Efficacy and tolerability of chemotherapy in Chinese patients with AIDS-related Burkitt lymphoma and diffuse large B-cell lymphoma: An observational study

Jiang Xiao,Shuxu Du,Hongxin Zhao,Di Yang,Guorui Dai,Guiju Gao

doi:10.1038/s41598-017-02086-4

Abstract

We evaluated the efficacy and tolerability of chemotherapy in HIV-infected patients with diffuse large B-cell lymphoma (DLBCL) receiving CHOP ± R (n = 17) or Burkitt lymphoma (BL) receiving CODOX-M/IVAC ± R (n = 15). The study was conducted in Beijing Ditan Hospital from January 2009 to August 2015. The following grade 4 adverse effects were observed in BL and DLBCL patients, respectively: neutropenia (80% versus 47.1%), anaemia (46.7% versus 5.9%), thrombocytopenia (53.3% versus 11.8%), bacterial pneumonia (33.3% versus 5.9%), and sepsis (20% versus 5.9%) (p < 0.05). In the BL group, 10 (66.7%) patients died from treatment-related or tumour-related causes, 5 (33.3%) achieved complete response, 1 achieved partial response (6.7%), and 7 developed progressive disease. The 1-year overall survival and progression-free survival rates were 33.3%. Of the DLBCL patients, 3 (17.6%) died from treatment-related causes, 14 (82.4%) achieved complete response, and 3 had progressive disease. The 1-year overall survival and progression-free survival rates were 82.4%. The strongest risk factor for death was relapse between chemotherapy cycles (adjusted hazard ratio = 47.3; 95%CI, 4.2–528.6, p = 0.002). Initiating antiretroviral therapy before chemotherapy failed to improve overall survival. DLBCL patients demonstrated good responses and survival outcomes, while BL patients could not tolerate chemotherapy due to more severe toxicity, and showed poor responses and survival outcomes.

Highlights

Malignant lymphoma is a rapidly growing, aggressive, AIDS-defining cancer that results in death within several weeks or months if left untreated
We included all HIV-infected patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) treated with a CHOP regimen with or without rituximab (CHOP ± R) and newly diagnosed Burkitt lymphoma (BL) treated with a CODOX-M/IVAC regimen with or without rituximab (CODOX-M/IVAC ± R) at the Centers for Infectious Diseases, Beijing Ditan Hospital, the largest referral hospital for HIV/AIDS patients in North China, from January 2009 to August 2015
From January 2009 to August 2015, 17 patients were diagnosed with DLBCL and received chemotherapy with a CHOP ± R regimen, while 15 patients were diagnosed with BL and were treated with a CODOX-M/IVAC ± R regimen

Summary

Introduction

Malignant lymphoma is a rapidly growing, aggressive, AIDS-defining cancer that results in death within several weeks or months if left untreated. In the era of combination antiretroviral therapy (cART), CHOP-based regimens have been widely used to treat DLBCL in HIV-infected patients as they have better efficacy than other chemotherapy regimens[4]. Coutinho et al.[5] demonstrated that HIV-infected patients diagnosed with DLBCL in the cART era have an excellent outcome when treated with CHOP-R, with an overall survival rate of 78%. CODOX-M/IVAC, a non-cross-resistant, intensive chemotherapy regimen developed by the American National Cancer Institute, confers high cure rates in HIV-infected patients with BL. It provides care and treatment to HIV/AIDS patients, including those with lymphoma. The objective of this observational study was to evaluate the efficacy and tolerability of chemotherapy in Chinese HIV-infected patients with lymphoma

Methods

Results

Conclusion