no difference was observed in RR (88.2% vs 95.6% p = 0.56), OS (89.4% vs 100% p = 0.3) and PFS (75.8% vs 86.7% p = 0.7) at 2 years. Stratifying pts based on HAART prior to HL diagnosis, stage and IPS, no difference was observed in RR, OS and PFS at 2 years.
Conclusions: Although HIV+ pts had more aggressive baseline features in this series, there were no differences in response rate or survival. Probably exposure to HAART tends to balance outcomes overtime.