Treatment of HIV-associated lymphomas: results of a multicenter retrospective study

Summary

Introduction

Since the beginning of AIDS epidemic, almost 70 million of human population have been infected with HIV, and about 35 million have died of AIDS. 35 millions of people around the world were living with HIV by the end of 2013. The HIV-infected patients are at risk of cancer, including lymphomas, despite a widespread accessibility of highly active antiretroviral therapy (HAART). In parallel with increasing number of people living with HIV, the number of patients suffering from HIV-associated malignancies of hematopoietic and lymphoid tissues has increased as well, as a result of their immunodeficiency state.

Methods

We have performed a retrospective multicenter study. Diagnosis of lymphoma in a HIV infected patient was the inclusion criterion. This study focuses on the outcomes in HIV-infected patients with lymphomas. Forty-seven patients were enrolled within the period from May 2006 to February 2015. We have analyzed the data on medical history, results of laboratory testing as well as treatment in hematological departments and AIDS-centers, as based on the established practice of Russian health care. The median follow-up of patients was 24 (3 to 106) months.

Results

The patients’ characteristics are depicted in Table 1. In 78% of the patients, HIV infection was detected before the diagnosis of lymphoma. CD4+ cell counts and viral load at the diagnosis of lymphoma were assessed only in 30% of cases. The levels of CD4+ cell counts were<200 cells/mm (50-420) in 70% of patients. The viral loads in 50% of the patients were<1000 RNA copies/mL (0-800 thousand copies/mL). The HIV-infected persons with lymphoma received 1 to 8 cycles of chemotherapy (ChT); 50% patients underwent > 5 ChT cycles. The lymphoma treatment regimens are shown in Table 2. Generally, cytostatic ChT in combination with Rituximab and HAART was not associated with excessive toxicity. Overall survival in HIV-infected patients with lymphomas was 70% at 2 years of observation. Appropriate rates for specific entities are as follows: HL, 80%; BL, 78,6%; DLBCL, 68,4%; intermediate BL/DLBCL lymphoma, 33,3%; undifferentiated aggressive B-cell lymphoma, 33,3%, and a patient with follicular lymphoma is still alive. Significant improvement of the overall survival rate is associated with administration of ChT in combination with HAART (75% vs 43%, p=0,024), and application of adequate ChT (83,3% vs 47,1%, p=0,013). Usage of ChT plus Rituximab improves overall survival (81,5% vs 33,3%, p=0,01) and reduces the probability of progression (11% vs 44,4%, p=0,02) of CD20+ B-cell lymphoma (n=36). LDH level above 500 U/l was a poor prognostic factor (56% vs 86,4%, p =0,01). The patient’s age, ECOG status, disease stage, presence of B symptoms and International Prognostic Index (IPI) had no impact on the outcome, thus suggesting influence of other factors that may include HIV-state (CD4+ cell levels and viral load).

Conclusions

HIV-infected patients were more often affected with DLBCL which was characterized by aggressive clinical course. The 2-year overall survival of the HIV-infected lymphoma patients with HIV was 70%. ChT in combination with HAART (75%) and adequate to diagnosis ChT (81.5%) improved overall survival. Usage of Rituximab reduced the probability of progression and improved overall survival of CD20+ B cell lymphoma in HIV infected individuals. The levels of LDH above 500 U/l are associated with unfavorable prognosis. HIV status seems to play an important prognostic role.

Table 1. Characteristics of the lymphoma patients under study

Keywords

Lymphoma, hiv infection, haart, polychemotherapy, rituximab, ldh activity