Outcomes for HIV-associated diffuse large B-cell lymphoma in the modern combined antiretroviral therapy era

authors

  • Besson Caroline
  • Lancar Rémi
  • Prevot Sophie
  • Algarte-Genin Michele
  • Delobel Pierre
  • Bonnet Fabrice
  • Meyohas Marie-Caroline
  • Partisani Marialuisa
  • Oberic Lucie
  • Gabarre Jean
  • Goujard Cécile
  • Boué François
  • Coppo Paul
  • Costello Régis
  • Hendel-Chavez Houria
  • Mekerri Nawel
  • Dos Santos Gabriella
  • Recher Christian
  • Delarue Richard
  • Casasnovas Rene-Olivier
  • Taoufik Yassine
  • Mounier Nicolas
  • Costagliola Dominique

keywords

  • Chemotherapy
  • Diffuse large B-cell lymphoma
  • Epidemiology
  • HIV
  • Non-Hodgkin's lymphoma

document type

ART

abstract

Objective: Non-Hodgkin's lymphoma (NHL) remains among the most frequent malignancies in persons living with HIV (PLWHIV). Survival among patients with HIV-associated diffuse large B-cell lymphoma (DLBCL), the most frequent NHL subtype, has improved markedly in recent years. We aimed to analyze characteristics and outcomes of DLBCL in HIV-infected patients in the era of modern combined antiretroviral therapy (cART). Design: PLWHIV with lymphoma were prospectively enrolled in the French ANRS-CO16 Lymphovir cohort between 2008 and 2015. We compared the patients treated with R-CHOP) (rituximab, cyclophosphamide, daunorubicin, vin-cristine, prednisolone) with HIV-negative DLBCL patients enrolled simultaneously in the R-CHOP arms of Lymphoma Study Association trials. Results: Among 110 PLWHIV with NHL, 52 (47%) had systemic DLBCL. These 52 cases had frequent extranodal disease (81%), poor performance status (35%) and advanced age-adjusted international prognostic index (aaIPI) (58%), and were mainly treated with R-CHOP (n = 44, 85%). Their median CD4(+) T-cell count was 233 cells/mu l, and 79% of patients were on cART. The 2-year overall and progression-free survival rates were both 75% (95% confidence interval: 64%, 88%). Factors associated with progression or death in univariate analysis were poor performance status [hazard ratio: 3.3 (1.2, 8.9)], more than one extranodal site [hazard ratio: 3.4 (1.1, 10.5)] and an advanced aaIPI [hazard ratio: 3.7 (1.0, 13.1)]. Progression-free survival after R-CHOP therapy did not differ from that of the HIV-negative counterparts (P = 0.11). Conclusion: In the recent cART era, despite frequent high-risk features, the 2-year overall survival of HIV-DLBCL patients reaches 75%. Outcomes after R-CHOP therapy are similar to those of HIV-negative patients with similar aaIPI. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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