Blood Journal
Leading the way in experimental and clinical research in hematology

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

  1. Stefan K. Barta1,
  2. Xiaonan Xue1,
  3. Dan Wang1,
  4. Roni Tamari2,
  5. Jeannette Y. Lee3,
  6. Nicolas Mounier4,
  7. Lawrence D. Kaplan5,
  8. Josep-Maria Ribera6,
  9. Michele Spina7,
  10. Umberto Tirelli7,
  11. Rudolf Weiss8,
  12. Lionel Galicier9,
  13. Francois Boue10,
  14. Wyndham H. Wilson11,
  15. Christoph Wyen12,
  16. Albert Oriol6,
  17. José-Tomás Navarro6,
  18. Kieron Dunleavy11,
  19. Richard F. Little11,
  20. Lee Ratner13,
  21. Olga Garcia6,
  22. Mireia Morgades6,
  23. Scot C. Remick14,
  24. Ariela Noy2, and
  25. Joseph A. Sparano1
  1. 1Albert Einstein Cancer Center, Bronx, NY;
  2. 2Division of Hematological Oncology, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, NY;
  3. 3Department of Biostatistics, University of Arkansas, Little Rock, AR;
  4. 4Groupe d'Etude des Lymphomes de l'Adulte (GELA), France;
  5. 5Adult Lymphoma Program, Division of Hematology-Oncology, University of California, San Francisco, CA;
  6. 6ICO-Hospital Germans Trias i Pujol, Jose Carreras Research Institute and PETHEMA Group, Badalona, Spain;
  7. 7Department of Medical Oncology, National Cancer Institute, Aviano, Italy;
  8. 8Private Practice for Hematology and Oncology, Bremen, Germany;
  9. 9Departments of Clinical Immunology, Hopital St. Louis, Assistance Publique-Hopitaux de Paris, Paris, France;
  10. 10Service de medecine interne et d'immunologie, Hopital Antoine Beclere, Clamart, France;
  11. 11Metabolism Branch and Clinical Investigations Branch, National Cancer Institute, Bethesda, MD;
  12. 12Department of Medicine, University Hospital Cologne, Cologne, Germany;
  13. 13Division of Oncology, Washington University, St. Louis, MO; and
  14. 14Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, WV

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).


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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