ISSN 1866-8836
Клеточная терапия и трансплантация

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

Marina Popova1, Tatyana Shneyder2, Igor Karaygin2, Olga Ponomarenko2, Ilya Zuyzgin2,11, Olga Ryabykina2, Olga Ruzhinskaya2, Olga Uspenskaya2, Nadezhda Medvedeva3, Anna Klimovich3, Vsevolod Potapenko3, Natalya Kotova3,11, Elena Zinina4, Natalya Popova4, Ylia Zhurba4, Alexander Myasnikov5, Svetlana Moshnina5, Alexey Evseev5, Tatyana Pospelova6, Kamil Kaplanov7, Tatyana Ksenzova8, Elena Karyagina9, Zhanna Stolypina9, Svetlana Dzola10, Alexander Levanov10, Evgenya Borzenkova1, Anastasya Nekrasova1, Natalya Mikhaylova1, Ludmila Zubarovskaya1, Boris Afanasyev1
1Raisa Gorbacheva Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St.Petersburg;
2Leningrad Regional Clinical Hospital, St.Petersburg;
3City Clinical Hospital №31, St.Petersburg;
4Surgut District Clinical Hospital, Surgut;
5Republican Clinical Hospital, Petrozavodsk;
6Center of Hematology, Novosibirsk;
7Volgograd Regional Clinical Oncologycal Hospital, Volgograd;
8Regional Clinical Hospital, Tumen’;
9City Clinical Hospital №15, St.Petersburg;
10Clinic of Profpathology and Hematology, Saratov State Medical University, Saratov;
11Petrov Research Institute of Oncology, St.Petersburg


Contact: Dr. Marina O.Popova
E-mail: marina.popova.spb@gmail.com
doi 10.18620/ctt-1866-8836-2016-5-3-67-70
Submitted 12 September 2016
Accepted 29 September 2016

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Cellular Therapy and Transplantation (CTT)
Volume 5, Number 3
Contents 

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).

Histological types of lymphoproliferative diseases in HIV-infected patients

 Clinical characteristics of the patients under study

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


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