Changes in the influence of lymphoma- and HIV-specific factors on outcomes in AIDS-related non-Hodgkin lymphoma

Stefan K. Barta, M. S. Samuel, Xiaonan (Nan) Xue, D. Wang, J. Y. Lee, N. Mounier, J. M. Ribera, M. Spina, U. Tirelli, R. Weiss, L. Galicier, F. Boue, R. F. Little, K. Dunleavy, W. H. Wilson, C. Wyen, S. C. Remick, L. D. Kaplan, L. Ratner, A. NoyJoseph A. Sparano

Research output: Contribution to journalArticle

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Abstract

Background: We undertook the present analysis to examine the shifting influence of prognostic factors in HIV-positive patients diagnosed with aggressive non-Hodgkin lymphoma (NHL) over the last two decades. Patients and methods: We carried out a pooled analysis from an existing database of patients with AIDS-related lymphoma. Individual patient data had been obtained prior from prospective phase II or III clinical trials carried out between 1990 until 2010 in North America and Europe that studied chemo(immuno)therapy in HIV-positive patients diagnosed with AIDS-related lymphomas. Studies had been identified by a systematic review. We analyzed patient-level data for 1546 patients with AIDS-related lymphomas using logistic regression and Cox proportional hazard models to identify the association of patient-, lymphoma-, and HIV-specific variables with the outcomes complete response (CR), progression- free survival, and overall survival (OS) in different eras: pre-cART (1989-1995), early cART (1996-2000), recent cART (2001-2004), and contemporary cART era (2005-2010). Results: Outcomes for patients with AIDS-related diffuse large B-cell lymphoma and Burkitt lymphoma improved significantly over time, irrespective of baseline CD4 count or age-adjusted International Prognostic Index (IPI) risk category. Two-year OS was best in the contemporary era: 67% and 75% compared with 24% and 37% in the pre-cART era (P < 0.001). While the age-adjusted IPI was a significant predictor of outcome in all time periods, the influence of other factors waxed and waned. Individual HIV-related factors such as low CD4 counts (<50/mm<sup>3</sup>) and prior history of AIDS were no longer associated with poor outcomes in the contemporary era. Conclusions: Our results demonstrate a significant improvement of CR rate and survival for all patients with AIDSrelated lymphomas. Effective HIV-directed therapies reduce the impact of HIV-related prognostic factors on outcomes and allow curative antilymphoma therapy for the majority of patients with aggressive NHL.

Original languageEnglish (US)
Article numbermdv036
Pages (from-to)958-966
Number of pages9
JournalAnnals of Oncology
Volume26
Issue number5
DOIs
StatePublished - May 1 2015

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AIDS-Related Lymphoma
Non-Hodgkin's Lymphoma
Lymphoma
HIV
Acquired Immunodeficiency Syndrome
Phase III Clinical Trials
Phase II Clinical Trials
Burkitt Lymphoma
Survival
Lymphoma, Large B-Cell, Diffuse
CD4 Lymphocyte Count
North America
Proportional Hazards Models
Disease-Free Survival

Keywords

  • AIDS
  • Burkitt lymphoma
  • Diffuse large B-cell lymphoma
  • HIV
  • IPI
  • Lymphoma

ASJC Scopus subject areas

  • Oncology
  • Hematology

Cite this

Changes in the influence of lymphoma- and HIV-specific factors on outcomes in AIDS-related non-Hodgkin lymphoma. / Barta, Stefan K.; Samuel, M. S.; Xue, Xiaonan (Nan); Wang, D.; Lee, J. Y.; Mounier, N.; Ribera, J. M.; Spina, M.; Tirelli, U.; Weiss, R.; Galicier, L.; Boue, F.; Little, R. F.; Dunleavy, K.; Wilson, W. H.; Wyen, C.; Remick, S. C.; Kaplan, L. D.; Ratner, L.; Noy, A.; Sparano, Joseph A.

