Abstract
e18528 Background: The addition of rituximab (R) to CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) and intensification with R plus EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) have improved survival for AIDS-related non-Hodgkin lymphomas (NHL) (Bouë, F, et al, JCO, 2006 and Dunleavy, K, et al, Blood, 2010). R-HCVAD (cyclophosphamide, vincristine, doxorubicin, dexamethasone) alternating with R-MTX-ARA-C (methotrexate, cytarabine) is also highly effective for diffuse large B cell (DLBCL), Burkitt (BL), and Burkitt-like lymphomas (BLL) (Fayad, L, et al, ASCO, 2007 and Thomas, D, et al, Cancer, 2006). Furthermore, heightened responses are described for HIV-Hodgkin lymphoma (HL) patients treated with ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) and HAART (Xicoy, B, et al, Haematologica, 2007 and Sunil, M, et al, ASH, 2009). Methods: We conducted a retrospective study to evaluate outcomes and characteristics of HIV patients with newly diagnosed lymphoma treated at M.D. Anderson Cancer Center from 1998 to 2010. Results: 56 patients were identified, 93% were male, and all but 2 were on HAART. Median age was 42.5 and 73.2% had advanced stage disease. Diagnoses included DLBCL (36%), BL (29%), BLL (25%), T-cell lymphoma (3%), and HL (7%). 80% of the DLBCL, BL, and BLL patients received CHOP (n=11), HCVAD/MTX-ARA-C (n=17), or dose-adjusted (DA) EPOCH (n=8) with 77% incorporation of R. Complete remissions (CR) occurred in 94% of DLBCL, 77% of BL, and 69% of BLL patients. Only 1 HL patient treated with ABVD entered into CR. At a median follow-up of 21.6 months 5 patients relapsed and 19 died. Patients with a CD4 count >100 had superior progression free survival (PFS) and overall survival (OS) (p= 0.019, p=0.016). In addition, HIV diagnosis of < 6 months improved OS (p=0.012), and a non-significant improvement in PFS and OS was seen for BL and BLL patients with DA-EPOCH+/-R. Conclusions: Our data highlights that CD4 count at diagnosis and time from HIV diagnosis are important prognostic factors for patients with HIV and lymphoma. While a small group size and varied regimens are limiting factors, a trend towards decreased BL or BLL progression or relapse was seen with DA-EPOCH+/-R.
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