HAART Improves Survival in Chemotherapy-Treated, HIV-Related NHL

SAN FRANCISCO—Use of highly active antiretroviral therapy (HAART) significantly increases disease-free survival among patients with HIV-related non-Hodgkin’s lymphoma (NHL), Michele Spina, MD, of Centro di Riferimento Oncologico, Aviano, Italy, said at the 37th Annual Meeting of the American Society of Clinical Oncology (ASCO abstract 1122).

The group prospectively analyzed outcomes in 235 patients with systemic HIV-related NHL who were diagnosed and treated at their institution between April 1988 and December 1999.

Dr. Spina said that 79 patients received HAART while 156 patients did not, in most cases because it was not yet available. As expected, severe immunosuppression was more common in the patients not receiving HAART: 45% of these patients had CD4 cell counts of 100/µL or less vs 25% of those on HAART.

Of the patients who received HAART, 37 started therapy before the NHL diagnosis and continued with HAART during chemotherapy and follow-up. Of the 42 patients who started HAART after the NHL diagnosis, 22 received HAART concurrently with chemotherapy and 20 after the end of chemotherapy. At the diagnosis of NHL, 70% of patients had ECOG performance status of 0-1, 70% had stage III/IV disease, 91% had extranodal disease, and 35% had abnormal serum LDH.

Among the patients, 206 received chemotherapy for NHL (CHOP or a CHOP-like regimen). Overall, 49 of the 199 evaluable patients had a complete remission, and 80 a partial remission. Among the complete responders, 45% have relapsed. Mortality is 78%, with NHL the leading cause of death in 90% of cases.

Both the univariate and multivariate analyses showed that HAART was a favorable prognostic factor for disease-free and overall survival. In the multivariate analysis, median overall survival for the non-HAART patients was 7 months vs 65 months for the HAART patients, a highly significant difference, Dr. Spina said.

The 3-year progression-free survival of HAART patients was 53% vs 17% in those not receiving HAART. Three-year disease-free survival was 86% and 57%, respectively. Dr. Spina concluded, "In our experience, HAART significantly improved disease-free survival in HIV patients with NHL treated with comparable chemotherapy regimens. CD4 counts appear to play a role in the maintenance of long-term antitumor response."