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Oral Combinational Antiretroviral Treatment in HIV-1 Infected Humanized Mice
Published on: October 6, 2022
Outcomes for HIV-associated diffuse large B-cell lymphoma in the modern combined antiretroviral therapy era
Caroline Besson1, Remi Lancar, Sophie Prevot
1aUnit of Hematology-Oncology, Centre Hospitalier de Versailles, Le ChesnaybUniversité Versailles Saint Quentin en Yvelines, Université Paris-Saclay, Communauté Paris-Saclay, PariscINSERM U1018, Centre pour la Recherche en Epidémiologie et Santé des Populations (CESP), Equipe 'Générations et Santé' Gustave Roussy, VillejuifdSorbonne Universités, INSERM, UPMC Univ Paris 06, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS1136), PariseUniversité Paris Sud, Faculté de médecine Paris Sud, Le Kremlin-BicêtrefPathology Unit, AP-HP, Hôpitaux Paris Sud Site Béclère, ClamartgInfectious Diseases Unit, CHU Toulouse, ToulousehInternal Medicine and Infectious Diseases Unit, CHU Bordeaux, INSERM U1219, Université de Bordeaux, BordeauxiInfectious Diseases Unit, AP-HP CHU Saint-Antoine, ParisjHIV Infection Unit, Hôpitaux Universitaires, StrasbourgkU1037, CRCT, University Toulouse III Paul SabatierlDepartment of Hematology, Institut Universitaire du Cancer (IUC), ToulousemDepartment of Hematology, AP-HP, CHU Pitié-Salpétrière, ParisnInternal Medicine Unit, AP-HP, Hôpitaux Paris Sud, Le Kremlin-BicêtreoClinical Immunology Unit, AP-HP, Hôpitaux Paris Sud Site Béclère, ClamartpDepartment of Hematology, AP-HP CHU Saint-Antoine, ParisqDepartment of Hematology, AP-HM, Assistance Publique Hôpitaux de Marseille, MarseillerImmunology Unit, AP-HP, Hôpitaux Paris Sud, Le Kremlin-BicêtresDepartment of Hematology, AP-HP, Hôpital Necker Enfants Malades, ParistHematology Unit, Centre Hospitalier Universitaire-Dijon, DijonuDepartment of Onco-Hematology, Archet Hospital, Nice, France.
Objective:
Non-Hodgkin's lymphoma (NHL) remains among the most frequent malignancies in persons living with HIV (PLWHIV). Survival among patients with HIV-associated diffuse large B-cell lymphoma (DLBCL), the most frequent NHL subtype, has improved markedly in recent years. We aimed to analyze characteristics and outcomes of DLBCL in HIV-infected patients in the era of modern combined antiretroviral therapy (cART).
Design:
PLWHIV with lymphoma were prospectively enrolled in the French ANRS-CO16 Lymphovir cohort between 2008 and 2015. We compared the patients treated with R-CHOP) (rituximab, cyclophosphamide, daunorubicin, vin-cristine, prednisolone) with HIV-negative DLBCL patients enrolled simultaneously in the R-CHOP arms of Lymphoma Study Association trials.
Results:
Among 110 PLWHIV with NHL, 52 (47%) had systemic DLBCL. These 52 cases had frequent extranodal disease (81%), poor performance status (35%) and advanced age-adjusted international prognostic index (aaIPI) (58%), and were mainly treated with R-CHOP (n = 44, 85%). Their median CD4 T-cell count was 233 cells/μl, and 79% of patients were on cART. The 2-year overall and progression-free survival rates were both 75% (95% confidence interval: 64%, 88%). Factors associated with progression or death in univariate analysis were poor performance status [hazard ratio: 3.3 (1.2, 8.9)], more than one extranodal site [hazard ratio: 3.4 (1.1, 10.5)] and an advanced aaIPI [hazard ratio: 3.7 (1.0, 13.1)]. Progression-free survival after R-CHOP therapy did not differ from that of the HIV-negative counterparts (P = 0.11).
Conclusion:
In the recent cART era, despite frequent high-risk features, the 2-year overall survival of HIV-DLBCL patients reaches 75%. Outcomes after R-CHOP therapy are similar to those of HIV-negative patients with similar aaIPI.
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