In: Annals of Oncology, Vol. 26, No. 5, mdv036, 01.05.2015, p. 958-966.

Research output: Contribution to journalArticle

Barta, SK, Samuel, MS, Xue, XN, Wang, D, Lee, JY, Mounier, N, Ribera, JM, Spina, M, Tirelli, U, Weiss, R, Galicier, L, Boue, F, Little, RF, Dunleavy, K, Wilson, WH, Wyen, C, Remick, SC, Kaplan, LD, Ratner, L, Noy, A & Sparano, JA 2015, 'Changes in the influence of lymphoma- and HIV-specific factors on outcomes in AIDS-related non-Hodgkin lymphoma', Annals of Oncology, vol. 26, no. 5, mdv036, pp. 958-966. https://doi.org/10.1093/annonc/mdv036
Barta, Stefan K. ; Samuel, M. S. ; Xue, Xiaonan (Nan) ; Wang, D. ; Lee, J. Y. ; Mounier, N. ; Ribera, J. M. ; Spina, M. ; Tirelli, U. ; Weiss, R. ; Galicier, L. ; Boue, F. ; Little, R. F. ; Dunleavy, K. ; Wilson, W. H. ; Wyen, C. ; Remick, S. C. ; Kaplan, L. D. ; Ratner, L. ; Noy, A. ; Sparano, Joseph A. / Changes in the influence of lymphoma- and HIV-specific factors on outcomes in AIDS-related non-Hodgkin lymphoma. In: Annals of Oncology. 2015 ; Vol. 26, No. 5. pp. 958-966.
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AU - Samuel, M. S.

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AU - Wang, D.

AU - Lee, J. Y.

AU - Mounier, N.

AU - Ribera, J. M.

AU - Spina, M.

AU - Tirelli, U.

AU - Weiss, R.

AU - Galicier, L.

AU - Boue, F.

AU - Little, R. F.

AU - Dunleavy, K.

AU - Wilson, W. H.

AU - Wyen, C.

AU - Remick, S. C.

AU - Kaplan, L. D.

AU - Ratner, L.

AU - Noy, A.

AU - Sparano, Joseph A.

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N2 - Background: We undertook the present analysis to examine the shifting influence of prognostic factors in HIV-positive patients diagnosed with aggressive non-Hodgkin lymphoma (NHL) over the last two decades. Patients and methods: We carried out a pooled analysis from an existing database of patients with AIDS-related lymphoma. Individual patient data had been obtained prior from prospective phase II or III clinical trials carried out between 1990 until 2010 in North America and Europe that studied chemo(immuno)therapy in HIV-positive patients diagnosed with AIDS-related lymphomas. Studies had been identified by a systematic review. We analyzed patient-level data for 1546 patients with AIDS-related lymphomas using logistic regression and Cox proportional hazard models to identify the association of patient-, lymphoma-, and HIV-specific variables with the outcomes complete response (CR), progression- free survival, and overall survival (OS) in different eras: pre-cART (1989-1995), early cART (1996-2000), recent cART (2001-2004), and contemporary cART era (2005-2010). Results: Outcomes for patients with AIDS-related diffuse large B-cell lymphoma and Burkitt lymphoma improved significantly over time, irrespective of baseline CD4 count or age-adjusted International Prognostic Index (IPI) risk category. Two-year OS was best in the contemporary era: 67% and 75% compared with 24% and 37% in the pre-cART era (P < 0.001). While the age-adjusted IPI was a significant predictor of outcome in all time periods, the influence of other factors waxed and waned. Individual HIV-related factors such as low CD4 counts (<50/mm3) and prior history of AIDS were no longer associated with poor outcomes in the contemporary era. Conclusions: Our results demonstrate a significant improvement of CR rate and survival for all patients with AIDSrelated lymphomas. Effective HIV-directed therapies reduce the impact of HIV-related prognostic factors on outcomes and allow curative antilymphoma therapy for the majority of patients with aggressive NHL.

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