Treatment factors affecting outcomes in HIV-associated non-Hodgkin lymphomas: a pooled analysis of 1546 patients

Abstract

Key Points Rituximab use is associated with significant improvement in all outcomes for patients with HIV-associated CD20-positive lymphomas. Infusional EPOCH chemotherapy is associated with better overall survival in patients with AIDS-related diffuse large B-cell lymphoma (DLBCL).

Prognostic variables and 4-year survival outcomes in CD20 Positive AIDS-Related Lymphoma in the Anti-retroviral treatment era: A Retrospective Review from a Single Centre in KwaZulu-Natal, South Africa

“…In this study, there was no improvement in outcome with the use of rituximab, in contrast to the clearly proven benefit in multiple international studies [ 16 , 42 – 44 ]. Unsurprisingly, patients who received 6–8 cycles of chemotherapy had a significantly better outcome than patients receiving < 6 cycles of chemotherapy (p = <0.001).…”

Prognostic variables and 4-year survival outcomes in CD20 Positive AIDS-Related Lymphoma in the Anti-retroviral treatment era: A Retrospective Review from a Single Centre in KwaZulu-Natal, South Africa

“…In this study, there was no improvement in outcome with the use of rituximab, in contrast to the clearly proven benefit in multiple international studies [ 16 , 42 – 44 ]. Unsurprisingly, patients who received 6–8 cycles of chemotherapy had a significantly better outcome than patients receiving < 6 cycles of chemotherapy (p = <0.001).…”

Survival of AIDS‐related diffuse large B‐cell lymphoma, Burkitt lymphoma, and plasmablastic lymphoma in the German HIV Lymphoma Cohort

“…The 63% 2‐year OS rate of patients with HIV‐DLBCL in our cohort is in line with previously reported data (Ribera et al , ; Barta et al , ). However, the OS appears to be lower than that reported with infusional regimens, such as R‐EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) or R‐CDE (rituximab, cyclophosphamide, doxorubicin, etoposide) (Spina et al , ; Dunleavy et al , ).…”

“…However, this observation may be explained by the better immune status of HIV-BL in our cohort (median CD4-cell count at diagnosis 0Á31 9 10 9 /l vs. 0Á207 9 10 9 /l). The 63% 2-year OS rate of patients with HIV-DLBCL in our cohort is in line with previously reported data (Ribera et al, 2008;Barta et al, 2013). However, the OS appears to be lower than that reported with infusional regimens, such as R-EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) or R-CDE (rituximab, cyclophosphamide, doxorubicin, etoposide) (Spina et al, 2005;Dunleavy et al, 2010).…”

Outcomes of human immunodeficiency virus‐associated Burkitt lymphoma and diffuse large B‐cell lymphoma treated in Australia: A report from the Australasian Lymphoma Alliance

“…The high deliverability and tolerability of this treatment in our cohorts was shown, with >85% of our patients completing the intended course of therapy with a low treatment‐related mortality rate. Immune recovery appeared to be adequate in our cohort, with a steady rise in the mean CD4 counts over the course of 12 months after chemotherapy, comparable to an earlier study by Rodrigo et al 34 This is important given that the majority (90%) of our cohort received concurrent ART, consistent with previous studies that have concluded that concurrent ART with chemotherapy resulted in better HIV control, accelerated immune recovery, reduced infectious complications and acquired immune deficiency syndrome (AIDS)‐defining events, and potentially improved treatment response rates and OS 11,35 . The four (10%) patients who did not receive concurrent ART were treated before the landmark START study was published, a study supporting the early initiation of ART in asymptomatic, immunocompetent patients with HIV, reflecting the clinical equipoise on the early initiation of ART at that time 36 .…”

Prognostic variables and 4-year survival outcomes in CD20 Positive AIDS-Related Lymphoma in the Anti-retroviral treatment era: A Retrospective Review from a Single Centre in KwaZulu-Natal, South Africa

“…In this study, there was no improvement in outcome with the use of rituximab, in contrast to the clearly proven benefit in multiple international studies [ 16 , 42 – 44 ]. Unsurprisingly, patients who received 6–8 cycles of chemotherapy had a significantly better outcome than patients receiving < 6 cycles of chemotherapy (p = <0.001).…”

Survival of AIDS‐related diffuse large B‐cell lymphoma, Burkitt lymphoma, and plasmablastic lymphoma in the German HIV Lymphoma Cohort

