Outcomes of treatment with CHOP and EPOCH in patients with HIV associated NHL in a low resource setting

Clement D Okello,Henry Ddungu,Jackson Orem,Yusuf Mulumba,Abrahams Omoding

doi:10.1186/s12885-020-07305-2

Abstract

BackgroundThe optimal chemotherapy regimen for treating HIV associated NHL in low resource settings is unknown. We conducted a retrospective study to describe survival rates, treatment response rates and adverse events in patients with HIV associated NHL treated with CHOP and dose adjusted-EPOCH regimens at the Uganda Cancer Institute.MethodsA retrospective study of patients diagnosed with HIV and lymphoma and treated at the Uganda Cancer Institute from 2016 to 2018 was done.ResultsOne hundred eight patients treated with CHOP and 12 patients treated with DA-EPOCH were analysed. Patients completing 6 or more cycles of chemotherapy were 51 (47%) in the CHOP group and 8 (67%) in the DA-EPOCH group. One year overall survival (OS) rate in patients treated with CHOP was 54.5% (95% CI, 42.8–64.8) and 80.2% (95% CI, 40.3–94.8) in those treated with DA-EPOCH. Factors associated with favourable survival were BMI 18.5–24.9 kg/m2, (p = 0.03) and completion of 6 or more cycles of chemotherapy, (p < 0.001). The overall response rate was 40% in the CHOP group and 59% in the DA-EPOCH group. Severe adverse events occurred in 19 (18%) patients in the CHOP group and 3 (25%) in the DA-EPOCH group; these were neutropenia (CHOP = 13, 12%; DA-EPOCH = 2, 17%), anaemia (CHOP = 12, 12%; DA-EPOCH = 1, 8%), thrombocytopenia (CHOP = 7, 6%; DA-EPOCH = 0), sepsis (CHOP = 1), treatment related death (DA-EPOCH = 1) and hepatic encephalopathy (CHOP = 1).ConclusionTreatment of HIV associated NHL with curative intent using CHOP and infusional DA-EPOCH is feasible in low resource settings and associated with > 50% 1 year survival.

Highlights

The optimal chemotherapy regimen for treating Human Immunodeficiency Virus (HIV) associated non-Hodgkin’s lymphoma (NHL) in low resource settings is unknown
Aggressive HIV associated NHLs are treated with CHOP; since the year 2016, a selected group of patients have been treated with DA-EPOCH based on the physicians’ judgement
Patients in the CHOP group received a variety of antiretroviral therapy (ART) combination with 42(39%) patients receiving either tenofovir or zidovudine in combination with lamivudine and efavirenz

Summary

Introduction

The optimal chemotherapy regimen for treating HIV associated NHL in low resource settings is unknown. We conducted a retrospective study to describe survival rates, treatment response rates and adverse events in patients with HIV associated NHL treated with CHOP and dose adjusted-EPOCH regimens at the Uganda Cancer Institute. HIV associated NHL in the post ART era include, but not limited to the infusional cyclophosphamide–doxorubicin–etoposide (CDE) with complete remission rate (CR) of 42%, median survival time of 17.8-month, and 1year survival rate of 55% [13]; and Cyclophosphamide, Doxorubicin, Vincristine and Prednisolone (CHOP) regimen with complete remission in 57.6 and 47% in patients treated with R-CHOP and CHOP respectively, with an overall survival of about 35 months for R-CHOP and 28 months for CHOP [14]. It has been reported to achieve 79% CR rate and 72% overall 2-year survival rate in patients with HIV associated NHL [15]

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