BACKGROUND Numerous studies have focused on lymphoma among patients infected with human immunodeficiency virus (HIV). However, little is known about the treatment options and survival rate of lymphoma in the Chinese people living with HIV (PLHIV). Our study aimed to investigate the prognosis and compare outcome of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (DA-EPOCH-R) with standard cyclophosphamide, doxorubicin, vincristine, prednisone and rituximab(R-CHOP) as front line therapy for PLHIV with diffuse large B-cell lymphoma (DLBCL) receiving modern combined antiretroviral therapy (cART). METHODS A retrospective analysis evaluating PLHIV with DLBCL was performed in Shanghai Public Health Clinical Center from July 2012 to September 2019. The demographic and clinical data were collected, and overall survival (OS) and progression-free survival (PFS) analyses of patients receiving R-CHOP or DA-EPOCH-R therapy were performed by Kaplan-Meier analysis. Additionally, a Cox multiple regression model was constructed to identify related factors for OS. RESULTS A total of 54 eligible patients were included in the final analysis with a median follow-up of 14 months (interquartile range [IQR]: 8-29 months). The proportion of high international prognostic index (IPI) patients was much larger in the DA-EPOCH-R group (n = 29) than that in the R-CHOP group (n = 25). The CD4 cell counts and HIV RNA levels were not significantly different between the two groups. The 2-year OS for all patients was 73%. However, OS was not significantly different between the two groups, with a 2-year OS rate of 78% for the DA-EPOCH-R group and 66% for the R-CHOP group. Only an IPI greater than 3 was associated with a decrease in OS, with a hazard ratio of 5.0. The occurrence of grade 3 and 4 adverse events of chemotherapy was not significantly different between the two groups. CONCLUSIONS Outcomes of R-CHOP therapy do not differ from those of DA-EPOCH-R therapy. No HIV-related factors were found to be associated with the OS of PLHIV in the modern cART era.

Clinical outcomes of people living with human immunodeficiency virus (HIV) with diffuse large B-cell lymphoma (DLBCL) in Shanghai, China.

OBJECTIVE: To analyze the clinical characteristics, pathological characteristics, and prognostic factors of AIDS-related lymphoma (ARL).MATERIALS AND METHODS: This was a retrospective study of the clinical characteristics, diagnosis and treatment process, and survival status of 32 patients with ARL. The patients were divided into a survival group and nonsurvival group according to their prognosis, and the factors affecting survival were analyzed. The patients' clinical characteristics were analyzed according to symptoms, sex, age, and laboratory indicators such as the lactate dehydrogenase (LDH) concentration, number of CD4+ T cells, Ann Arbor stage, pathological typing, and international prognostic index (IPI) score. A univariate regression analysis was performed to compare the clinical characteristics of the treatment group and nontreatment group. The impact of chemotherapy and combined antiviral therapy on survival time was assessed.RESULTS: Thirty-two patients were included in the study; 31 were male and 23 were aged >40 years. The average LDH concentration was 639.8 U/L, and the average CD4+ lymphocyte count was 167 cells/μL. Diffuse large B-cell lymphoma was present in 40.6% (13/32) of the patients; a B-lymphocyte source accounted for 90.6% (29/32) of cases, and a T-lymphocyte source accounted for 9.4% (3/32). The proportion of patients who received anti-lymphoma treatment was 84.4% (27/32). Twenty-three patients died during follow-up and nine survived. Univariate analysis showed that the prognostic factors were age, the CD4+ T-lymphocyte count, and the IPI score. The average progression-free survival (PFS) time in the highly active antiretroviral therapy (HAART) group before chemotherapy was 4.81 months, while the average PFS time without antiviral therapy before chemotherapy was about 1.91 months. This difference was statistically significant. The median 2-year survival time in patients who received antiviral therapy before chemotherapy was 33.3 months, while that in patients who did not receive antiviral therapy was 27.3 months. Early HAART therapy combined with standardized chemotherapy was shown to improve the patients' prognosis. It also improved the overall survival (OS) rate and PFS time. However, there was no significant difference in the OS rates between 1 and 2 years.CONCLUSION: The CD4+ T-cell count and IPI score were key factors affecting the prognosis of patients with ARL. An increased LDH concentration was also a prognostic factor. A certain correlation between the disease severity and prognosis was found. The use of standard anti-lymphoma treatment can effectively improve the survival rate of patients. 

Analysis of clinical features and prognostic factors of AIDS-related lymphoma

Objective: To analyze the clinical characteristics, pathological features and survival of patients with AIDS related non-Hodgkin's lymphoma (ARL) . Methods: The clinical data of 53 ARL cases diagnosed and received care at Zhongnan hospital of Wuhan University were retrospectively studied, and 106 controls were enrolled as control group according to 1∶2 for paired cases and control. SPSS 13.0 package was used for statistical analysis. Kaplan-Meier was applied to assess the survival probability. Results: The mean age of patients with ARL was 43 (11-67) years. Male versus female was approximately 4∶1. The median CD4(+) T cell count was (146±20) /ml. The Ann Arbor clinical classification showed that 52.8% of the cases were of stage Ⅲ and Ⅳ. Approximately 54.7% of the patients had elevated serum lactate dehydrogenase (LDH) . According to international prognosis index score, 64.2% of the patients were in high risk group. Diffuse large B-cell lymphoma (DLBCL) was the predominant histological subtype. Among 53 cases, 33 cases (62.3%) received combination of anti-HIV therapy and anti-NHL (CHOP) chemotherapy regimen, 8 cases (15.1%) only received anti-HIV therapy, and 12 cases (22.6%) asked for alleviative treatment. Median survival time was (6.0±1.3) months for ARL cases versus (48.0±10.0) months for controls (P<0.05) . After eliminating cases who did not receive anti-lymphoma treatment, ARL cases showed a lower 1-year OS rates than control group (60.6% versus 83.0%) , but no difference about 2-, 3- and 5-year OS rates (53.5% versus 60.5%, 48.1% versus 45.9%, and 39.1% versus 27.5%, respectively) . Conclusions: ARL is more common in young adults; one-year mortality rate is high. Anti-HIV therapy combined with anti-NHL therapy could significantly improve the prognosis of ARL patients. CHOP regimen may be more suitable for ARL patients.

[Clinicpathological features and survival of patients with AIDS related non-Hodgkin's lymphoma].

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[Clinicpathological features and survival of patients with AIDS related non-Hodgkin's lymphoma].