CHOP Chemotherapy for Aggressive Non-Hodgkin Lymphoma with and without HIV in the Antiretroviral Therapy Era in Malawi

• Published in: PloS one 2016-03, Vol.11 (3), p.e0150445
• Main Authors: Gopal, Satish, Fedoriw, Yuri, Kaimila, Bongani, Montgomery, Nathan D, Kasonkanji, Edwards, Moses, Agnes, Nyasosela, Richard, Mzumara, Suzgo, Varela, Carlos, Chikasema, Maria, Makwakwa, Victor, Itimu, Salama, Tomoka, Tamiwe, Kamiza, Steve, Dhungel, Bal M, Chimzimu, Fred, Kampani, Coxcilly, Krysiak, Robert, Richards, Kristy L, Shea, Thomas C, Liomba, N George
• Format: Article
• Language: English
• Subjects: Adult; Adults; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Antirheumatic Agents - therapeutic use; B-cell lymphoma; Biology and Life Sciences; Bone marrow; Cancer; Cancer therapies; CD4 antigen; Cell survival; Chemotherapy; Consent; Cyclophosphamide; Cyclophosphamide - therapeutic use; Doxorubicin; Doxorubicin - therapeutic use; Drug therapy; Female; Hemoglobin; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - epidemiology; Hospitals; Human immunodeficiency virus; Humans; Laboratories; Lymphocytes B; Lymphocytes T; Lymphoma; Lymphoma, Non-Hodgkin - complications; Lymphoma, Non-Hodgkin - drug therapy; Lymphoma, Non-Hodgkin - epidemiology; Lymphoma, Non-Hodgkin - pathology; Malawi - epidemiology; Male; Medical diagnosis; Medicine; Medicine and Health Sciences; Middle Aged; Mortality; Neutropenia; Non-Hodgkin's lymphomas; Oncology; Pathology; Patient outcomes; Patients; People and Places; Prednisone - therapeutic use; Radiation therapy; Ribonucleic acid; RNA; Survival Analysis; Trends; Ultrasonic imaging; Vincristine - therapeutic use
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0150445

There are no prospective studies of aggressive non-Hodgkin lymphoma (NHL) treated with CHOP in sub-Saharan Africa. We enrolled adults with aggressive NHL in Malawi between June 2013 and May 2015. Chemotherapy and supportive care were standardized, and HIV+ patients received antiretroviral therapy (ART). Thirty-seven of 58 patients (64%) were HIV+. Median age was 47 years (IQR 39-56), and 35 (60%) were male. Thirty-five patients (60%) had stage III/IV, 43 (74%) B symptoms, and 28 (48%) performance status ≥ 2. B-cell NHL predominated among HIV+ patients, and all T-cell NHL occurred among HIV- individuals. Thirty-one HIV+ patients (84%) were on ART for a median 9.9 months (IQR 1.1-31.7) before NHL diagnosis, median CD4 was 121 cells/μL (IQR 61-244), and 43% had suppressed HIV RNA. HIV+ patients received a similar number of CHOP cycles compared to HIV- patients, but more frequently developed grade 3/4 neutropenia (84% vs 31%, p = 0.001), resulting in modestly lower cyclophosphamide and doxorubicin doses with longer intervals between cycles. Twelve-month overall survival (OS) was 45% (95% CI 31-57%). T-cell NHL (HR 3.90, p = 0.017), hemoglobin (HR 0.82 per g/dL, p = 0.017), albumin (HR 0.57 per g/dL, p = 0.019), and IPI (HR 2.02 per unit, p