Prognostic factors and outcome of human herpesvirus 8-associated primary effusion lymphoma in patients with AIDS.
OBJECTIVE
Primary effusion lymphoma (PEL) is a rare high-grade B-cell non-Hodgkin's lymphoma associated with Kaposi sarcoma-associated herpesvirus/human herpesvirus 8 (KSHV/HHV-8) infection, and is mostly observed in the course of HIV infection. The prognosis is poor, with reported median survival time shorter than 6 months. To date, no prognostic factor has been identified in this subset of lymphoma.


METHODS
We describe here a large series of HIV-infected patients with PEL, including 28 cases diagnosed in six centers during an 11-year time period. Prognosis analysis was performed using a Cox proportional hazard regression model. Statistically significant covariates were further analyzed in a forward, stepwise multivariate model.


RESULTS
After a median follow-up of 3.8 years (range, 10 months to 10.8 years), nine patients (32%) were still alive, and eight of them remained progression free. The median survival was 6.2 months, and the 1-year overall survival rate was 39.3%. Fourteen patients (50%) achieved complete remission, with a 1-year disease-free survival rate at 78.6%. In a multivariate analysis, only a performance status more than 2 (hazard ratio, 5.84; 95% CI, 1.76 to 19.33) and the absence of highly active antiretroviral therapy (HAART) before PEL diagnosis (hazard ratio, 3.26; 95% CI, 1.14 to 9.34) were found to be independent predictors for shorter survival.


CONCLUSIONS
Based on a retrospective series of 28 patients, two prognostic factors were identified as being independently associated with impaired clinical outcome in HIV-related PEL--(1) a poor performance status and (2) the absence of HAART before PEL diagnosis.
Department of Clinical Immunology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75 475 Paris cedex 10, France. emmanuelle.boulanger@sls.ap-hop-paris.fr
Emmanuelle
E
Boulanger
Laurence
L
Gérard
Jean
J
Gabarre
Jean-Michel
JM
Molina
Christophe
C
Rapp
Jean-François
JF
Abino
Jacques
J
Cadranel
Sylvie
S
Chevret
Eric
E
Oksenhendler
D000163:Acquired Immunodeficiency Syndrome; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D001201:Ascites / Q000150:complications; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D019288:Herpesvirus 8, Human; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000188:drug therapy / Q000401:mortality* / Q000821:virology; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000150:complications; D016066:Pleural Effusion, Malignant / Q000150:complications; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome