LY-08. Efficacy and safety of first-line chemotherapy in patients with lymphoma and HIV infection: results of a case-control study
Ivan V. Tsygankov, Marina O. Popova, Yulia A. Rogacheva, Kirill V. Lepik, Yuri R. Zalyalov, Lilia V. Stelmakh, Sergey N. Bondarenko, Vadim V. Baykov, Natalia B. Mikhailova, Alexander D. Kulagin
RM Gorbacheva Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov University, St. Petersburg, Russia
Contact: Dr. Marina O. Popova, e-mail: marina.popova.spb@gmail.com
Summary
Introduction
Widespread use of modern antiretroviral therapy (ART) and supportive therapy makes possible to use more aggressive anti-cancer chemotherapy (ChT) regimens in HIV-infected patients with lymphomas. The aim of the study was to evaluate the safety and efficacy of first-line CT in patients with HIV-related lymphomas, in comparison with patients without HIV.
Patients and methods
The study included 26 patients with HIV-related lymphomas (study group), who were treated with ChTs in our clinic since 2016. The control group included 26 patients without HIV infection with lymphomas who were treated with ChTs over the same period. The characteristics of these groups are shown in table 1. The patients with plasmoblastic lymphoma received the modified ChT: bortezomib instead of vincristine (2 patients in the study group, one case in the controls). HIV status at the start of chemotherapy in the study group was as follows: viral load (PCR-detectable HIV RNA) was suppressed to <50 copies/ml; median CD4+ cell count was 251 cells/µl (50-680); all the patients with HIV received ART, taking into account possible drug-drug interactions. The median follow-up time was 19 (3-44) months. The overall response rate (ORR), toxicity, overall survival (OS), progression-free survival (PFS), and time to progression (TTP) within 24 months from the start of ChTs were evaluated. The efficacy evaluation was based on the results of PET-CT, CT scans. Common Terminology Criteria for Adverse Events (CTCAE 5.0) were used to assess toxicity.
Tablе 1. Clinical characteristics of the patients and comparison group
Results
The ORR was 76.9% (CR, 57.6%) in the study group versus 69.3% (CR, 46.3%) in the control group. The incidence of hepatotoxicity did not differ between the groups (p=1.0), while the liver damage in the study group was more severe, probably, due to the presence of concomitant viral hepatitis in these patients. The incidence of 2-4 grade anemia was significantly higher than in the control group (p=0.08). OS within 24 months from the start of ChT for both groups (n=52) was 82.7%, in the study group, 80.8%, and did not significantly differ from the control group (84.6%; p=0.557). The PFS and TTP rates in the study group were 76.9% and 15.4%, respectively, which also did not differ significantly from the controls (71.3%; p=0.905; 15.4%; p=0.734).
Conclusion
The overall response rate to first-line therapy in patients with HIV-related lymphomas was 76.9%, the two-year overall survival was 80.8%, the progression-free survival was 76.9%, the time to progression was 15.4%, and did not differ significantly from the patients without HIV. Patients with HIV-related lymphomas have significantly higher incidence of 2-4 grade anemia during first-line chemotherapy compared to the control group. Our data confirm that the efficacy and safety of first-line chemotherapy in patients with HIV-related lymphomas is comparable to the patients without HIV.
Keywords
Lymphoma, HIV-related, chemotherapy, response rate.
