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Chemotherapy Consisting of Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine With Granulocyte-Colony-Stimulating Factor in HIV-Infected Patients With Newly Diagnosed Hodgkin's Disease: A Prospective, Multi-institutional AIDS Clinical Trials Group Study (ACTG 149)

Levine Alexandra M.; Li, Ping; Cheung, Tony; Tulpule, Anil; Von Roenn, Jamie; Nathwani, Bharat N.; Ratner, Lee
JAIDS Journal of Acquired Immune Deficiency Syndromes: August 15th, 2000

To ascertain the results of standard ABVD chemotherapy (doxorubicin, bleomycin, vinblastine, dacarbazine) in HIV-infected patients with newly diagnosed Hodgkin's disease (HD), a nonrandomized, prospective, multiinstitutional clinical trial was conducted by the AIDS Clinical Trials Group (ACTG), in HIV-infected patients with Hodgkin's disease. All patients received the standard ABVD regimen, with granulocyte-colony-stimulating factor (G-CSF). Antiretroviral therapy was not used. Between May, 1992 and August, 1996, 21 patients were added to the study and treated. The median CD4 count was 113 cells/mm3, and 29% had a history of a clinical AIDS-defining condition before diagnosis of HD. Systemic “B” symptoms were present in 90% at diagnosis. Stage IV HD was present in 67%, with bone marrow involvement in 12 (57%). Nodular sclerosis HD was present in 38%, with mixed cellular disease in 31%. Among all patients entered and treated, complete remission (CR) was attained in 9 (43%; 90% confidence interval [CI], 24%-63%), whereas partial response occurred in 4 (19%), leading to an overall objective response rate of 62% (90% CI, 42%-79%). Despite routine use of G-CSF, 10 patients (47.6%) experienced life-threatening neutropenia, with absolute neutrophil counts <500 cells/mm3. In all, nine opportunistic infections occurred in 6 patients (29%) during the study or shortly thereafter. Median survival was 1.5 years. Results of this study suggest that alternative treatment strategies should be explored, including use of chemotherapy together with antiretroviral therapy.

Address correspondence and reprint requests to Alexandra M. Levine, Division of Hematology, University of Southern California School of Medicine, University of Southern California/Norris Cancer Center, 1441 Eastlake Avenue, Room 3134, Los Angeles, CA 90033, U.S.A.

T. Cheung is currently affiliated with the University of Medicine and Dentistry, New Jersey Medical School, Newark, New Jersey, U.S.A.

Manuscript received January 6, 2000; accepted May 9, 2000.

© 2000 Lippincott Williams & Wilkins, Inc.