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Pathogenesis:
Hodgkin's disease arises in the lymph nodes and spreads stepwise from one group of nodes to contiguous groups. Hessol et al. have observed an excess number of cases of HodgkinÕs disease in a cohort of HIV-infected homosexual men, and suggest that it may be an HIV-related malignancy. Others, however, have not confirmed an excess number of cases. The clinical behavior of Hodgkin's disease in AIDS patients is rather unpredictable and presentation usually involves late clinical stages (III and IV) with mixed cellularity as the predominant histological type. The etiology of Hodgkin's disease remains unknown. Case clustering (multiple cases in a single household) may suggest a viral origin. EBV has also been implicated.
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Symptoms:
Most pafients present with cervical or mediastinal adenopathy. Systemic symptoms including itching, high fever, night sweats and weight loss may or may not be present. Bone involvement may produce pain in the diseased area.
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Diagnosis:
The diagnosis of Hodgkin's disease rests on the identification of Reed-Stenberg cells or morphological variants through lymph node biopsy. Because of frequent bone marrow involvement suggests the usefulness of bone marrow biopsies.
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Treatment:
Disease staging is the principal factor in selecting appropriate treatment. For advanced stage disease (III and IV) combination chemotherapy is the choice treatment. MOPP and ABVD are both effective 4-drug regimens. MOPP alternating with ABVD has shown similar benefit. oral combination drug programs are also being evaluated. As in NHL, the complete response rate to chemotherapy is low. The addition of colony-stimulating factors may reduce the rate of primary failure and risk of long term complications. Early stage (I and II) Hodgkin's disease is most frequently treated with radiation therapy.
A combination of adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) with G-CSF is currently being studied by the AIDS Clinical Trials Group (ACTG) for the treatment of AIDS-related Hodgkin's disease.
REFERENCES:
Cesarman E et al. Kaposi's sarcoma-associated herpesvirus-like DNA sequences in AIDS related body-cavity-based lymphomas. NEJM 332:1181-5, 1995.
Gill PS et al. HIV-related malignant lymphoma: clinical aspects, treatment, and pathogenesis. Canc Invest 6: 413-6, 1988.
Hessol NA et al. Increased incidence of Hodgkin disease in homosexual men with HIV infection. Ann Int Med 117:309-11, 1992.
Hernier BG at al. Pathogenesis of AIDS lymphomas. AIDS 8: 1025-1049, 1994.
MacMahon EME et al. Epstein-Barr virus in AIDS-related primary central nervous system lymphoma. Lancet 338: 969-73, 1991.
Schiramizu B et al. Identification of a common clonal human immunodeficiency virus integration site in human immunodeficiency virus-associated lymphomas. Cancer Res
54: 2069-72,1994.
So Y et al. Primary central nervous system lymphoma in AIDS: a clinical and pathological study. Ann Neurol 20: 566-72, 1986.
OTHER REPORTS:
Galleto G and Levine A. AIDS-associated primary central nervous system lymphoma (commentary). JAMA 269:92-3, 1993.
Leven A et al. Multicenter phase II study of mitoguazone (MGBG) in relapsed or refractory AIDS-lymphoma. Proc Am Soc Clin Oncol, 1995.
Levine A. Lymphoma in acquired immunodeficiency syndrome. Sem in Oncol 17(l):
104-112,1990.
Levine A et al. Low-dose chemotherapy with central nervous system prophylaxis and zidovudine maintenance in AIDS-related lymphoma. JAMA 266: 84-8, 1991.
Marco M. The lymphoma project report: current issues in research and treatment of AIDS associated lymphoma. Treatment Action Group, 1995.
Remick SC et al. Novel oral combination chemotherapy in the treatment of intermediate-grade and high-grade AIDS-related non-Hodgkin's lymphomas. J Clin Onc 11: 1691-1701, 1993.
Urba WJ and Longo DL. Hodgkin's disease (review article). NEJM 326: 678-87, 1992.
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Baumgartner J et al. Primary central nervous system lymphoma: Natural history and response to radiation therapy in 55 patents with acquired immunodeficiency syndrome. J Neurosurg 73:206-211, 1990.
Canellos GP et al. Chemotherapy of advanced Hodgkin's disease with MOPP, ABVD, or MOPP alternating with ABVD. NEJM 327:1478-84,1992.
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