Antiretroviral Therapy, Rituximab Active in Aids-Related DLBCL

Those patients with aids-related diffuse large B-cell lymphoma (DLBCL) undergoing treatment with antiretroviral therapy and rituximab had similar long-term survival as patients with immunocompetent-DLBCL, according to the results of a population-based study published in Hematological Oncology.

“Our data clearly support the current guidelines that HIV‐infected persons on anti-retroviral therapy with DLBCL should receive the same therapeutic approach as immunocompetent individuals,” wrote Annarita Conconi, of the division of hematology at Ospedale degli Infermi, Biella, Italy, and colleagues.

According to the researchers, there is still debate about the optimal chemotherapy regimen and the use of rituximab in patients with aids-related diffuse large B-cell lymphoma. In this population-based study, Conconi and colleagues looked at the prognostic factors and outcomes of 58 consecutive patients with aids-related diffuse large B-cell lymphoma from the Swiss HIV Cohort Study. These patients were compared with 326 patients with immunocompetent-DLBCL from the Hematology Division of the Amedeo Avogadro University and the Oncology Institute of Southern Switzerland.

At diagnosis, those patients with aids-related diffuse large B-cell lymphoma were significantly younger (49 vs 67 years; P < .001), and had a higher proportion of men (86% vs 52%; P < .0001). Additionally, patients with aids-related diffuse large B-cell lymphoma had poor (performance status [PS] 2–4: 40% vs 17%; P < .0001), B-symptoms (53% vs 27%; P < .0001), serologic evidence of hepatitis C and B virus infection, and advanced stage disease (P < .006).

With a median follow-up of 6 years, 36% of patients with immunocompetent-DLBCL and 34% of patients with aids-related diffuse large B-cell lymphoma had died.

Median survival at 5 years was 68% in immunocompetent patients and 63% in HIV patients. Patient's AIDs-related lymphoma international prognostic index predicted overall survival and progression-free survival in patients with aids-related diffuse large B-cell lymphoma.

Looking at 148 patients aged younger than 61 (40 HIV-infected and 108 immunocompetent) who were uniformly treated with RCHOP or RCHOP-like regimens, there was no significant difference in overall survival between the two groups. However, a greater proportion of early deaths occurred in patients with HIV (6.5% vs 17.5%). The 1-year overall survival in this group was 94% for immunocompetent patients and 82% for those with aids-related diffuse large B-cell lymphoma.

Commenting on the results of this study, Stefan K. Barta, MD, of the department of hematology/oncology at Fox Chase Cancer Center, said that these results give somewhat of a real-world experience compared with a lot of previous publications that looked at patients from clinical trials.

“What is interesting and important in this trial is that patients in this cohort who were HIV-positive and had DLBCL at about 5 years had about the same progression-free and overall survival as patients who were HIV negative,” Barta told Cancer Network. “This is confirming the current practice that we treat these patients the same as immunocompetent patients.”