Hodgkin’s Disease: Clinical Presentation and Treatment

  • Umberto Tirelli
  • Emanuela Vaccher
  • Michele Spina
  • Antonino Carbone
Part of the Cancer Treatment and Research book series (CTAR, volume 104)


The incidence of Hodgkin’s disease is modestly increased in HIV-infected individuals. Most large series have been reported from Western European countries,such as Italy,Spain, and France. HIV-associated Hodgkin’s disease is characterized by a higher frequency of unfavorable histologic subtypes (such as mixed cellularity) and advanced stage (with extranodal involvement). Patients with Hodgkin’s disease and HIV infection tend to present with a relatively high CD4 lymphocyte count compared with non-Hodgkin’s lymphoma, but opportunistic infection nevertheless commonly complicates systemic chemotherapy. Because of the disseminated nature of the disease at presentation, systemic chemotherapy is usually indicated. This chapter will focus on the epidemiology, clinicopathological features, and treatment of Hodgkin’s disease occurring in HIV-infected individuals. Further information regarding the molecular biology of HIV-associated Hodgkin’s disease is provided in chapter 6.


Human Immunodeficiency Virus Human Immunodeficiency Virus Infection Acquire Immunodeficiency Syndrome Anaplastic Large Cell Lymphoma Multicenter AIDS Cohort Study 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Tirelli U, Errante D, Dolcetti R, et al. Hodgkin’s disease and human immunodeficiency virus infection: Clinicopathologic and virologic features of 114 patients from the Italian Cooperative Group on AIDS and Tumors. J Clin Oncol 1995;13:1758.PubMedGoogle Scholar
  2. 2.
    Rubio R. Hodgkin’s disease associated with human immunodeficiency virus infection. A clinical study of 46 cases. Cancer 1994;73:2400.Google Scholar
  3. 3.
    Andrieu JM, Roithmann S, Tourani JM, et al. Hodgkin’s disease during HIV-1 infection: the French registry experience. Ann Oncol 1993;4:635PubMedGoogle Scholar
  4. 4.
    Lowenthal DA, Straus DJ, Campbell SW, Gold JWM, Clarkson BD, Koziner B. AIDS-related lymphoid neoplasia. The Memorial Hospital experience. Cancer 1988; 61: 2325Google Scholar
  5. 5.
    Knowles DM, Chamulak GA, Subar M, et al. Lymphoid neoplasia associated with the acquired immunodeficiency syndrome (AIDS). Ann Intern Med 1988; 108: 744.PubMedGoogle Scholar
  6. 6.
    Ames ED, Conjalka MS, Goldberg AF, et al. Hodgkin’s disease and AIDS. Twenty-three new cases and a review of the literature. Hematol Oncol Clin North Am 1991; 5: 343.PubMedGoogle Scholar
  7. 7.
    Ree HJ, Strauchen JA, Khan AA, et al. Human immunodeficiency virus-associated Hodgkin’s disease. Clinicopathologic studies of 24 cases and preponderance of mixed cellularity type characterized by the occurrence of fibrohistiocytoid stromal cells. Cancer 1991;67:1614.PubMedCrossRefGoogle Scholar
  8. 8.
    Newcom SR, Ward M, Napoli VM, Kutner M. Treatment of human immunodeficiency virus-associated Hodgkin’s disease. Is there a clue regarding the cause of Hodgkin’s disease? Cancer 1993; 71: 3138.PubMedCrossRefGoogle Scholar
  9. 9.
    Biggar RJ, Honn J, Lubin JH, Goedert JJ, Greene MH, Fraumeni JF. Cancer trends in a population at risk of acquired immunodeficiency syndrome. J Nall Cancer Inst 1985; 74: 793Google Scholar
  10. 10.
    Bernstein L, Levin D, Menck H, Ross RK. AIDS-related secular trends in cancer in Los Angeles County men: a comparison by marital status. Cancer Res 1989; 49: 466PubMedGoogle Scholar
  11. 11.
    Biggar RJ, Horm J, Goedert JJ, Melbye M. Cancer in a group at risk of acquired immunodeficiency syndrome (AIDS) through 1984. Am JEpidemiol 1987; 126: 578Google Scholar
  12. 12.
    Rabkin CS, Yellin F. Cancer incidence in a population with a high prevalence of infection with human immunodeficiency virus type 1. J Nall Cancer Inst 1994; 86: 1711CrossRefGoogle Scholar
  13. 13.
