A prognostic index for systemic AIDS-related non-Hodgkin lymphoma treated in the era of highly active antiretroviral therapy.
BACKGROUND
The established International Prognostic Index for lymphomas has not included patients with systemic AIDS-related non-Hodgkin lymphoma.


OBJECTIVE
To establish the most appropriate prognostic index for use in patients with systemic AIDS-related non-Hodgkin lymphoma.


METHODS
A prospective study involving univariate and multivariable analyses of patients with AIDS-related non-Hodgkin lymphoma whose data were used to examine standard and new criteria for survival after diagnosis.


METHODS
The Chelsea and Westminster cohort of HIV-1-infected persons.


METHODS
9621 HIV-positive patients, 111 in whom AIDS-related non-Hodgkin lymphoma was treated after 1996, in the era of highly active antiretroviral therapy (HAART).


METHODS
Cox proportional hazards regression analysis to determine the prognostic significance of multiple clinicopathologic variables.


RESULTS
Survival of patients with AIDS-related non-Hodgkin lymphoma has increased in the HAART era (log-rank chi-square, 9.23; P = 0.002). Univariate analyses using the established International Prognostic Index factors of age, tumor stage, lactate dehydrogenase level, Eastern Cooperative Oncology Group performance status, and number of extranodal sites were confirmed to be significant variables. Regression modeling for patients in whom disease was diagnosed after 1996 revealed only 2 independent predictors of death: International Prognostic Index risk group and CD4 cell count. These predictors yielded 4 internally validated risk strata with predicted 1-year survival rates of 82%, 47%, 20%, and 15% (P < 0.001). Prognostic risk scores in the highest quartile yielded a likelihood ratio for death of 7.90 (hazard ratio, 1.0), whereas a prognostic score less than 1.0 yielded a likelihood ratio of 0.23 (hazard ratio, 0.15 [95% CI, 0.06 to 0.33]).


CONCLUSIONS
The sample was small, and different HAART regimens were used.


CONCLUSIONS
For patients with AIDS-related non-Hodgkin lymphoma that was diagnosed in the era of HAART, application of the International Prognostic Index remains useful. The addition of CD4 cell count provides further independent prognostic information. Patients who present with AIDS-related non-Hodgkin lymphoma and a low CD4 cell count have a poor prognosis; this information can be used to guide therapeutic options.
Bower
Mark
M
The Chelsea and Westminster Hospital, London, United Kingdom. m.bower@imperial.ac.uk
Gazzard
Brian
B
Mandalia
Sundhiya
S
Newsom-Davis
Tom
T
Thirlwell
Christina
C
Dhillon
Tony
T
Young
Anne Marie
AM
Powles
Tom
T
Gaya
Andrew
A
Nelson
Mark
M
Stebbing
Justin
J
D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D006801:Humans; D015993:Life Tables; D016013:Likelihood Functions; D016483:Lymphoma, AIDS-Related / Q000276:immunology / Q000401:mortality*; D008228:Lymphoma, Non-Hodgkin / Q000276:immunology / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors