Outcome of HIV-associated lymphoma in a resource-limited setting of Jos, Nigeria

Silas, Olugbenga A.; Achenbach, Chad; Hou, Lifang; Murphy, Robert L.; Egesie, Julie O; Sagay, Solomon A.; Agbaji, Oche; Agaba, PA; Musa, Jonah; Manasseh, A N; Jatau, ED; Dauda, Ayuba M; Akanbi, Maxwell O; Mandong, BM

doi:10.1186/s13027-017-0144-7

Cited by 12 publications

(10 citation statements)

References 31 publications

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“…The generally accepted cut-off for age according to IPI is 60-years [ 25 – 28 ]. We found that age ≥ 40 years was associated with a 2.5-fold increase in the hazards of death, which is similar to a study that was conducted in Nigeria [ 10 ]. Larger studies have provided conflicting results on the prognostic relevance of age categories which are below 60 years of age.…”

Section: Discussionsupporting

confidence: 88%

“…Literature on the survival of African patients with lymphoma is steadily increasing. However, these studies included a relatively small number of HIV-infected patients (8–75) [ 6 – 10 ]. Notwithstanding, cohort studies of lymphoma patients in southern Africa report 12-month overall survival (OS) rates of 40–45% regardless of the treatment used [ 6 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Survival of HIV-infected patients with high-grade non-Hodgkin’s lymphomas: A retrospective study of experiences in Zimbabwe

et al. 2020

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Background Rituximab in combination with chemotherapy is now widely accepted as standard of care for AIDS-related lymphomas (ARLs) of B-cell origin. However, the clinical impact of rituximab in resource limited settings remains unknown. Different settings and patient heterogeneity may affect the effect of any given treatment. The study objectives were to determine if rituximab use was associated with improved 18-month overall survival (OS) of patients with ARLs and to identify correlates of 18-month OS. Methods A retrospective review of medical records of adult HIV infected patients treated for high-grade large cell non-Hodgkin’s lymphoma with chemotherapy +/- rituximab between 2015–2017 was conducted. Vital status and disease progression/relapse at 18 months were determined. Survival functions were estimated using Kaplan-Meier methodology. Equality of survival functions were assessed using Log-rank tests and Cox regression analysis to identify risk factors for mortality. Results One hundred and twenty-four eligible medical records were identified. This was a cohort of black Africans with a median age of 42 (IQR: 33–47) and a 57% male gender distribution. Overall survival at 6, 12 and 18 months for the population was 75.9%, 44.0% and 30.6% respectively. Over the study period, 72.6% of patients were diagnosed with disease progression/ relapse. There was a higher rate of rituximab use in patients who were treated at a private institution and those with medical insurance. Rituximab use was not associated with a reduction in 18-month mortality [adjusted hazard ratio (aHR)1.28, (95% CI 0.63–2.60)]. Risk factors for 18-month mortality were male gender [aHR 1.89, (95% CI 1.04–3.43)], age 40+ years [aHR 2.49, (1.33–4.67)], receipt of <3 chemotherapy cycles [aHR 2.48, (95% CI 1.33–4.60)] and low socioeconomic status [aHR 2.44, (95% CI 1.28–4.67)]. Conclusions Predictors of mortality were male gender, older age, low socioeconomic status and receipt of a less than half of the recommended number of chemotherapy cycles. Rituximab use was not associated with an improvement in 18-month OS in Zimbabwean patients with ARLs.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Survival of HIV-infected patients with high-grade non-Hodgkin’s lymphomas: A retrospective study of experiences in Zimbabwe

et al. 2020

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“…Normal BMI and completion of 6 or more cycles of chemotherapy were associated with favourable survival in our study. A retrospective study on HIV associated lymphomas in Nigeria reported stage of lymphoma as the only factor predictive of survival [ 24 ]. Other factors that have been noted to predict survival include type of lymphoma [ 25 ], age, ECOG performance scores, stage of lymphoma and LDH level [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of treatment with CHOP and EPOCH in patients with HIV associated NHL in a low resource setting

