Changing Incidence and Survival in Patients with AIDS-Related Non-Hodgkin's Lymphomas in the Era of Highly Active Antiretroviral Therapy (HAART)

Abstract

To determine role of highly active antiretroviral therapy (HAART) and additional factors in incidence and outcome of patients with AIDS-related non-Hodgkin's lymphomas (NHL) we retrospectively analyzed 257 cases of AIDS-related NHL (24 low-grade, 168 high-grade B-cell, 6 high-grade T-cell, and 59 primary CNS lymphomas (PCNSL) among 2004 patients with HIV-infection treated at the University Hospital of Frankfurt, Germany from January 1983 to May 1999. Data were evaluated by univariate and multivariate analyses, using overall survival as end point. Patients received CHOP-like therapy as standard treatment. Until May 1999 incidence of all diagnosed cases of NHL was decreasing (1991-94: 14.2% versus 1995-5/99: 12.8%). Mainly, the incidence of low-grade NHL and PCNSL clearly decreased whereas the incidence of high-grade B-cell NHL increased compared to all diagnosed cases of NHL (1983-86: 53.3% versus 1995-5/99: 78.6%). One-year survival probability of all screened patients with AIDS related NHL was 54%, while 5-year survival rate remained 5%. We found age <25 years, development of NHL in the years before 1990, IVDU, CD4 counts <150/microl, PCNSL as well as NHL as the AIDS index disease, to be highly significant independent predictors of poor survival, including increased hazard ratios. In the era of HAART incidence of NHL is decreasing, mainly the incidence of low-grade NHL and PCNSL. Overall survival of patients has been prolonged with HAART. This development is mainly due to improvement of antiretroviral therapy, rather than to any fundamental changes in the chemotherapeutic treatment of NHL. Therefore, new treatment approaches for AIDS-related NHL should focus on more efficient antiretroviral therapy in association with combination chemotherapy.

Beneficial Effect of Highly Active Antiretroviral Therapy on the Prognosis of AIDS-Related Systemic Non-Hodgkin Lymphomas

“…Indeed, recent large cohort studies addressing this question gave conflicting results. [9][10][11][12][13][14][15][16][17] These discrepancies may be at least related to the duration of the follow-up, the response to HAART, the design of the statistical analyses performed, and the heterogeneity of the antitumoral chemotherapy administered in patients. The objective of this study was to evaluate the impact of HAART on the clinical outcome of patients with ARL who were treated uniformly with the same chemotherapy regimens throughout the duration of the period, which extended over 8 years.…”

Linfomas asociados a infección por Virus de Inmunodeficiencia Humana: Experiencia de un centro hospitalario de la V región, Chile

“…La edad mediana en esta serie fue de 39,5 años, lo cual es concordante con otros reportes 7,[18][19][20] . Por otra parte, existió un claro predominio de pacientes varones en este estudio, hecho que se ha atribuido a una mayor incidencia de infección por VIH en pacientes del género masculino [20][21][22][23] . En todos los casos el diagnóstico de linfoma se efectuó en etapa SIDA, con seis pacientes (42,8%) con recuentos de linfocitos CD4 < 50 céls/mm 3 , lo cual es compatible con el incremento del riesgo de ocurrencia de linfoma en estados de inmunodefi ciencia severa 2,8 .…”

“…No obstante, destaca el hecho que todos los pacientes sobrevivientes a la fecha, hayan recibido TARGA asociada a quimioterapia intravenosa, y más aún, que cinco de ellos se encuentren en RC a la fecha de redacción de este informe. Dicha observación concuerda con algunos reportes que han demostrado la viabilidad del uso concomitante de quimioterapia y TARGA [22][23]25,29 . Considerando el grado de compromiso clí-nico e inmunológico, los tipos histológicos más frecuentes y el bajo número de pacientes que se encontraba recibiendo TARGA al momento del diagnóstico de linfoma, se sugiere que el comportamiento de esta serie respecto a la asociación diagnóstica Linfoma/VIH se asemeja al observado durante la era pre-TARGA, con predominio de aquellos tipos histológicos defi nitorios de SIDA y bajos porcentajes de remisión completa.…”

Antigen-Presenting Cell Modulation Induces a Memory Response to p24 in Peripheral Blood Leukocytes from Human Immunodeficiency Virus-Infected Individuals

“…As a further confounding variable, the role of the viral load as an independent predictor of disease progression for CD4 counts greater than 350 cells/mm 3 has been difficult to ascertain (22), even in light of the in vitro data suggesting immunesuppressive effects of the virus on proliferation to recall and HIV-1 antigens (28,30,37). Incomplete reconstitution in some individuals is suggested by the fact that the incidence of malignancy continues to be high in individuals infected with and treated for their HIV-1 disease (9,27).With the ongoing efforts in HIV vaccine research, the ability to identify individuals with competent cellular immunity becomes important for additional reasons. Questions such as who will respond to vaccination as well as what factors affect their ability to respond are critically important in determining responder populations as well as the immunopathology for individuals without this immunity.…”

“…As a further confounding variable, the role of the viral load as an independent predictor of disease progression for CD4 counts greater than 350 cells/mm 3 has been difficult to ascertain (22), even in light of the in vitro data suggesting immunesuppressive effects of the virus on proliferation to recall and HIV-1 antigens (28,30,37). Incomplete reconstitution in some individuals is suggested by the fact that the incidence of malignancy continues to be high in individuals infected with and treated for their HIV-1 disease (9,27).…”