Epidemiological features and efficacy of treatment in HIV-associated lymphomas
HIV-infected patients are at high risk for cancer. The number of patients with NHL among HIV+ individuals is 5.6% per year, compared with 0.015% of the general population . Risk of Hodgkin’s lymphoma in HIV-infected patients is higher in 33 times than the general population, according to studies announced at the 22nd International AIDS Conference (AIDS 2018). Antiretroviral therapy (ART) significantly influences on the risk of cancer which depend on the level of CD4-lymphocytes, and improve the effectiveness of treatment . The ART increase the level of CD4 cells, reduce the risk of infectious complications and allow administering chemotherapy in standard doses, however, HIV-associated lymphomas continue to be one of the leading causes of death . The aim of our study was to determine the epidemiological characteristics and evaluate the effectiveness of treatment of HIV-associated lymphomas.
Patients and methods
A retrospective study included 12 patients who were observed on the basis of the National Clinical Hospital No. 2 City Hematology Center from 2013 to 2017 (5 years), diagnosed with HIV- lymphomas. The average age of the patients was 37.4 ± 6.8 years. Distribution by sex: men, 8 (67%), women, 4 (33%). The statistical analysis was performed using MSExcel, Statistica 12.0 software.
HIV-associated lymphomas were represented by the following clinical types: diffuse large B-cell lymphoma (DLBCL), 7 (58.3%); Hodgkin’s lymphoma, 4 (33.4%); plasmablastic lymphoma, 1 (8%). Extranodal localization of lymphoma was diagnosed in 50% of patients. A prognostic index for HIV-associated lymphomas (ARL-IPI) was calculated for DLBCL: 1 patient (14.29%) entered high-risk group; 5 patients were at intermediate risk (71.43%); 1 person was at low risk (14.29%). Before the diagnosis of lymphoma, all the patients had HIV-positive status for 5-10 years and did not receive ART because of low viral loads (<100 copies/mL). A several-fold increase of viral load (94 to 1700000 copies/mL) was registered at the time of lymphoma diagnosis. Co-infections were detected: hepatitis B, 25%; C, 58.33% of the cases. Patients with plasmablastic lymphoma and DLBCL were treated with R-CHOP and R-MPV; Hodgkin’s lymphoma, according to ABVD protocol. Nine patients (75%) have received 4-8 courses of chemotherapy. Complete remission of the disease was achieved in 6 patients (66.7%); partial remission, in 1 patient (22.2%); relapse was registered in 1 patient (11.1%) associated with self-withdrawal of ART; progression was documented in one case (11.1%). Treatment failure correlated with duration of HIV infection (r = 0.67, p <0.05). The patients who responded to chemotherapy (n=8) achieved low viral load on the background of ART, i.e., less than 100 copies/ml. Three patients (25%) received only 1-2 courses of chemotherapy due to co-morbidity or low adherence to the therapy. These patients did not receive ART for various reasons and did not achieve remission. The overall 2-years survival of 9 patients with HIV-associated lymphomas who completed programmed chemotherapy was 89%; in Hodgkin’s lymphoma, 100%; in DLBCL – 75%.
Diffuse large B-cell lymphomas with aggressive course were more often diagnosed in HIV-infected patients. The chemotherapy failure correlated with duration of HIV infection before lymphoma diagnosis. Overall survival at 2 years in treated patients was 89%. Due to ART, the entire program of chemotherapy can be fulfilled, and good overall survival rates can be achieved in HIV-associated lymphomas, being
close to general patient cohorts.
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HIV infection, lymphoma, diffuse large B-cell lymphoma, Hodgkin’s lymphoma, chemotherapy, oncohematology.