European Journal of Medical Research - Deutsche AIDS ...

54 EUROPEAN JOURNAL OF MEDICAL RESEARCH
June 27, 2007
28 pts (82%) HAART was given prior to HD and 6/26 pts
(23%) had a prior AIDS defining illness. The median CD4
counts at HD diagnosis was 300/l.. Pts received/are receiving
ABVD (n=11), BEACOPP baseline-21 (n=18) or BEA-
COPP-14 (n=1). Grade 3/4 peripheral neuropathy and grade
3/4 infections occurred in 6 of 21 pts each. To date response
data are available in 15 pts (CR in 10 pts, PR in 4, SD in 1). 3
pts have died, all of them diagnosed with stage IVB HD.
Causes of death were treatment related sepsis during the 1st
course of CT (n=1), progressive HD (n=1) and both, progressive
HD and HIV-infection (n=1).
Conclusions: In pts with HIV-HD risk-adapted CT and concomitant
HAART is safe and effective. However, hematological
toxicity is considerable. These preliminary data suggest
that the prognosis of HIV-HD might approach results
achieved in the HIV-negative population with HD.
B.6 (Vortrag)
Current trends in AIDS-Related Lymphoma
(ARL) – preliminary results of the German ARL
Cohort Study
Hoffmann C. 1 , Wyen C. 2 , Mayr C. 3 , Plettenberg A. 1 ,
Oette M. 4 , van Lunzen J. 5 , Rockstroh J. 6 , Esser S. 7 ,
Jäger H. 8 , Horst H.-A. 9 , Hentrich M. 10 , Mosthaf F. 11 ,
Greiffendorf I. 12 , Hammond A. 13 , Fätkenheuer G. 2 , German
ARL Cohort Study Group
1 ifi Institut, Hamburg, Germany, 2 Universität Köln, Köln,
Germany, 3 Ärzteforum Seestrasse, Berlin, Germany,
4 Universität Düsseldorf, Düsseldorf, Germany,
5 Universitätsklinikum Eppendorf, Hamburg, Germany,
6 Universität Bonn, Bonn, Germany, 7 Universität Essen, Essen,
Germany, 8 MucResearch GmbH, München, Germany,
9 Universitätsklinikum Schleswig-Holstein, Kiel, Germany,
10 Klinikum Harlaching, München, Germany,
11 Schwerpunktpraxis, Karlsruhe, Germany, 12 Klinikum
Krefeld, Krefeld, Germany, 13 Klinikum Augsburg, Augsburg,
Germany
Background: The incidence of ARL has decreased less profoundly
than that of other AIDS-defining illnesses.
Chemotherapy is hampered by toxicity and infectious complications.
The German ARL Cohort Study was initiated in order
to analyze the characteristics and outcome of patients (pts.)
with ARL with respect to potential risk factors and to the use
of specific polychemotherapy (PCT) and antiretroviral therapy
(ART).
Methods: This prospective multicenter cohort study includes
pts with new or recurrent ARL (including Hodgkin’s Disease,
HD) diagnosed since January 2005. After enrolment, pts are
followed every six months.
Results: As of January 2007, 103 patients (93 males, 10 females)
from 16 centers were included in the cohort. The most
common histological diagnosis was diffuse large B-cell lymphoma
(40 %), followed by Burkitt lymphoma (19 %) and HD
(15 %). Mean age at ARL diagnosis was 44.5 years (range,
23.0–72.5). Median CD4 count was 211 cells/ul and 35 % of
the patients had a prior AIDS-defining illness. In 30 %, HIV
was diagnosed at the time of ARL diagnosis. Only 51 % were
treated with HAART, and 22 % had a plasma viremia below
50 copies/ml. There were more HD cases in virologically suppressed
pts. than in pts with detectable viremia (30 % vs 10
%, p=0.03). Sixty-two pts (60 %) received a CHOP-based
PCT while 11 pts (11 %) received a protocol of short and intensified
PCT which was adapted from the German multicenter
study group for adult acute lymphoblastic leukemia. The
remaining 30 pts received other or no PCT. In 41 %, immunotherapy
with rituximab was added to PCT. Of the 48 pts
with available staging after completion of PCT, 29 (60 %) pts
achieved complete remission of ARL. After a median followup
of 5.9 months, 27 pts had died, among them 13 from progressive
lymphoma. There were 6 treatment-related deaths
(bloodstream infections) which were not related to specific
PCT regimens.
Conclusions: Preliminary data of this ongoing, prospective
study suggest that many of ARL pts. do not receive ART at
the time of diagnosis. HD seems to be more frequent in patients
on ART. The high mortality and the relatively low rates
of complete remission observed in this cohort underline the
need for intensive efforts to improve treatment concepts of pts
with ARL.
B.7 (Vortrag)
Second line chemotherapy with IMVP16 after
failure of CHOP in patients with HIV-related
Non-Hodgkin-Lymphomas
Müller M. 1 , Kölsche F. 1 , Marretta L. 1 , Träder C. 1 ,
Weiss R. 2 , Zwingers T. 3 , Kowol S. 1 , Arasteh K. 1
1 Vivantes Auguste-Viktoria-Klinikum Berlin, Department of
Gastroenterology / Infectious Diseases, Berlin, Germany,
2 Private Praxis, Bremen, Germany, 3 Estimate GmbH,
Augsburg, Germany
Objective: Since decades the CHOP regimen is a well established
first line therapy for NHL. In former days HIV-patients
with NHL had a poor prognosis. The introduction of HAART
improved the overall survival. The impact of immunotherapy
(Rituximab) in HIV-related NHL is under investigation. However,
it is not clear as to how non-responders should be managed
further.
Method: Retrospective analysis of a single centre cohort of
140 HIV-patients with NHL, between 1/1989 and 10/2005.
After failure of standard CHOP regimen (relapse or insufficient
response) some patients received IMVP-16, a second
line regimen, which is used in HIV-negative patients with
lymphomas.
Results: 29 patients with at least one cycle of IMVP-16 were
identified with a median follow up of 26,2 months. Characteristics
at NHL diagnosis: Median age: 41,9 years (range: 31-
75years), median CD4: 180/l, (range 20-560), HIV-stage
(CDC) "C": 15 patients "B": 10 patients "A": 4 patients.
NHL-stage (Ann-Arbor) I+II: 7 patients, III+IV: 22 patients.
NHL-histology: DLBCL: 18 patients, Burkitt/Burkitt-like
lymphomas: 5 patients, others: 6 patients. 2 patients were
treated before 1997, 27 patients after 1997 (HAART era). 9
patients are still alive with a median follow up of 52 months
(range 35-92 months), 20 patients died after a median survival-time
of 11 months (range 4-22 months).
Conclusion: There is no standard second line chemotherapy
in patients with relapsed or progressive HIV-related NHL´s.
High dose chemotherapy and autologous stem-cell transplantation
should be discussed in all patients. IMVP-16 might be a
less invasive option.