    Biggar RJ, Burnett W, Mikl J, Nasca P. Cancer among New York men at risk of acquired immunodeficiency syndrome. Int J Cancer 1989; 43: 979PubMedCrossRefGoogle Scholar
  14. 14.
    Biggar RJ, Curtis RE, Coté TR, Rabkin CS, Melbye M. Risk of other cancers following Kaposi’s sarcoma: relation to acquired immunodeficiency syndrome. Am J Epidemiol 1994; 139: 362PubMedGoogle Scholar
  15. 15.
    Reynolds P, Saunders LD, Layefsky ME, Lemp GF. The spectrum of acquired immunodeficiency syndrome (AIDS)-associated malignancies in San Francisco, 1980–1987. Am J Epidemiol 1993; 137: 19PubMedGoogle Scholar
  16. 16.
    Hessol NA, Katz MH, Liu JY, Buchbinder SP, Rubino CJ, Holmberg SD. Increased incidence of Hodgkin’s disease in homosexual men with HIV infection. Ann Intern Med 1992; 117: 309.PubMedGoogle Scholar
  17. 17.
    Koblin PA, Hessol NA, Zauber AG et al. Increased incidence of cancer among homosexual men, New York City and San Francisco, 1978–1990. Am J Epidemiol 1996; 144: 916PubMedCrossRefGoogle Scholar
  18. 18.
    Lyter DW, Bryant J, Thackeray R, Rinaldo CR, Kingsley LA. Incidence of human immunodeficiency virus-related and nonrelated malignancies in a large cohort of homosexual men. J Clin Oncol 1995; 13: 2540.Google Scholar
  19. 19.
    Lyter DW, Kingsley LA, Rinaldo CR, Bryant J. Malignancies in the multicenter AIDS cohort study (MACS), 1984–1994 [Abstract]. Proceedings of ASCO 1996; 15: 305Google Scholar
  20. 20.
    Serraino D, Pezzotti P, Dorrucci M, Alliegro MB, Sinicco A, Rezza G for the WV Italian Seroconversion Study Group. Cancer incidence in a cohort of human immunodeficiency virus seroconverters. Cancer 1997; 79: 1004.Google Scholar
  21. 21.
    Serraino D, Pezzotti P, Dorrucci M, Alliegro MB, Sinicco A, Rezza G for the HIV Italian Seroconversion Study Group. Cancer incidence in a cohort of human immunodeficiency virus seroconverters. Cancer 1997; 79: 1004.Google Scholar
  22. 22.
    Ahmed T, Wormser GP, Stahl RE, et al. Malignant lymphomas in a population at risk for acquired immunodeficiency syndrome. Cancer 1987; 60: 719.PubMedCrossRefGoogle Scholar
  23. 23.
    Roithmann S, Tourani JM, Andrieu JM. Hodgkin’s disease in HIV-infected intravenous drug abusers. N Engl J Med 1990; 323: 275.PubMedGoogle Scholar
  24. 24.
    Tirelli U, Vaccher E, Rezza G, et al. Hodgkin’s disease and infection with the human immunodeficiency virus (WV) in Italy. Ann Intern Med 1988; 108: 309Google Scholar
  25. 25.
    Rabkin CS, Biggar RI, Baptiste MS, Abe T, Kohler BA, Nasca PC. Cancer incidence trends in women at high risk of human immunodeficiency virus (HIV) infection. Int J Cancer 1993; 55: 208PubMedCrossRefGoogle Scholar
  26. 26.
    Ragni MV, Belle SH, Jaffe RA, et al. Acquired immunodeficiency syndrome-associated non-Hodgkin’s lymphomas and other malignancies in patients with hemophilia. Blood 1993; 81: 1889PubMedGoogle Scholar
  27. 27.
    Rabkin CS, Hilgartner MW, Hedberg KW, et al. Incidence of lymphomas and other cancers in HIV-infected and HIV-uninfected patients with hemophilia. J Am Med Assoc 1992; 267: 1090CrossRefGoogle Scholar
  28. 28.
    Carbone A, Dolcetti R, Gloghini A, et al. Immunophenotypic and molecular analyses of acquired immune deficiency syndrome-related and Epstein-Barr virus-associated lymphomas: a comparative study. Hum Pathol 1996;27:133PubMedCrossRefGoogle Scholar
  29. 29.
