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

Stefan K. Barta; M. S. Samuel; X. 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. Noy; J. A. Sparano

doi:10.1093/annonc/mdv036

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

Stefan K. Barta, M. S. Samuel, X. 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. NoyJ. A. Sparano

Research output: Contribution to journal › Article › peer-review

74 Scopus citations

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/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.

Original language	English (US)
Pages (from-to)	958-966
Number of pages	9
Journal	Annals of Oncology
Volume	26
Issue number	5
DOIs	https://doi.org/10.1093/annonc/mdv036
State	Published - May 1 2015

Keywords

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

ASJC Scopus subject areas

Hematology
Oncology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/annonc/mdv036

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Barta, S. K., Samuel, M. S., Xue, X., 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., ... Sparano, J. A. (2015). Changes in the influence of lymphoma- and HIV-specific factors on outcomes in AIDS-related non-Hodgkin lymphoma. Annals of Oncology, 26(5), 958-966. https://doi.org/10.1093/annonc/mdv036

Barta, SK, Samuel, MS, Xue, X, 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, pp. 958-966. https://doi.org/10.1093/annonc/mdv036

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

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/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.",

keywords = "AIDS, Burkitt lymphoma, Diffuse large B-cell lymphoma, HIV, IPI, Lymphoma",

author = "Barta, {Stefan K.} and Samuel, {M. S.} and X. Xue and D. Wang and Lee, {J. Y.} and N. Mounier and Ribera, {J. M.} and M. Spina and U. Tirelli and R. Weiss and L. Galicier and F. Boue and Little, {R. F.} and K. Dunleavy and Wilson, {W. H.} and C. Wyen and Remick, {S. C.} and Kaplan, {L. D.} and L. Ratner and A. Noy and Sparano, {J. A.}",

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doi = "10.1093/annonc/mdv036",

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T1 - Changes in the influence of lymphoma- and HIV-specific factors on outcomes in AIDS-related non-Hodgkin lymphoma

AU - Barta, Stefan K.

AU - Samuel, M. S.

AU - Xue, X.

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, J. A.

PY - 2015/5/1

Y1 - 2015/5/1

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.

AB - 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.

KW - AIDS

KW - Burkitt lymphoma

KW - Diffuse large B-cell lymphoma

KW - HIV

KW - IPI

KW - Lymphoma

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

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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