Treatment of human immunodeficiency virus-related lymphoma with risk-adapted intensive chemotherapy: Final analysis of the NHL-HIV 93 trial

Abstract

6524 Background: Treatment of AIDS-related lymphoma (ARL) is still controversial, as intensive chemotherapy could exacerbate immunodeficiency, with subsequent adverse effects for patients. We aimed to compare the effectiveness of risk-adapted intensive chemotherapy in patients with ARL treated in the NHL-HIV 93 randomized trial, before and after the use of highly active antiretroviral therapy (HAART). Methods: 485 patients aged from 18 to 67 years were randomly assigned to CHOP based chemotherapy with a pretreatment stratification of the dose-intensity according to the HIV score which is based on performance status, prior AIDS and CD4+ cell counts <0.1 G/l. Chemotherapy was administered in conjunction with HAART for the 187 patients enrolled after June 1996. Three main histologic types of ARL were represented in the study population: diffuse large cell lymphoma (54%), Burkitt lymphoma (20%) and immunoblastic lymphoma (17%). Results: With 6 years median follow-up, the OS was estimated, in the low risk group (HIV score=0, n=218), at 51% for high-dose CHOP (ACVBP) versus 47% for CHOP (p=0.85). In the intermediate risk group (HIV score=1, n=177), it was 28% for CHOP versus 24% for ld-CHOP (p=0.19) and in the high risk group (HIV score=2–3, n=90), 11% for ld-CHOP versus 3% for VS (vincristine, steroid) (p=0.14). CR rate of CHOP was significantly different of the ld-CHOP (49% vs. 32%, p=0.02) but not of the ACVBP (51% vs. 61%, p=0.17). Patients in the post HAART area had higher CD4 + counts, lower HIV score and less Burkittts subtype than patients in the pre-HAART area. After adjusting for the follow up, OS was higher in the post HAART area (21% vs. 37% at 3 yrs, p<0.001) but there was no difference between the therapeutic effects of the chemotherapy arm in each risk group. Time dependent Cox model demonstrated that the only significant factors were HAART (RR 1.6, p=0.0002), HIV score (RR 1.7, p=0.0001) and IPI score (RR 1.5, p=0.0012). Conclusions: Our findings indicate that benefit of ACVBP in ARL is not significant over the standard CHOP chemotherapy even in the post HAART area. On the other hand, ld-CHOP is not an alternative for CHOP because it led to lower CR rate and poor survival. No significant financial relationships to disclose.