    Bellas C, Santón A, Manzanal A, et al. Pathological, immunological, and molecular features of Hodgkin’s disease associated with HIV infection. Comparison with ordinary Hodgkin’s disease. Am J Surg Pathol 1996;20(12):1520PubMedCrossRefGoogle Scholar
  30. 30.
    Tirelli U, Vaccher E, Zagonel V, et al. CD30 (Ki-1) - positive anaplastic large-cell lymphomas in 13 patients with and 27 patients without human immunodeficiency virus infection: The first comparative clinicopathologic study from a single institution that also includes 80 patients with other human immunodeficiency virus-related systemic lymphomas. J Clin Oncol 1995;13:373PubMedGoogle Scholar
  31. 31.
    Boiocchi M, De Re V, Gloghini A, et al. High incidence of monoclonal EBV episomes in Hodgkin’s disease and anaplastic large-cell Ki-l-positive lymphomas in HIV-1-positive patients. Int J Cancer 1993;54:53PubMedCrossRefGoogle Scholar
  32. 32.
    Carbone A, Gloghini A, Zanette I, Canal B, Volpe R. Demonstration of Epstein-Barr viral genomes by in situ hybridization in acquired immune deficiency syndrome-related high grade and anaplastic large cell CD30+ lymphomas. Am J Clin Pathol 1993;99:289PubMedGoogle Scholar
  33. 33.
    Carbone A, Gloghini A, Volpe R, Boiocchi M, Tirelli U, and the Italian Cooperative Group on AIDS and Tumors. High frequency of Epstein-Barr virus latent membrane protein-1 expression in acquired immunodeficiency syndrome Treatment of Hodgkin’s Disease related Ki-1 (CD30) - positive anaplastic large cell lymphomas. Am J Clin Pathol 1994;101:768PubMedGoogle Scholar
  34. 34.
    Carbone A, Weiss LM, Gloghini A, Ferlito A. Hodgkin’s disease: old and recent clinical concepts. Ann Otol Rhinol Laryngol 1996;105:751PubMedGoogle Scholar
  35. 35.
    Carbone A, Tirelli U, Gloghini A, Volpe R, Boiocchi M Human immunodeficiency virus-associated systemic lymphomas may be subdivided into two main groups according to Epstein-Barr viral latent gene expression. J Clin Oncol 1993;11:1674PubMedGoogle Scholar
  36. 36.
    Hamilton-Dutoit SJ, Pallesen G, Karkov J, Skinh0j P, Franzmann MB, Pedersen C. Identification of EBV-DNA in tumour cells of AIDS-related lymphomas by in situ hybridization. Lancet 1989;I:554.CrossRefGoogle Scholar
  37. 37.
    Herndier BG, Sanchez HC, Chang KL, Chen YY, Weiss LM. High prevalence of Epstein-Barr virus in the Reed-Sternberg cells of H[V-associated Hodgkin’s disease. Am J Pathol 1993; 142: 1073–1079PubMedGoogle Scholar
  38. 38.
    Di Luca D, Dolcetti R, Mirandola P, et al. Human herpesvirus 6: a survey of presence and variant distribution in normal and peripheral lymphocytes and lymphoproliferative disorders. J Infect Dis 1994;170:211PubMedCrossRefGoogle Scholar
  39. 39.
    Dolcetti R, Di Luca D, Carbone A, et al Human herpesvirus 6 in human immunodeficiency virus-infected individuals: association with early histologic phases of lymphadenopathy syndrome but not with malignant lymphoproliferative disorders. JMed Virol 1996;48:344CrossRefGoogle Scholar
  40. 40.
    Cesarman E, Chang Y, Moore PS, Said JW, Knowles DM Kaposi’s sarcoma-associated herpesvirus-like DNA sequences in AIDS-related body-cavity-based lymphomas N Engl J Med 1995;332:1186PubMedCrossRefGoogle Scholar
  41. 41.
    Gaidano G, Pastore C, Gloghini A, et al. Distribution of human herpesvirus-8 sequences throughout the spectrum of AIDS-related neoplasia. AIDS 1996;10(9):941PubMedCrossRefGoogle Scholar
  42. 42.
    Gaidano G, Carbone A. AIDS-related lymphomas: from pathogenesis to pathology. Br J Haematol 1995;90:235.PubMedCrossRefGoogle Scholar
  43. 43.
    Carbone A, Gloghini A, Vaccher E, et al. Kaposi’s sarcoma-associated herpesvirus DNA sequences in AIDS-related and AIDS-unrelated lymphomatous effusions. Br J Haematol 1996;94:533.PubMedCrossRefGoogle Scholar
  44. 44.
