![Page 1: Dr Silvia Montoto - BHIVA · Dr Silvia Montoto Barts and The London NHS Trust 18-20 April 2012, The International Convention Centre, Birmingham 18th Annual Conference of the British](https://reader033.vdocuments.us/reader033/viewer/2022052718/5f0613dc7e708231d4162d62/html5/thumbnails/1.jpg)
Dr Silvia Montoto Barts and The London NHS Trust
18-20 April 2012, The International Convention Centre, Birmingham
18th Annual Conference of the British HIV Association (BHIVA)
![Page 2: Dr Silvia Montoto - BHIVA · Dr Silvia Montoto Barts and The London NHS Trust 18-20 April 2012, The International Convention Centre, Birmingham 18th Annual Conference of the British](https://reader033.vdocuments.us/reader033/viewer/2022052718/5f0613dc7e708231d4162d62/html5/thumbnails/2.jpg)
HIV status does not impact on outcome in patients with classical Hodgkin lymphoma treated with ABVD
chemotherapy in the HAART era
Silvia Montoto, Centre for Haemato-Oncology, www.bci.qmul.ac.uk
C Orkin, K Shaw, J Okosun, S Gandhi, P Fields, A Wilson, M Shanyinde, K Cwynarski, R Marcus, J de Vos, AM Young, M Tenant-Flowers, M Johnson, D Chilton, J Gribben, M Bower
Medical Oncology, Chelsea & Westminster Hospital; Department of Haematology, Royal Free Hospital; Haematological Medicine, King’s College Hospital; Haematology, Guys and St Thomas Hospital; Centre for Statistics in Medicine, University of Oxford, Department of Sexual Health, King’s
College Hospital; Infection and Immunity, Barts and The London NHS Trust; HIV Medicine, Royal Free Hospital; HIV Medicine, Guys and St Thomas’ NHS Trust.
![Page 3: Dr Silvia Montoto - BHIVA · Dr Silvia Montoto Barts and The London NHS Trust 18-20 April 2012, The International Convention Centre, Birmingham 18th Annual Conference of the British](https://reader033.vdocuments.us/reader033/viewer/2022052718/5f0613dc7e708231d4162d62/html5/thumbnails/3.jpg)
Background
• The incidence of lymphoma is increased in patients with HIV
infection
• The outcome of patients with NHL and HIV infection in the
HAART era is similar to the outcome of NHL in HIV-negative
patients
• The standard treatment in patients with Hodgkin lymphoma (HL)
in the general population (ABVD chemotherapy) results in a high
cure rate
• The outcome of patients with HL depends on the International
Prognostic Score (IPS: Hasenclever index)
![Page 4: Dr Silvia Montoto - BHIVA · Dr Silvia Montoto Barts and The London NHS Trust 18-20 April 2012, The International Convention Centre, Birmingham 18th Annual Conference of the British](https://reader033.vdocuments.us/reader033/viewer/2022052718/5f0613dc7e708231d4162d62/html5/thumbnails/4.jpg)
Aim
• To analyze the outcome of patients with HL treated with
ABVD in the HAART era according to HIV status
![Page 5: Dr Silvia Montoto - BHIVA · Dr Silvia Montoto Barts and The London NHS Trust 18-20 April 2012, The International Convention Centre, Birmingham 18th Annual Conference of the British](https://reader033.vdocuments.us/reader033/viewer/2022052718/5f0613dc7e708231d4162d62/html5/thumbnails/5.jpg)
Patients and methods: study population
224 HL
131 non HIV
93 HIV ABVD ABVD
ABVD: doxorubicin, bleomycin, vinblastine, dacarbazine
Study period: 1997-2010 5 University Hospitals in London
![Page 6: Dr Silvia Montoto - BHIVA · Dr Silvia Montoto Barts and The London NHS Trust 18-20 April 2012, The International Convention Centre, Birmingham 18th Annual Conference of the British](https://reader033.vdocuments.us/reader033/viewer/2022052718/5f0613dc7e708231d4162d62/html5/thumbnails/6.jpg)
Patients and methods: HIV patients, characteristics and management
• Concomitant diagnoses of HIV and HL: 9 patients
• Prior AIDS: 22 (24%)
• Median CD4 count: 185/μl
