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

Stefan K. Barta, Xiaonan Xue, Dan Wang, Roni Tamari, Jeannette Y. Lee, Nicolas Mounier, Lawrence D. Kaplan, Josep-Maria Ribera, Michele Spina, Umberto Tirelli, Rudolf Weiss, Lionel Galicier, Francois Boue, Wyndham H. Wilson, Christoph Wyen, Albert Oriol, José-Tomás Navarro, Kieron Dunleavy, Richard F. Little, Lee Ratner, Olga Garcia, Mireia Morgades, Scot C. Remick, Ariela Noy, Joseph A. Sparano

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).

Abstract

Limited comparative data exist for the treatment of HIV-associated non-Hodgkin lymphoma. We analyzed pooled individual patient data for 1546 patients from 19 prospective clinical trials to assess treatment-specific factors (type of chemotherapy, rituximab, and concurrent combination antiretroviral [cART] use) and their influence on the outcomes complete response (CR), progression free survival (PFS), and overall survival (OS). In our analysis, rituximab was associated with a higher CR rate (odds ratio [OR] 2.89; P < .001), improved PFS (hazard ratio [HR] 0.50; P < .001), and OS (HR 0.51; P < .0001). Compared with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), initial therapy with more dose-intense regimens resulted in better CR rates (ACVBP [doxorubicin, cyclophosphamide, vindesine, bleomycin and prednisolone]: OR 1.70; P < .04), PFS (ACVBP: HR 0.72; P = .049; “intensive regimens”: HR 0.35; P < .001) and OS (“intensive regimens”: HR 0.54; P < .001). Infusional etoposide, prednisone, infusional vincristine, infusional doxorubicin, and cyclophosphamide (EPOCH) was associated with significantly better OS in diffuse large B-cell lymphoma (HR 0.33; P = .03). Concurrent use of cART was associated with improved CR rates (OR 1.89; P = .005) and trended toward improved OS (HR 0.78; P = .07). These findings provide supporting evidence for current patterns of care where definitive evidence is unavailable.

  • Submitted April 24, 2013.
  • Accepted August 27, 2013.
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