Clinical characteristics of human immunodeficiency virus-associated Hodgkin lymphoma patients in Japan
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The incidence of Hodgkin lymphoma (HL) is paradoxically increasing in the combination anti-retroviral therapy (cART) era. However, there has been no nationwide survey of human immunodeficiency virus (HIV)-associated HL (HIV-HL) in Japan. We retrospectively examined the clinical characteristics and outcomes of 19 newly diagnosed HIV-HL patients at 11 HIV/AIDS and hematology regional hospitals in Japan between 1991 and 2010. At the time of HL diagnosis, 79 % of patients were receiving cART. All the patients, but one received HL diagnoses in the cART era. The median CD4+ cell count at HIV-HL diagnosis was 169/μl. Mixed-cellularity classical Hodgkin lymphoma was the most common subtype occurring in 68 % of the patients; 89 % of the patients were positive for Epstein–Barr virus. Of these 19 patients, 84 % were in advanced stages, with bone marrow involvement observed in 47 % of the patients; 58 % had extranodal sites. All the treated patients were given cART concurrent with HL therapy. The complete remission rate of the treated patients was 87 %. The median OS of the entire cohort was 17 months. These results suggest that the characteristics of HIV-HL in Japan are more aggressive than those of non-HIV-associated HL in Japan, but standard chemotherapy is effective and feasible.
KeywordsHodgkin lymphoma HIV infection ABVD Antiretroviral therapy EBV
We are indebted to Mr. Roderick J. Turner, Associate Professor Edward F. Barroga and Professor J. Patrick Barron, Chairman of the Department of International Medical Communications of Tokyo Medical University, for their editorial review of the English manuscript.
Conflict of interest
This study was supported in part by a Health and Labour Sciences Research Grant from the Ministry of Health, Labour, and Welfare of Japan (grant number: H22-AIDS-I-002).
- 7.Hoffmann C, Chow KU, Wolf E, Faetkenheuer G, Stellbrink HJ, van Lunzen J, Jaeger H, Stoehr A, Plettenberg A, Wasmuth JC, Rockstroh J, Mosthaf F, Horst HA, Brodt HR. Strong impact of highly active antiretroviral therapy on survival in patients with human immunodeficiency virus-associated Hodgkin’s disease. Br J Haematol. 2004;125(4):455–62.PubMedCrossRefGoogle Scholar
- 9.Spina M, Carbone A, Gloghini A, Serraino D, Berretta M, Tirelli U. Hodgkin’s disease in patients with HIV infection. Adv Hematol. 2011, pii:402682 [Epub ahead of print].Google Scholar
- 10.Xicoy B, Ribera JM, Miralles P, Berenguer J, Rubio R, Mahillo B, Valencia ME, Abella E, Lopez-Guillermo A, Sureda A, Morgades M, Navarro JT, Esteban H. Results of treatment with doxorubicin, bleomycin, vinblastine and dacarbazine and highly active antiretroviral therapy in advanced stage, human immunodeficiency virus-related Hodgkin’s lymphoma. Haematologica. 2007;92(2):191–8.PubMedCrossRefGoogle Scholar
- 13.The world health organization classification of malignant lymphomas in Japan: incidence of recently recognized entities. Lymphoma Study Group of Japanese Pathologists. Pathol Int. 2000; 50(9):696–702.Google Scholar
- 14.Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011. CA: Cancer J Clin. 2011; 61(4):212–36.Google Scholar
