A few Phase II studies in HIV-negative patients have demonstrated the safety of the combination of rituximab with ABVD and its efficacy Proteasome inhibitor (CR/CRu rates: 81–93%; 3–5 year EFS: 83% and 5-year OS: 96%). These results are still very preliminary and several randomized studies are comparing chemotherapy (ABVD or BEACOPP) with and without rituximab. The standard
strategy in good performance status immunocompetent patients with relapsed/refractory HL consists of inducing a response with salvage chemotherapy and consolidating it with high-dose therapy with autologous stem cell rescue (HDT/ASCR). This is based on two old randomized studies demonstrating the superiority of HDT/ASCR over only chemotherapy [53,54]. However, no randomized studies have compared PD0325901 cost different salvage regimens, and a number of Phase II studies support the use of different regimens, with no evidence of superiority of one over the others. The most commonly used regimens are ESHAP, DHAP, MINE, IGEV, GEM-P.
No series has been published specifically on the treatment of relapsed/refractory HL in HIV patients. Thus recommendations are based on small studies of HDT/ASCR. As in the general population, the salvage protocols used vary and include ABVD, MOPP, CMOPP-ABV, MOPP/ABV, COPP-ABV, BEACOPP, vinorelbine, ESHAP, MINE, ifosfamide-VP16, ifosfamide-VP16-mitoxantrone and RT [25,55–57]. Several retrospective and prospective small pilot studies have demonstrated the feasibility of HDT/ASCR in
patients with HIV and lymphoma [56,58], leading to the design of multicentre prospective studies aiming at confirming these results. Thus, the AIDS Malignancy Consortium Study 020 included 27 HIV patients with relapsed lymphoma, of whom 20 (5 with HL) received HDT/ASCR with dose-reduced busulfan-cyclophosphamide as the conditioning regimen . There were only six episodes of febrile neutropenia and one treatment-related death due to veno-occlusive disease. CMV infection was demonstrated in four patients. Another prospective study by the Italian Cooperative Group on AIDS and Tumours (GICAT) recruited 50 patients . Only 27 (including eight HL) patients actually received HDT/ASCR with no treatment-related Urocanase deaths or associated infections. Four-year PFS and OS for the entire population was 49% and 50%, respectively, whereas it was 76% and 75% for those who actually received HDT/ASCR. A large retrospective registry matched-cohort study has demonstrated that the outcomes of patients with HIV infection who receive HDT/ASCR for relapsed/refractory lymphoma are comparable to those seen in HIV-negative patients . At 30 months, the PFS and OS for HIV-positive patients were 61% and 61.5%, respectively, whereas the corresponding figures for the control population were 56% and 70%, respectively (p = NS both for PFS and for OS).