Outcome of poor prognostic phenotype non-Hodgkin lymphoma treatment among HIV-positive patients compared with HIV-negative counterparts in the HAART era: Experience from Hurlingham Oncology Clinic, Nairobi

Abstract

18535 Background: In human immunedeficiency virus (HIV) related non-Hodgkin’s lymphoma (HIV-NHL) two interrelated life- threatening diseases are considered for treatment decision. Before highly active antiretroviral therapy (HAART), chemotherapy associated toxicity made it difficult for HIV-NHL patients to tolerate treatment. This has remarkably changed in the HAART era. These patients are best treated with standard protocols including: cyclophosphamde, doxorubicin, vincristine and prednisone (CHOP); rituximab-CHOP (R-CHOP): methotrexate, doxorubicin, cyclophosphamide, vincrstine, prednisone and bleomycin (MACOP-B). Methods: We reviewed records of patients with aggressive and highly aggressive phenotype NHLs aged 13 years and above, treated from June 1994 to May 2006. Information included demographic details, pathologic subtype, extent of disease, treatment, outcome. Results: Seventy-five patients - 43 M; 32 F. Age range 13–78 years, median 44.5. Thirty-two (42.7%) were HIV+, 32 (42.7%) HIV- and 11 (14.7%) HIV status undetermined. All HIV+ patients took HAART. Twenty-four (32%) were diffuse large B-cell, 7 (9.3%) transformed follicular, 3 (4%) Burkitt’s 32 (42.7%) only referred to as aggressive/highly aggressive and 9 (12%) others. Thirty-eight (50.7%) were in the high risk International Prognostic Index (IPI) category and 27 (36%) had IPI undetermined. Nine of 21 (42.9%) HIV+ patients had CD4+ cell counts <100/ml. Treatments given upfront were: CHOP-35 patients (46.7%), MACOP-B-14 (18.7%), R-CHOP-11 (14.7%), and dropouts - 8 (10.7%). Seven of 32 (21.9%) HIV-NHL achieved complete remission (CR) vs 24 of 32 (75%) HIV-patients; highly significant (P<0.0001). Five (15.6%) of HIV+ patients had treatment related deaths vs none in HIV- group (P<0.00001). No significant correlation emerged between treatment outcome and IPI score (P= 0.22), or CD4+ cell counts (P = 0.15). HIV+ patients had a median follow-up of 5.5 months, mean of 9; those for HIV- patients were 17 and 30 months respectively; highly significant (P = 0.0036 and 0.0018 respectively). Conclusions: The outcome of treatment was significantly inferior among HIV+ patients. No significant financial relationships to disclose.