Epidemiology and outcome of lymphomas in HIV-infected patients: a multicenter retrospective study

Summary

Background

Since the beginning of global epidemic, almost 70 million of people have been infected with the HIV virus, and about 35 million people have died of AIDS. HIV infected patients are at risk for cancer including lymphomas, despite the widespread accessibility of highly active antiretroviral therapy (HAART). In parallel with increasing number of patients living with HIV, the number of patients suffering from HIV-associated malignancies of hematopoietic and lymphoid tissues has increased as well. The aim of our study was to determine epidemiological characteristics and the outcome of lymphomas in HIV-infected patients in Russian Federation.

Materials and methods

We performed a retrospective multicenter study. The inclusion criterion was a diagnosis of lymphoma in HIV-infected patients. Seventy-three patients were enrolled over a period from May 2006 to Dec 2015. We analyzed data of medical histories, laboratory tests, treatment in hematological hospitals and AIDS Centers, as based on established local guidelines. The median follow-up of the patients was 24 (2-110) months.

Results

Epidemiological and clinical characteristics (diagnosis) of the patients’ are presented in Figure 1. Table 1 presents clinical features of the HIV patients with lymphoproliferative disorders, characteristics of lymphoma status, and treatment data. Overall survival at 2 years in HIV-infected patients with lymphomas was 64% (HL, 80%; NHL, 60%; MM, 100%), time to progression (TTP) was 17% (HL, 20%; NHL, 16.7%; MM, 0%). Favorable prognostic factors for OS were: chemotherapy (ChT) in combination with HAART, adequacy of ChT for the type and stage of lymphoma. Favorable prognostic factors for TTP were: adequate ChT for the type and stage of disorder. Adverse prognostic factors for OS and TTP were: LDH level >500 U/L; B symptoms. Usage of ChT+Rituximab improved overall survival (67.6% vs 42%, p=0.07) and reduces the probability of progression of CD20+ B-cell lymphoma (8% vs 37%, p=0.01). Patient’s age, ECOG status, disease stage, presence of B symptoms and International Prognostic Index (IPI) had no impact on the outcome, which indicates to presence of other factors, which could include HIV Status (CD4+ cell levels, and viral load).

Conclusions

Aggressive DLBCL in HIV-positive patients was diagnosed more often than other lymphoma types. The 2-year OS in patients with HIV and lymphomas was 64%. Adequate ChT, with regard to type and stage of lymphoma in combination with HAART improved overall survival. LDH levels higher than 500 U/L and B-symptoms were adverse prognostic factors. Usage of Rituximab for CD20 B-cell lymphomas reduced the probability of progression. HIV status seems to play an important prognostic role for the further outcomes. Continuous prospective studies are required in the field.

Keywords

Hiv, lymphoma, polychemotherapy, rituximab, haart, lactate dehydrogenase