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Hodgkin's Disease and chemotherapy--followup to your 12/13 answer
Dec 28, 2001

I was interested in your response on 12/13/01 to the person who was asking if stage 1A Hodgkin's disease was adequately tresated with radiation alone.

I had Hodgkin's, stage 1A , Nodular Sclerosing type (and found out I was HIV+ at the same time as the cancer diagnosis) last December. After some consulting, my doctors decided that ABVD was the best treatment, with radiation to follow.

Your answer said 6 cycles of chemotherapy. What's a cycle? 6 treatments? I had 8 treatments of ABVD(is that 8 cycles?), and then 20 days of radiation. My viral load at the start of Cancer/HIV treatment was 15,000 and my CD4 was 150 or so. I also started HIV meds at the same time, and we stayed away from some drugs that might interferes with chemotherapy or vice-versa (both my doctors (oncologist and HIV doctor did this in consultation with doctors in San Francisco, over the phone). I started Kaletra and Sustiva immediatly, and remain on those now, after 1 year. My VL is undetectable, and my CD4 is a little low, at about 120. I am also doing PCP prophylaxis (Pentamidine). I am doing well and have no other symptoms, but I was wondering if I should have had more chemotherapy, based on your last answer. Also, do you think my CD4 count will rise? Thanks.

Response from Dr. Dezube

In HIV patients with Hodgkin's disease, I personally recommend 6 cycles of ABVD chemotherapy. Each cycle of ABVD chemotherapy consists of 2 treatments, so that 6 cycles of chemotherapy = 12 treatments of chemotherapy. For Stage 1A, nodular sclerosing type, some oncologist give 4 cycles of ABVD (8 treatments) PLUS radiation therapy. This is totally appropriate and should be all that you need. You do not need to get any more chemotherapy. The 20 days of radiation therapy will more than adequately compensate for the last 2 cycles (4 treatments) of ABVD. On the other hand, I do NOT believe that radiation therapy alone (i.e. no chemotherapy) is adequate. So, in short, you should be okay with the combination of chemotherapy plus radiation. No need to worry. Finally, as a disclaimer, the above is soley my opinion. Obviously different oncologists may have different view points. Hope this clarifies your situation. If not, then write back to me. yours, BD

PS: your CD4 counts should indeed rise over the next year.

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