AIDS-related non-Hodgkin lymphoma: final analysis of 485 patients treated with risk-adapted intensive chemotherapy

• Published in: Blood 2006-05, Vol.107 (10), p.3832-3840
• Main Authors: Mounier, Nicolas, Spina, Michele, Gabarre, Jean, Raphael, Martine, Rizzardini, Giuliano, Golfier, Jean-Baptiste, Vaccher, Emanuela, Carbone, Antonino, Coiffier, Bertrand, Chichino, Guido, Bosly, Andre, Tirelli, Umberto, Gisselbrecht, Christian
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Antiretroviral Therapy, Highly Active; CD4 Lymphocyte Count; Cyclophosphamide - administration & dosage; Doxorubicin - administration & dosage; Drug Administration Schedule; Female; Humans; Lymphoma, AIDS-Related - classification; Lymphoma, AIDS-Related - drug therapy; Lymphoma, AIDS-Related - mortality; Male; Middle Aged; Neoplasm Staging; Prednisolone - administration & dosage; Risk Assessment; Survival Analysis; Vincristine - administration & dosage
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2005-09-3600

We aimed to compare AIDS risk–adapted intensive chemotherapy in AIDS-related lymphoma (ARL) patients before and after the advent of highly active antiretroviral therapy (HAART). A total of 485 patients aged from 18 to 67 years were randomly assigned to chemotherapy after stratification according to an HIV score based on performance status, prior AIDS, and CD4+ cell counts below 0.10 × 109/L (100/mm3). A total of 218 good-risk patients (HIV score 0) received ACVBP (doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisolone) or CHOP (doxorubicin, cyclophosphamide, vincristine, and prednisolone); 177 intermediate-risk patients (HIV score 1), CHOP or low-dose CHOP (Ld-CHOP); and 90 poor-risk patients (HIV score 2-3), Ld-CHOP or VS (vincristine and steroid). The 5-year overall survival (OS) in the good-risk group was 51% for ACVBP versus 47% for CHOP (P = .85); in the intermediate-risk group, 28% for CHOP versus 24% for Ld-CHOP (P = .19); and in the poor-risk group, 11% for Ld-CHOP versus 3% for VS (P = .14). The time-dependent Cox model demonstrated that the only significant factors for OS were HAART (relative risk [RR] 1.6, P < .001), HIV score (RR 1.7, P < .001), and the International Prognostic Index (IPI) score (RR 1.5, P < .001) but not chemotherapy regimen. Our findings indicate that in ARL patients, HIV score, IPI score, and HAART affect survival but not the intensity of the CHOP-based chemotherapy.