5 years ago

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

Outcomes for HIV-associated diffuse large B-cell lymphoma in the modern combined antiretroviral therapy era
Prevot, Sophie, Casasnovas, Rene-Olivier, Delobel, Pierre, Recher, Christian, Goujard, Cécile, Bonnet, Fabrice, Algarte-Genin, Michele, Besson, Caroline, Mekerri, Nawel, Meyohas, Marie-Caroline, Lancar, Remi, Mounier, Nicolas, Delarue, Richard, Hendel-Chavez, Houria, Gabarre, Jean, Partisani, Marialuisa, Oberic, Lucie, Boue, François, the ANRS-CO16 LYMPHOVIR Cohort, Costello, Regis, Taoufik, Yassine, Coppo, Paul, Costagliola, Dominique, Dos Santos, Gabriella
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/μl, 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.
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