HIV status does not impair the outcome of patients diagnosed with diffuse large B-cell lymphoma treated with R-CHOP in the cART era

Rita Coutinho*, Alessia D. Pria, Shreyans Gandhi, Katharine Bailey, Paul Fields, Kate Cwynarski, Andrew Wilson, Panagiotis Papanastasopoulos, Melinda Tenant-Flowers, Andrew Webb, Fiona Burns, Robert Marcus, Chloe Orkin, Silvia Montoto, Mark Bower

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    51 Citations (Scopus)

    Abstract

    Objective:

    To compare the outcome of patients diagnosed with HIV infection and diffuse large B-cell lymphoma (DLBCL) treated with R-CHOP in the cART era with that of a HIV-negative control group.

    Methods:

    From 2003 to 2011, 305 patients (97 HIV-positive) were diagnosed with DLBCL and treated with R-CHOP. Clinical features were compared using chi-square or Fisher's exact test. Survival analysis was performed using the Kaplan-Meier method and log-rank test. Multivariate analysis was performed using the Cox regression proportional hazards model.

    Results:

    HIV-positive patients had more B symptoms and extranodal sites of disease at diagnosis, but the proportion of patients with high-intermediate/high-risk disease according to the international prognostic index (IPI) was similar between groups. Response rate was 73%, both for patients with and without HIV infection. After a median follow-up of 48 months, 30 patients relapsed after achieving a complete remission, including four HIV-positive patients. Ninety-six patients have died (19 HIV-positive), 73 of them due to DLBCL. Three patients (one HIV-positive) died due to treatment toxicity. Patients with HIV infection had a significantly longer disease-free survival (DFS) (5-year: 94 vs. 77%; P = 0.03) and overall survival (OS) (78 and 64% for HIV-positive and HIV-negative patients, respectively; P = 0.03). These results were confirmed on multivariate analysis when controlled for other potential prognostic confounders.

    Conclusion:

    HIV-positive patients diagnosed with DLBCL in the cART era have an excellent outcome when treated with standard immunochemotherapy. Therefore, the choice of chemotherapy in patients with lymphoma should not be influenced by HIV status.

    Original languageEnglish
    Pages (from-to)689-697
    Number of pages9
    JournalAids
    Volume28
    Issue number5
    DOIs
    Publication statusPublished - 13 Mar 2014

    Keywords

    • R-CHOP chemotherapy
    • diffuse large B-cell lymphoma
    • survival
    • prognosis
    • HIV
    • outcome
    • ACTIVE ANTIRETROVIRAL THERAPY
    • NON-HODGKIN-LYMPHOMA
    • AIDS-RELATED LYMPHOMA
    • GENE-EXPRESSION
    • PLUS RITUXIMAB
    • PHASE-II
    • CHEMOTHERAPY
    • TRIAL
    • SURVIVAL
    • RISK

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