    Karcher DS. Clinically unsuspected Hodgkin disease presenting initially in the bone marrow of patients infected with the human immunodeficiency virus. Cancer 1993; 71: 1235PubMedCrossRefGoogle Scholar
  45. 45.
    Hair LS, Rogers JD, Chadburn A, Sisti MBJ, Knowles DM, Powers JM. Intracerebral Hodgkin’s disease in a human immunodeficiency virus-seropositive patient. Cancer 1991; 67: 2931Google Scholar
  46. 46.
    Shaw MT, Jacobs SR. Cutaneous Hodgkin’s disease in a patient with human immunodeficiency virus infection. Cancer 1989; 64: 2585Google Scholar
  47. 47.
    Tirelli U, Errante D, Vaccher E, et al. Hodgkin’s disease in 92 patients with HIV infection: the Italian experience. Ann Oncol 1992; 3: S69CrossRefGoogle Scholar
  48. 48.
    Monfardini S, Tirelli U, Vaccher E, Foà R, Gavosto F, for the Gruppo Italiano Cooperativo AIDS e Tumori (GICAT). Hodgkin’s disease in 63 intravenous drug users infected with human immunodeficiency virus. Ann Oncol 1991; 2 (suppl 2): 201PubMedCrossRefGoogle Scholar
  49. 49.
    Tirelli U, Vaccher E, Serraino D, et al. Comparison of presenting clinical and laboratory findings of patients with persistent generalized lymphadenopathy (PGL) syndrome and malignant lymphoma (ML). Hematologica 1987; 72: 563Google Scholar
  50. 50.
    Errante D, Zagonel V, Vaccher E, et al. Hodgkin’s disease in patients with HIV infection and in the general population: comparison of clinicopathological features and survival. Ann Oncol 1994; 5 (Suppl 2): S37CrossRefGoogle Scholar
  51. 51.
    Coiffier B. Prognostic factors in Hodgkin’s disease and non-Hodgkin’s lymphomas. Curr Opin Oncol 1991; 3: 843PubMedCrossRefGoogle Scholar
  52. 52.
    Coker DD, Morris DM, Coleman JJ, Schimpff SC, Wiernik PH, Elias EG. Infections among 210 patients with surgically staged Hodgkin’s disease. Am J Med 1983; 75: 97PubMedCrossRefGoogle Scholar
  53. 53.
    Notter DT, Grossman PL, Rosenberg SA, Remington JS. Infections in patients with Hodgkin’s disease: a clinical study of 300 consecutive adult patients. Rev Infect Dis 1980; 2: 761PubMedCrossRefGoogle Scholar
  54. 54.
    Errante D, Tirelli U, Gastaldi R, et al. Combined antineoplastic and antiretroviral therapy for patients with Hodgkin’s disease and human immunodeficiency virus infection. A prospective study of 17 patients. Cancer 1994; 73: 437CrossRefGoogle Scholar
  55. 55.
    Zittoun R, Eghbali, H, Audebert A, et al. Association d’epirubicine, bleomycine, vinblastine et prednisone (EBVP) avant radiotherapie dans le stades localises de la maladie de Hodgkin. Bull Cancer 1987; 74: 151PubMedGoogle Scholar
  56. 56.
    Kaplan L, Kahn J, Northfelt D, Abrams D, Volberding P. Novel combination chemotherapy for Hodgkin’s disease in HIV-infected individuals [Abstract]. Proceedings of ASCO 1991; 10: 33Google Scholar
  57. 57.
    Tirelli U, Errante D, Gisselbrecht C, et al. Epirubicin, bleomycin, vinblastine and prednisone (EBVP) chemotherapy (CT) in combination with antiretroviral therapy and primary use of G-CSF for patients with Hodgkin’s disease and HIV infection (HD-HIV) [Abstract]. Proceedings of ASCO 1996: 15: 304Google Scholar
  58. 58.
    Levine AM, Cheung T, Tulpule A, Huang J, Testa M. Preliminary results of AIDS Clinical Trials Group (ACTG) study # 149: phase II trial of ABVD chemotherapy with G-CSF in HIV infected patients with Hodgkin’s disease (HD) [Abstract]. AIDS 1997; 14: Al2Google Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Umberto Tirelli
  • Emanuela Vaccher
  • Michele Spina
  • Antonino Carbone

There are no affiliations available

Personalised recommendations