et al. 2020

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Background: The optimal chemotherapy regimen for treating HIV associated NHL in low resource settings is unknown. We conducted a retrospective study to describe survival rates, treatment response rates and adverse events in patients with HIV associated NHL treated with CHOP and dose adjusted-EPOCH regimens at the Uganda Cancer Institute. Methods: A retrospective study of patients diagnosed with HIV and lymphoma and treated at the Uganda Cancer Institute from 2016 to 2018 was done. Results: One hundred eight patients treated with CHOP and 12 patients treated with DA-EPOCH were analysed. Patients completing 6 or more cycles of chemotherapy were 51 (47%) in the CHOP group and 8 (67%) in the DA-EPOCH group. One year overall survival (OS) rate in patients treated with CHOP was 54.5% (95% CI, 42.8-64.8) and 80.2% (95% CI, 40.3-94.8) in those treated with DA-EPOCH. Factors associated with favourable survival were BMI 18.5-24.9 kg/m 2 , (p = 0.03) and completion of 6 or more cycles of chemotherapy, (p < 0.001). The overall response rate was 40% in the CHOP group and 59% in the DA-EPOCH group. Severe adverse events occurred in 19 (18%) patients in the CHOP group and 3 (25%) in the DA-EPOCH group; these were neutropenia (CHOP = 13, 12%; DA-EPOCH = 2, 17%), anaemia (CHOP = 12, 12%; DA-EPOCH = 1, 8%), thrombocytopenia (CHOP = 7, 6%; DA-EPOCH = 0), sepsis (CHOP = 1), treatment related death (DA-EPOCH = 1) and hepatic encephalopathy (CHOP = 1). Conclusion: Treatment of HIV associated NHL with curative intent using CHOP and infusional DA-EPOCH is feasible in low resource settings and associated with > 50% 1 year survival.

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“…Normal BMI and completion of 6 or more cycles of chemotherapy were associated with favourable survival in our study. A retrospective study on HIV associated lymphomas in Nigeria reported stage of lymphoma as the only factor predictive of survival (27). Other factors that have been noted to predict survival include type of lymphoma (28), age, ECOG performance scores, stage of lymphoma and LDH level (29).…”

Section: Discussionmentioning

confidence: 99%

Comparison Of Treatment Outcomes Between Epoch And Chop Regimens In Patients With Hiv Associated NHL In A Low Resource Setting

Okello

Omoding

Ddungu

et al. 2020

Preprint

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Purpose: The optimal chemotherapy regimen for treating HIV associated NHL in low resource settings is unknown. We conducted a retrospective study to compare survival rates, treatment response rates and adverse events in patients with HIV associated NHL treated with EPOCH and CHOP regimens at the Uganda Cancer Institute.Methods: A retrospective study of patients diagnosed with HIV and lymphoma and treated at the Uganda Cancer Institute from 2016 – 2018 was done.Results: One hundred eight patients treated with CHOP and 12 patients treated with EPOCH were analysed. Patients completing 6 or more cycles of chemotherapy were 51 (47%) in the CHOP group and 8 (67%) in the EPOCH group (p=0.20). One year overall survival (OS) rate in patients treated with CHOP was 54.5% (95% CI, 42.8 – 64.8) and 80.2% (95% CI, 40.3 – 94.8) in those treated with EPOCH. The survival rates were not statistically different in the two groups; hazard ratio, 0.43 (95% CI, 0.10 - 1.78; p=0.24). Factor associated with favourable survival were BMI 18.5-24.9 kg/m2, (p=0.03) and completion of 6 or more cycles of chemotherapy, (p<0.001). The overall response rate was 40% in the CHOP group and 59% in the EPOCH group (P = 0.66). Severe adverse events occurred in 19 (18%) patients in the CHOP group and 3 (25%) in the EPOCH group (p=0.53). Severe adverse events were neutropenia (CHOP=13, 12%; EPOCH=2, 17%; p=0.65), anaemia (CHOP=12, 12%; EPOCH=1, 8%; P=0.71), thrombocytopenia (CHOP=7, 6%; EPOCH=0; p=0.36), sepsis (CHOP=1), treatment related death (EPOCH=1) and hepatic encephalopathy (CHOP=1).Conclusion: Overall survival rate, treatment response rates and adverse events were not different in patients treated with CHOP and EPOCH.

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Outcome of HIV-associated lymphoma in a resource-limited setting of Jos, Nigeria

Cited by 12 publications

References 31 publications

Survival of HIV-infected patients with high-grade non-Hodgkin’s lymphomas: A retrospective study of experiences in Zimbabwe

Survival of HIV-infected patients with high-grade non-Hodgkin’s lymphomas: A retrospective study of experiences in Zimbabwe

Outcomes of treatment with CHOP and EPOCH in patients with HIV associated NHL in a low resource setting

Comparison Of Treatment Outcomes Between Epoch And Chop Regimens In Patients With Hiv Associated NHL In A Low Resource Setting

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