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Recurrent Lymphoma Infrequent With HIV, But Prognosis Remains Poor
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15th European AIDS Conference, October 21-24, 2015, Barcelona
Mark Mascolini
Recurrent Hodgkin lymphoma (HL) or non-Hodgkin lymphoma (NHL) proved infrequent after complete remission in a 32-center German study [1]. But outcomes remained poor with recurrent lymphoma, and the study could not pinpoint recurrence predictors.
Researchers working with the German AIDS-Related Lymphoma Cohort noted that people with HIV have a markedly higher risk of HL and NHL than people without HIV. Although incidence of HL and NHL has dropped since combination antiretroviral therapy (ART) arrived, they observed, lymphoma is still an important cause of morbidity and mortality in people with HIV, and recurrent disease after complete remission remains challenging.
To chart lymphoma recurrence rates and to assess potential risk factors, the German team conducted this observational analysis of HIV-positive adults with histologically proven lymphoma after January 1, 2005 at one of 32 participating centers. Cohort members had follow-up every 6 months.
The study included 394 people with NHL and 105 with HL recruited between January 2005 and December 2014. The NHL and HL groups did not differ by gender (93% men), average age (about 45.5), prior AIDS diagnosis (about 27%), or average CD4 count (266 NHL, 287 HL). The NHL group included a lower proportion taking ART at lymphoma diagnosis (39% versus 69%, P < 0.001), a lower proportion with an undetectable viral load (28% versus 57%, P < 0.001), and a higher proportion with a high International Prognostic Index (17% versus 5%, P < 0.01).
Overall survival proved moderately higher with HL than NHL (67 versus 62 months, P = 0.08). Of the 499 people with HL or NHL, 311 (62%) had complete remission. Thirty-nine of those 311 (12.5%) had recurrent disease, including 31 of 235 people (13.2%) with NHL and 8 of 76 (10.5%) with HL Median time to recurrent disease measured 7.3 months, and median overall survival with recurrent disease was 29 months (P < 0.001 compared with people without recurrent disease). Lymphoma accounted for 68% of deaths in people who died after lymphoma recurrence.
Comparing people with and without recurrent disease, the researchers could identify no recurrence predictors from a list that included sex, age, prior AIDS, average CD4 count, ART at diagnosis, undetectable viral load, high International Prognostic Index, bone marrow infiltration, central nervous system involvement, NHL subtype, or bulky disease. Among NHL patients with complete remission, 64% received CHOP therapy and 33% BALL. Among NHL patients with recurrent disease, 18% used CHOP and 5% BALL, a significant difference (P < 0.01). But the researchers observed that the higher recurrence rate with CHOP may reflect NHL subtype and other unmeasured factors.
Most NHL recurrences (83%) emerged in the first year after chemotherapy. In contrast, no HL recurrences developed in the first year, while 63% occurred in the second year and the rest in later years. Recurrent NHL incidence was 8.3 per 100 person-years in the first year after chemotherapy and 0.9 per 100 person-years after the first year (P < 0.01). Recurrent HL incidence was 0 in the first year after chemotherapy and 2.8 per 100 person-years after the first year (P < 0.01).
The researchers concluded HL and NHL recur infrequently after complete remission in people with HIV, but outcomes after recurrence remain poor, mainly because of lymphoma progression. They called for better treatment options for recurrent lymphoma in people with HIV infection.
Reference
1. Schommers P, Gillor D, Wyen C, et al. Recurrent disease in HIV-infected patients with Hodgkin lymphoma (HL) or non-Hodgkin lymphoma (NHL) in the German AIDS-related Lymphoma Cohort Study. 15th European AIDS Conference, October 21-24, 2015, Barcelona. Abstract PS5/3.
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