Long-Term Survival of a Patient With Human Immunodeficiency Virus Infection and Hodgkin's Lymphoma

A. Hafeez Diwan, MD, Phd, Jay Umbreit, MD, Beverly P. Nelson, MD

Disclosures

South Med J. 2002;95(8) 

In This Article

Discussion

In patients with HIV infection and Hodgkin's disease, the prognosis is usually poor because of advanced disease at presentation, unfavorable histologic subtype, aggressive clinical course, and associated opportunistic infections.[5] Reported causes of death have included infection, HL, a combination of both infection and HL, or treatment-related toxicities.[5]

This HIV-positive man had stage IV nodular sclerosis HL, with extensive bone marrow involvement. In one series of 45 cases of HIV-associated HL, the overall incidence of bone marrow involvement was 24%.[8] While 40% of the patients (18 of 45) in the same series had nodular sclerosis HL, the incidence of marrow involvement in the specific subtype was not provided. However, less than 10% of patients who have nodular sclerosis HL without HIV infection are reported to have bone marrow involvement at the time of diagnosis.[9,10] Thus, our patient had an unusually aggressive form of nodular sclerosis HL.

Despite the presence of clinically aggressive disease, this 29-year-old man achieved complete remission but had relapse after 3 years. He again attained complete remission with additional chemotherapy and remained free of disease for 9 years, even though he had several opportunistic infections. This is unusual, since HIV-associated HLs are notoriously difficult to treat, despite routine use of granulocyte colony-stimulating factor (G-CSF), as shown by Levine et al.[11] Of the 21 patients studied by these authors, 10 had life-threatening neutropenia, despite G-CSF administration. These authors documented a 29% incidence of opportunistic infections, with a median survival of 1.5 years.[11] Although durable long-term remission and cure of advanced stage HL in patients with HIV infection is unusual, a small number of patients in one large series of 114 patients have had such favorable clinical outcome.[10]

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