• Undetectable VL: 60% (52/87)
• HAART during ABVD: 92 patients
• Prophylaxis: co-trimoxazole or pentamidine, fluconazole, aciclovir, azithromycin
![Page 7: Dr Silvia Montoto - BHIVA · Dr Silvia Montoto Barts and The London NHS Trust 18-20 April 2012, The International Convention Centre, Birmingham 18th Annual Conference of the British](https://reader033.vdocuments.us/reader033/viewer/2022052718/5f0613dc7e708231d4162d62/html5/thumbnails/7.jpg)
Patients and methods
HIV-ve (%) HIV+ve (%) p-value
Male gender 57% 89% <0.001
Age (median, range)
> 45 years
31 (16-70)
20%
41 (26-73)
33%
0.03
B-symptoms 40% 81% <0.001
WCC >15 x109/L 17% 0 <0.001
Lymphocyte <0.6 x109/L 5% 68%
Hb <10.5 g/L 21% 44% <0.001
Albumin <40 g/L 37% 79% <0.001
Bone marrow involvement 4% 45% <0.001
Stage III-IV 35% 80% <0.001
IPS >3 26% 68% <0.001
Hasenclever index (IPS): Male gender Age > 45 years
WCC > 15 x 109/L
Lymphocyte count <0.6 x 109/L
Hb <10.5 g/L
Albumin < 40 g/L
Stage IV
![Page 8: Dr Silvia Montoto - BHIVA · Dr Silvia Montoto Barts and The London NHS Trust 18-20 April 2012, The International Convention Centre, Birmingham 18th Annual Conference of the British](https://reader033.vdocuments.us/reader033/viewer/2022052718/5f0613dc7e708231d4162d62/html5/thumbnails/8.jpg)
Results: response
HIV-ve
N (%)
HIV+ve
N (%)
Complete response (CR)/ Unconfirmed CR (CRu)
103 (79%) 69 (74%)
Partial response (PR) 17 (13%) 16 (17%)
Stable disease (SD)/progression
11 (8%) 7 (8%)
Toxic death - 1
![Page 9: Dr Silvia Montoto - BHIVA · Dr Silvia Montoto Barts and The London NHS Trust 18-20 April 2012, The International Convention Centre, Birmingham 18th Annual Conference of the British](https://reader033.vdocuments.us/reader033/viewer/2022052718/5f0613dc7e708231d4162d62/html5/thumbnails/9.jpg)
Results: overall survival (OS)
0.0
0
0.2
5
0.5
0
0.7
5
1.0
0
0 5 10 15
Time (years)
HIV- (5-yr OS: 88%, 95%CI: 80-93)
HIV+ (5-yr OS: 81%, 95%CI: 69-89)
p=0.15
![Page 10: Dr Silvia Montoto - BHIVA · Dr Silvia Montoto Barts and The London NHS Trust 18-20 April 2012, The International Convention Centre, Birmingham 18th Annual Conference of the British](https://reader033.vdocuments.us/reader033/viewer/2022052718/5f0613dc7e708231d4162d62/html5/thumbnails/10.jpg)
Results: event-free survival (EFS)
0.0
0
0.2
5
0.5
0
0.7
5
1.0
0
0 5 10 15
Time (years)
HIV- (5-yr EFS: 66%, 95%CI: 57-74)
HIV+ (5-yr EFS: 59%, 95%CI: 47-70)
p=0.5
![Page 11: Dr Silvia Montoto - BHIVA · Dr Silvia Montoto Barts and The London NHS Trust 18-20 April 2012, The International Convention Centre, Birmingham 18th Annual Conference of the British](https://reader033.vdocuments.us/reader033/viewer/2022052718/5f0613dc7e708231d4162d62/html5/thumbnails/11.jpg)
Results: multivariate analysis
DFS
(p value)
EFS
(p value)
OS
(p value)
IPS
0-2 vs 3-7
0.9
0.15
0.09
HIV status
-ve vs +ve
0.5
0.9
0.6
![Page 12: Dr Silvia Montoto - BHIVA · Dr Silvia Montoto Barts and The London NHS Trust 18-20 April 2012, The International Convention Centre, Birmingham 18th Annual Conference of the British](https://reader033.vdocuments.us/reader033/viewer/2022052718/5f0613dc7e708231d4162d62/html5/thumbnails/12.jpg)
Conclusions
• Patients diagnosed with HL in the setting of HIV infection have more extensive disease with more adverse prognostic factors than HIV-ve patients
• However, when treated with ABVD HIV positive status does not adversely affect overall survival or event-free survival
![Page 13: Dr Silvia Montoto - BHIVA · Dr Silvia Montoto Barts and The London NHS Trust 18-20 April 2012, The International Convention Centre, Birmingham 18th Annual Conference of the British](https://reader033.vdocuments.us/reader033/viewer/2022052718/5f0613dc7e708231d4162d62/html5/thumbnails/13.jpg)
Thanks!