Clinical Outcomes of People Living with Human Immunodeficiency Virus (HIV) with Diffuse Large B-Cell Lymphoma (DLBCL) in Shanghai, China
The intersection of human immunodeficiency virus (HIV) infection and cancer, particularly lymphoma, has been a significant area of research due to the increased risk of malignancies in people living with HIV (PLHIV). Among these malignancies, diffuse large B-cell lymphoma (DLBCL) is the most common histological type of non-Hodgkin lymphoma (NHL) associated with HIV infection, accounting for 50% to 80% of cases in the current era. This article provides a comprehensive overview of a study conducted in Shanghai, China, which investigated the clinical outcomes of PLHIV with DLBCL, focusing on treatment options, survival rates, and prognostic factors.
Introduction
Before the advent of combined antiretroviral therapy (cART), HIV infection inevitably progressed to acquired immunodeficiency syndrome (AIDS), significantly increasing the risk of opportunistic tumors, particularly NHL. The risk of HIV-associated lymphoma was over 100 times greater than that in non-HIV-infected individuals. With the widespread availability of cART, the incidence of these malignancies has decreased but remains significantly higher than in the general population. DLBCL is the most common type of NHL associated with HIV infection, and its treatment has evolved with the introduction of modern cART.
The primary chemotherapeutic regimens for DLBCL include R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) and DA-EPOCH-R (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab). However, the comparative effectiveness of these regimens in PLHIV with DLBCL remains controversial. This study aimed to evaluate the prognosis and compare the outcomes of DA-EPOCH-R with R-CHOP as frontline therapy for PLHIV with DLBCL receiving modern cART.
Methods
The study was a retrospective analysis conducted at the Shanghai Public Health Clinical Center from July 2012 to September 2019. The inclusion criteria were HIV-1 positivity, age older than 18 years, and a diagnosis of DLBCL confirmed by histological analysis using the 2016 World Health Organization (WHO) classification of lymphoma. Lymphoma staging was performed according to the Ann Arbor system, and tumor response was classified using the 2007 revised Cheson criteria.
The demographic and clinical data collected included age, gender, CD4 cell count, HIV RNA levels, cART regimen, and lymphoma stage. The primary outcomes were overall survival (OS) and progression-free survival (PFS), analyzed using Kaplan-Meier analysis. A Cox multiple regression model was constructed to identify factors associated with OS.
Results
A total of 54 eligible patients were included in the final analysis, with a median follow-up of 14 months. The mean age was 48 years, and 89% of the patients were men. Twenty-five patients received R-CHOP, and 29 received DA-EPOCH-R. The median CD4 count was 130 cells/μL, and 52% of the patients were on cART at the time of DLBCL diagnosis. The HIV RNA load data were available for 39 patients, with a median level of 30,300 copies/mL.
The 2-year OS for all patients was 73%, with no significant difference between the R-CHOP and DA-EPOCH-R groups (66% vs. 78%, respectively). The 5-year OS rates were similar for both groups (65% vs. 66%). The 2-year PFS was 64%, with no significant difference between the groups (64% for both). Cox regression analysis identified an International Prognostic Index (IPI) greater than 3 as the only factor associated with a decrease in OS, with a hazard ratio of 5.0.
Discussion
The study found that the outcomes of R-CHOP therapy did not differ significantly from those of DA-EPOCH-R therapy in PLHIV with DLBCL. This finding is consistent with previous studies that have shown similar survival rates for both regimens in the modern cART era. The 2-year OS rate of 73% in this study is higher than previously reported rates in China, likely due to higher CD4 cell counts and more robust cART regimens.
The study also highlighted the importance of the IPI in predicting survival outcomes. Patients with an IPI greater than 3 had a significantly worse prognosis, with a hazard ratio of 5.0. No HIV-related factors, such as CD4 cell count or HIV RNA levels, were associated with OS, indicating that in the modern cART era, these factors may no longer be significant determinants of survival in PLHIV with DLBCL.
The study’s limitations include a small sample size (n=54) and a relatively short follow-up period (median, 14 months). Additionally, factors such as MYC, BCL-2, and BCL-6 rearrangements, which may affect prognosis, were not available for analysis. Future studies with larger sample sizes and longer follow-up periods are needed to confirm these findings and explore additional prognostic factors.
Conclusion
In conclusion, this study provides valuable insights into the treatment and prognosis of PLHIV with DLBCL in the modern cART era. The findings suggest that both R-CHOP and DA-EPOCH-R are effective treatment options, with no significant difference in survival outcomes. The IPI remains a critical factor in predicting survival, while HIV-related factors may no longer play a significant role. These results underscore the importance of early diagnosis and treatment of DLBCL in PLHIV to improve survival outcomes.
doi.org/10.1097/CM9.0000000000001180
Was this helpful?
0 / 0