Authors: Ribera, Josep-Maria¹; Oriol, Albert¹; Morgades, Mireia¹; González-Barca, Eva²; Miralles, Pilar³; López-Guillermo, Armando⁴; Gardella, Santiago⁵; López, Andres⁶; Abella, Eugenia⁷; García, Marta⁸

Source: British Journal of Haematology, Volume 140, Number 4, February 2008 , pp. 411-419(9)

Publisher: Wiley-Blackwell

Abstract:

Summary

Immunochemotherapy with cyclophosphamide, adriamycin, vincristine, prednisone and rituximab (R-CHOP) is the standard treatment in non-immunosuppressed patients with diffuse large B-cell lymphoma (DLBCL), but its adequacy has not been definitively established in patients with human immunodeficiency virus (HIV)-related lymphoma. This phase II trial aimed to evaluate the safety and efficacy of six cycles of R-CHOP in patients with HIV-related DLBCL and to determine whether response to highly active antiretroviral therapy (HAART) had prognostic impact. Patients were eligible if they had performance status <3 and absence of active opportunistic infections. Eighty-one patients were enrolled, 57 in stages III or IV, International Prognostic Index (IPI) 0 or 1 (n = 26), 2 (n = 19), 3 (n = 20) and 4 or 5 (n = 16), and median CD4 lymphocyte count of 0·158 × 10⁹/l. The main adverse events were neutropenia (48% of cycles) and infections (10% of cycles), which were fatal in seven patients. Complete response was achieved in 55 (69%) patients, with an estimated 3-year disease-free survival of 77% and 3-year overall survival of 56%. IPI score and virological response to HAART were the prognostic parameters for response and survival. In HIV-related DLBCL R-CHOP is feasible, safe and effective. The prognosis depends on lymphoma-related parameters and on the response to HAART.

Keywords: HIV-related diffuse large B-cell lymphoma; CHOP; rituximab; highly active antiretroviral therapy; virological response

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1365-2141.2007.06943.x

Affiliations: 1: Haematology Department, Institut Català d'Oncologia-Hospital Universitari Germans Trias i Pujol, Badalona 2: Haematology Department, Institut Català d'Oncologia-HospitalIDuran y Reynals, L'Hospitalet de Llobregat, Barcelona 3: Infectious Diseases Department, Hospital Gregorio Marañón, Madrid 4: Haematology Department, Hospital Clinic, Barcelona 5: Haematology Department, Institut Català d'Oncologia-Hospital Josep Trueta, Girona 6: Haematology Department, Hospital Vall d'Hebron, Barcelona 7: Haematology Department, Hospital del Mar, Barcelona 8: Haematology Department, Consorci Hospitalari, Terrassa, Spain

Publication date: 2008-02-01

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