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)

To ascertain the results of standard ABVD chemotherapy (doxorubicin, bleomy cin, vinblastine, dacarbazine) in HIV-infected patients with newly diagnose d Hodgkin's disease (HD), a nonrandomized, prospective, multiinstitutional clinical trial was conducted by the AIDS Clinical Trials Group (ACTG). in H IV-infected patients with Hodgkin's disease. All patients received the stan dard ABVD regimen, with granulocyte-colony-stimulating factor (G-CSF). Anti retroviral therapy was not used. Between May, 1992 and August, 1996,21 pati ents were added to the study and treated. The median CD4 count was 113 cell s/mm(3) and 29% had a history of a clinical AIDS-defining condition before diagnosis of HD. Systemic "B" symptoms were present in 90% at diagnosis. St age IV HD was present in 67%. with bone marrow involvement in 12 (57%). Nod ular sclerosis HD was present in 38%, with mixed cellular disease in 31%. A mong all patients entered and treated, complete omission (CR) was attained in 9 (43%: 90% confidence interval [CI], 24%-63%), whereas partial response occurred in 4 (19%), leading to an overall objective response rate of 62% (90% CI, 42%-79%). Despite routine use of G-CSF, 10 patients (47.6%) experi enced life-threatening neutropenia, with absolute neutrophil counts <500 ce lls/mm(3). In all, nine opportunistic infections occurred in 6 patients (29 %) during the study or shortly thereafter. Median survival was 1.5 years. R esults of this study suggest that alternative treatment strategies should b e explored, including use of chemotherapy together with antiretroviral ther apy.