“…The 63% 2‐year OS rate of patients with HIV‐DLBCL in our cohort is in line with previously reported data (Ribera et al , ; Barta et al , ). However, the OS appears to be lower than that reported with infusional regimens, such as R‐EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) or R‐CDE (rituximab, cyclophosphamide, doxorubicin, etoposide) (Spina et al , ; Dunleavy et al , ).…”

“…However, this observation may be explained by the better immune status of HIV-BL in our cohort (median CD4-cell count at diagnosis 0Á31 9 10 9 /l vs. 0Á207 9 10 9 /l). The 63% 2-year OS rate of patients with HIV-DLBCL in our cohort is in line with previously reported data (Ribera et al, 2008;Barta et al, 2013). However, the OS appears to be lower than that reported with infusional regimens, such as R-EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) or R-CDE (rituximab, cyclophosphamide, doxorubicin, etoposide) (Spina et al, 2005;Dunleavy et al, 2010).…”

Outcomes of human immunodeficiency virus‐associated Burkitt lymphoma and diffuse large B‐cell lymphoma treated in Australia: A report from the Australasian Lymphoma Alliance

“…The high deliverability and tolerability of this treatment in our cohorts was shown, with >85% of our patients completing the intended course of therapy with a low treatment‐related mortality rate. Immune recovery appeared to be adequate in our cohort, with a steady rise in the mean CD4 counts over the course of 12 months after chemotherapy, comparable to an earlier study by Rodrigo et al 34 This is important given that the majority (90%) of our cohort received concurrent ART, consistent with previous studies that have concluded that concurrent ART with chemotherapy resulted in better HIV control, accelerated immune recovery, reduced infectious complications and acquired immune deficiency syndrome (AIDS)‐defining events, and potentially improved treatment response rates and OS 11,35 . The four (10%) patients who did not receive concurrent ART were treated before the landmark START study was published, a study supporting the early initiation of ART in asymptomatic, immunocompetent patients with HIV, reflecting the clinical equipoise on the early initiation of ART at that time 36 .…”

Prognostic variables and 4-year survival outcomes in CD20 Positive AIDS-Related Lymphoma in the Anti-retroviral treatment era: A Retrospective Review from a Single Centre in KwaZulu-Natal, South Africa

“…In this study, there was no improvement in outcome with the use of rituximab, in contrast to the clearly proven benefit in multiple international studies [ 16 , 42 – 44 ]. Unsurprisingly, patients who received 6–8 cycles of chemotherapy had a significantly better outcome than patients receiving < 6 cycles of chemotherapy (p = <0.001).…”

Survival of AIDS‐related diffuse large B‐cell lymphoma, Burkitt lymphoma, and plasmablastic lymphoma in the German HIV Lymphoma Cohort

“…The 63% 2‐year OS rate of patients with HIV‐DLBCL in our cohort is in line with previously reported data (Ribera et al , ; Barta et al , ). However, the OS appears to be lower than that reported with infusional regimens, such as R‐EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) or R‐CDE (rituximab, cyclophosphamide, doxorubicin, etoposide) (Spina et al , ; Dunleavy et al , ).…”

“…However, this observation may be explained by the better immune status of HIV-BL in our cohort (median CD4-cell count at diagnosis 0Á31 9 10 9 /l vs. 0Á207 9 10 9 /l). The 63% 2-year OS rate of patients with HIV-DLBCL in our cohort is in line with previously reported data (Ribera et al, 2008;Barta et al, 2013). However, the OS appears to be lower than that reported with infusional regimens, such as R-EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) or R-CDE (rituximab, cyclophosphamide, doxorubicin, etoposide) (Spina et al, 2005;Dunleavy et al, 2010).…”

Outcomes of human immunodeficiency virus‐associated Burkitt lymphoma and diffuse large B‐cell lymphoma treated in Australia: A report from the Australasian Lymphoma Alliance

“…The high deliverability and tolerability of this treatment in our cohorts was shown, with >85% of our patients completing the intended course of therapy with a low treatment‐related mortality rate. Immune recovery appeared to be adequate in our cohort, with a steady rise in the mean CD4 counts over the course of 12 months after chemotherapy, comparable to an earlier study by Rodrigo et al 34 This is important given that the majority (90%) of our cohort received concurrent ART, consistent with previous studies that have concluded that concurrent ART with chemotherapy resulted in better HIV control, accelerated immune recovery, reduced infectious complications and acquired immune deficiency syndrome (AIDS)‐defining events, and potentially improved treatment response rates and OS 11,35 . The four (10%) patients who did not receive concurrent ART were treated before the landmark START study was published, a study supporting the early initiation of ART in asymptomatic, immunocompetent patients with HIV, reflecting the clinical equipoise on the early initiation of ART at that time 36 .…”