Influence of highly active anti‐retroviral therapy on response to treatment and survival in patients with acquired immunodeficiency syndrome‐related non‐Hodgkin's lymphoma treated with cyclophosphamide, hydroxydoxorubicin, vincristine and prednisone

Abstract

Combined highly active anti-retroviral therapy (HAART) with protease and reverse transcriptase inhibitors has modified the natural history of opportunistic infections and neoplasms in human immunodeficiency virus (HIV)-infected patients. We analysed the influence of HAART on the response to treatment and survival in a series of 58 patients with acquired immune deficiency syndrome (AIDS)-related non-Hodgkin's lymphoma (NHL) treated with CHOP (cyclophosphamide, hydroxydoxorubicin, vincristine and prednisone). Two groups of patients were included: (i) forty-one patients diagnosed with NHL between 1988 and 1996 who were not treated with HAART; (ii) seventeen patients diagnosed since 1996, who were receiving or commenced HAART when NHL was diagnosed. The response rate to CHOP was higher in group 2 (13 out of 17 cases; 75%) than in group 1 (14 out of 41 cases; 34%) (P = 0.003). The 2-year probability of event-free survival (EFS) [95% confidence interval (CI)] for group 1 was 0.5 (0.24-0.74), whereas for group 2 it was 0.85 (0.61-0.90) (P = 0.024). The lymphoma-free survival (LFS) was also significantly different for both groups (2-year LFS probability 0.53 vs. 1.0, P = 0.04). The median (95% CI) overall survival (OS) for group 1 was 7 months (range, 3-10.8 months), whereas it was not reached in group 2 (P = 0.0015). In the multivariate analysis for remission attainment, the only variables with a higher probability to achieve complete remission (CR) were HAART (P = 0.01) and International Prognostic Index score 1 (P = 0.02). The only statistically significant variable in the multivariate analysis for EFS was HAART (P = 0.049) and the variables with prognostic value for OS in the multivariate analysis were B symptoms (P = 0.01) and HAART (P = 0.003). Patients with AIDS-related NHL treated with CHOP and HAART had a higher CR rate than those treated only with CHOP. In this study, HAART was an independent prognostic factor for CR, OS and EFS in patients with AIDS-related NHL.

Effect of highly active antiretroviral therapy on survival among HIV‐infected men with Kaposi sarcoma or non‐Hodgkin lymphoma

“…In one study, Vaccher et al 43 found reduced opportunistic infections and mortality among patients exposed to HAART and combination cyclophosphamide, hydroxydoxorubicin, vincristine and prednisone chemotherapy (CHOP) compared to those exposed only to CHOP. Similarly, Navarro et al 44 found response to CHOP to be higher among those on HAART compared to those not receiving HAART. It remains possible, however, that the prolonged survival in our study might be due to the use of newer modalities of cancer therapy such as Taxol for KS and Rituximab for lymphoma in the era of HAART.…”

Cytologic features of plasmablastic lymphoma

“…The median and overall survivals in the series by Feldstein et al appear to be similar to acquired immunodeficiency syndrome (AIDS)-related lymphoma survival in the highly active antiretroviral therapy (HAART) era reported elsewhere. 11,23,24 In summary, PBL is a variant of large cell lymphoma with heterogeneous cytologic findings but distinct immunophenotype. Knowledge of the cytomorphologic spectrum of PBL and detection of CD138 expression by flow cytometry can be helpful in achieving a correct diagnosis.…”

Intensive chemotherapy with cyclophosphamide, doxorubicin, high‐dose methotrexate/ifosfamide, etoposide, and high‐dose cytarabine (CODOX‐M/IVAC) for human immunodeficiency virus–associated Burkitt lymphoma

“…32 Another study has suggested that concomitant HAART and standarddose CHOP chemotherapy may actually improve CR and overall survival rates in patients with AIDS-related lymphomas by reducing the incidence and morbidity of opportunistic infections. 33 In the pre-HAART era, a few Phase II studies of aggressive chemotherapy regimens included HIV-positive patients with BL. At MSKCC, 3 of 9 HIV-positive patients (30%) with BL were cured with an aggressive ALL regimen.…”