Population‐based outcome analysis of diffuse large B‐cell lymphoma in people living with HIV infection and competent individuals

Abstract

The prognostic factors and outcome of 58 acquired immunodeficiency syndrome-related diffuse large B-cell lymphoma (AR-DLBCL) patients from the Swiss HIV Cohort Study, diagnosed from 2004 to 2011, were compared with those of 326 immunocompetent (IC)-DLBCL from the Hematology Division of the Amedeo Avogadro University (Italy) and the Oncology Institute of Southern Switzerland. Median follow-up was 6 years; 5-year overall survival (OS) was 68% (95% CI: 63%-73%) in IC-DLBCL and 63% (95% CI: 49%-75%) in AR-DLBCL (P = .220). The acquired immunodeficiency syndrome-related lymphoma international prognostic index predicted OS in AR-DLBCL. Among 148 patients younger than 61 years (40 AR-DLBCL and 108 IC-DLBCL) treated with RCHOP/RCHOP-like regimens, 20 IC-DLBCL and 9 AR-DLBCL patients died and OS was not significantly different. A higher proportion of early deaths occurred in the AR-DLBCL: indeed, 1-year OS was 94% (95% CI: 87%-97%) in IC-DLBCL and 82% (95% CI: 66%-91%) in AR-DLBCL patients. After rituximab and active antiretroviral therapy introduction, AR-DLBCL and IC-DLBCL patients treated with curative intent have similar long-term survival.

The effectiveness of rituximab and HIV on the survival of Ontario patients with diffuse large B‐cell lymphoma

“…Moreover, antibiotic prophylaxis is routine, maintenance rituximab is not standard practice, and more recent phase II and population-based studies completed in this era have suggested excellent disease control without the same propensity for causing infectious toxicities suggested by the earlier Kaplan trial. 19,[27][28][29][30][31][32] Our results are consistent with this evolution in literature and practice. In the current era, the benefit of rituximab appears to be safely realized when administered with concomitant immune reconstitution via HAART, thoughtful antibiotic prophylaxis, and careful selection of patients according to CD4+ cell count.…”

“…Modern HAART is not associated with added myelosuppression and an emphasis on compliance has led to immune reconstitution even during the course of chemotherapy. Moreover, antibiotic prophylaxis is routine, maintenance rituximab is not standard practice, and more recent phase II and population‐based studies completed in this era have suggested excellent disease control without the same propensity for causing infectious toxicities suggested by the earlier Kaplan trial 19,27‐32 . Our results are consistent with this evolution in literature and practice.…”

Human Immunodeficiency Virus Related Non-Hodgkin’s Lymphoma

“…3 A population based outcome analysis of DLBCL in people living with HIV infection and competent individuals in Italy by Conconi et al in 2018, showed that DLBCL patients are more likely positive for hepatitis B virus (61% vs 4%) and hepatitis C virus (25% vs 13%) infections. 35…”