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Hodgkin's Disease: What do you think about this staging and dosing?
Mar 2, 2001

Dear Doctor, I am a healthy 34 yo male living with HIV for almost 12 yrs now. My last tests showed an undetectable viral load and a CD4 in the 900's (IL2 study) I was diagnosed with Hodgkin's disease about 2 months ago after I discovered a lump in my neck. The staging tests (gallium,CAT,Bone marrow aspiration) showed involvement in my neck where the lump was, and an enlarged spleen with no abnormalities or lesions. My oncologist told me I am probably a stage 3, and there is no way to confirm spleen involvement without surgery. I began AVBD immediately, and will get 6 cycles total, unless my follow up x rays show that I need more. I have done plenty of research on my own since my diagnosis. I've read about people with chest masses, stomach masses, spinal cord, etc., but find it very odd that I could have involvement in my neck and spleen, but nowhere in between. Should my spleen be removed just to be safe? One more question about the dosing please. My first cycle was at half strength. The second was begun at full strength, but the second half was ultimately cancelled after my WBC were repeatedly too low. Now I'm on Cycle 3 at 3/4 strength. Is all this dosing reduction going to affect my prognosis? Thanks for you time.

Response from Dr. Dezube

Two very important questions about Hodgkin's disease (HD). 1) Although HD in HIV-negative patients tends to be contiguous (i.e. doesn't skip from the neck to the spleen), it is not uncommon to have such skip areas in patients who are HIV+. (I have many such patients in my practice). Your spleen should NOT be removed. ABVD will easily treat the HD in your spleen.

2) Your question about dosing is more difficult. Are you on G-CSF (neupogen), a drug used to raise your white cells? You will have your best prognosis if you receive conventional doses of ABVD. To achieve this, I use G-CSF liberally and I make sure my patients are NOT taking combivir or AZT (zidovudine) which interfere with ABVD. What antivirals are you taking? If indeed you are already using G-CSF and avoiding AZT at all costs, then your oncologist has no choice but to lower you ABVD dose when your counts are low. When we do lower the dose, we usually do so by 25%.

Good luck! Many of my HD patients are celebrating their 10 year anniversary of being disease free.

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