- 17.Franceschi S, Dal Maso L, Pezzotti P, Polesel J, Braga C, Piselli P, Serraino D, Tagliabue G, Federico M, Ferretti S, De Lisi V, La Rosa F, Conti E, Budroni M, Vicario G, Piffer S, Pannelli F, Giacomin A, Bellu F, Tumino R, Fusco M, Rezza G. Incidence of AIDS-defining cancers after AIDS diagnosis among people with AIDS in Italy, 1986-1998. J Acquir Immune Defic Syndr. 2003;34(1):84–90.CrossRefGoogle Scholar
- 20.Ogura M, Itoh K, Kinoshita T, Fukuda H, Takenaka T, Ohtsu T, Kagami Y, Tobinai K, Okamoto M, Asaoku H, Sasaki T, Mikuni C, Hirano M, Chou T, Ohnishi K, Ohno H, Nasu K, Okabe K, Ikeda S, Nakamura S, Hotta T, Shimoyama M. Phase II study of ABVd therapy for newly diagnosed clinical stage II-IV Hodgkin lymphoma: Japan Clinical Oncology Group study (JCOG 9305). Int J Hematol. 2010;92(5):713–24.PubMedCrossRefGoogle Scholar
- 21.Itoh K, Kinoshita T, Watanabe T, Yoshimura K, Okamoto R, Chou T, Ogura M, Hirano M, Asaoku H, Kurosawa M, Maeda Y, Omachi K, Moriuchi Y, Kasai M, Ohnishi K, Takayama N, Morishima Y, Tobinai K, Kaba H, Yamamoto S, Fukuda H, Kikuchi M, Yoshino T, Matsuno Y, Hotta T, Shimoyama M. Prognostic analysis and a new risk model for Hodgkin lymphoma in Japan. Int J Hematol. 2010;91(3):446–55.PubMedCrossRefGoogle Scholar
- 26.Weiss LM, von Wasielewski R, Delsol G, Poppema S, Stein H. Mixed cellularity classical Hodgkin lymphoma. WHO Classification Tumors of Haematopoetic and Lymphoid Tissues, 4th ed.; 2008. p 331.Google Scholar
- 27.Hishima T, Oyaizu N, Fujii T, Tachikawa N, Ajisawa A, Negishi M, Nakamura T, Iwamoto A, Hayashi Y, Matsubara D, Sasao Y, Kimura S, Kikuchi Y, Teruya K, Yasuoka A, Oka S, Saito K, Mori S, Funata N, Sata T, Katano H. Decrease in Epstein–Barr virus-positive AIDS-related lymphoma in the era of highly active antiretroviral therapy. Microbes Infect. 2006;8(5):1301–7.PubMedCrossRefGoogle Scholar
- 28.Stein H, Delsol G, Pileris SA, Weiss LM, Poppema S, Jaffe ES. Classical Hodgkin lymphoma, introduction. WHO Classification Tumors of Haematopoetic and Lymphoid Tissues, 4th Ed.; 2008. p 326.Google Scholar
- 31.Levine AM, Li P, Cheung T, Tulpule A, Von Roenn J, Nathwani BN, Ratner L. 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). J Acquir Immune Defic Syndr. 2000;24(5):444–50.PubMedCrossRefGoogle Scholar
- 36.Schmitz N, Pfistner B, Sextro M, Sieber M, Carella AM, Haenel M, Boissevain F, Zschaber R, Muller P, Kirchner H, Lohri A, Decker S, Koch B, Hasenclever D, Goldstone AH, Diehl V. Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin’s disease: a randomised trial. Lancet. 2002;359(9323):2065–71.PubMedCrossRefGoogle Scholar
- 37.Re A, Michieli M, Casari S, Allione B, Cattaneo C, Rupolo M, Spina M, Manuele R, Vaccher E, Mazzucato M, Abbruzzese L, Ferremi P, Carosi G, Tirelli U, Rossi G. High-dose therapy and autologous peripheral blood stem cell transplantation as salvage treatment for AIDS-related lymphoma: long-term results of the Italian Cooperative Group on AIDS and Tumors (GICAT) study with analysis of prognostic factors. Blood. 2009;114(7):1306–13.PubMedCrossRefGoogle Scholar
- 38.Spitzer TR, Ambinder RF, Lee JY, Kaplan LD, Wachsman W, Straus DJ, Aboulafia DM, Scadden DT. Dose-reduced busulfan, cyclophosphamide, and autologous stem cell transplantation for human immunodeficiency virus-associated lymphoma: AIDS Malignancy Consortium study 020. Biol Blood Marrow Transplant. 2008;14(1):59–66.PubMedCrossRefGoogle Scholar