HIV+ pts have a 25-fold higher risk of developing NHL. Two independent prognostic factors influence incidence and prognosis: highly active antiretroviral therapy (HAART) and CD4+ lymphocyte count. Diagnosis of NHL can occur simultaneously (naive pts), or after diagnosis of HIV infection (experience-pts).
Single institution retrospective cohort study conducted in ASST FBF-Sacco Polo Luigi Sacco (Milan, Italy). Pts aged > =18 years, diagnosis of HIV infection and NHL, on HAART treated with first line R-CHOP-like chtp from Jan 2007 to Jan 2017. Chi-square, Fisher’s exact or Wilcoxon Rank-sum test, log-rank test or Cox regression model for OS, PFS and RR were used.
We enrolled 46 HIV+ pts: 11 naive-pts, 35 experience-pts (exp-pts). No difference in median age at diagnosis (49vs48ys p = 0.40), sex (male 72.7vs85.7% p = 0.37), histological types: DLBCL (2vs24), BL (3vs3), PEL (1vs0), PCNSL (1vs0), PBL (2vs2) low-grade NHL (2vs4) T-cell NHL(0 vs 2) (p = 0.13). Naïve-pts higher stage (stage IV 90.9vs41.2% p = 0.05). No difference in frequency of B symptoms (40vs41% p = 0.99), bulky masses (18.2vs20.6% p = 0.99), ≥2 extranodal sites (45.5vs40% p = 0.61), CNS involvement (44.4vs38.2% p = 0.99), AIDS-definig diseases (44.4vs28.6% p = 0.43) HCV/HBV infection (p = 0.08/0.99). Naive-pts aaIPI intermediate-high risk (90.0vs58.1% p = 0.11). CD4+ count at NHL diagnosis(102vs222/mcl p = 0.05). During R-CHOP-like chtp naïve-pts more infectious toxicity (50% vs 10.7% p = 0.02). During a median (IQR 2-44) follow-up of 12 mts no difference in RR (CR 60% vs 62.5% p = 0.85), median OS (67 mts vs 69.4 mts p = 0.3) and PFS (p = 0.8).
The compromised immune status in naïve-pts may explain their worst NHL conditions at diagnosis and toxicity during chtp. The immediate start of HAART in combination with chemotherapy probably reduce the impact of these factors in term of response to treatment and survival (RR, PFS and OS). CD4+ count together with HAART remain the independent prognostic factor with the greatest influence on OS [exp vs naïve-pts: OS HR 0.83 (95% CI); OS/CD4+ HR 1.80 (95% CI)]. Naive-pts should be treated with standard chtp regimens, without modification of dose or schedule.
Has not received any funding.
All authors have declared no conflicts of interest.