title: Improved survival in HIV-associated diffuse large B-cell lymphoma with the addition of rituximab to chemotherapy in patients receiving highly active antiretroviral therapy.
abstract: OBJECTIVE
  Recent trials suggest serious toxicity in HIV-associated non-Hodgkin's lymphoma (NHL) with rituximab (R) and chemotherapy (CT), offsetting the benefit of rituximab.
  
  
  METHODS
  We retrospectively reviewed experience with CHOP-R vs. CT in 40 patients with HIV-associated diffuse large B-cell lymphoma (DLBCL) diagnosed between December 1992 and February 2006, all of whom were treated with curative intent.
  
  
  RESULTS
  In a univariate analysis, International Prognostic Index (IPI) score, prior AIDS, HAART, and rituximab were significant for overall survival (OS). In a multivariate analysis, IPI 0-1 (p < .02), no prior AIDS (p < .0002), and receiving CHOP-R (p < .01) were significant for improved OS, and HAART use (p < .09) retained a trend for improved OS. The hazard ratio (HR) for patients with high IPI receiving CHOP-R was 0.3 (95% CI 0.1-0.8). Patients without prior AIDS receiving CHOP-R had an HR of 0.5 (95% CI 0.1-1.7). The OS at 30 months in patients not receiving HAART was 0%. With HAART, OS was 33% for CT and 86% for CHOP-R; HR for CHOP-R was 0.4 (95% CI 0.1-1.2). Toxic deaths were 3 (33%) for CHOP-R and 6 (25%) for CT (p = ns); all toxic deaths with CHOP-R were in patients not receiving HAART. Rituximab-treated patients had a lower death rate from lymphoma (CHOP-R, 2 [16%] vs. CT, 15 [63%]; p < .04), and overall mortality (CHOP-R, 5 [42%] vs. CT, 21 [88%]; p < .01).
  
  
  CONCLUSIONS
  These retrospective data suggest that fatal toxicity of rituximab in HIV-NHL is not increased provided HAART is used, that the addition of rituximab to CT improved outcome, and that further prospective trials investigating this issue are warranted.
authors.affiliation: Department of Hematology, University of British Columbia, Vancouver, Canada.
authors.forename: H
authors.initials: H
authors.lastname: Ezzat
authors.forename: D
authors.initials: D
authors.lastname: Filipenko
authors.forename: L
authors.initials: L
authors.lastname: Vickars
authors.forename: P
authors.initials: P
authors.lastname: Galbraith
authors.forename: C
authors.initials: C
authors.lastname: Li
authors.forename: K
authors.initials: K
authors.lastname: Murphy
authors.forename: J S G
authors.initials: JS
authors.lastname: Montaner
authors.forename: M
authors.initials: M
authors.lastname: Harris
authors.forename: R S
authors.initials: RS
authors.lastname: Hogg
authors.forename: S
authors.initials: S
authors.lastname: Vercauteren
authors.forename: C S
authors.initials: CS
authors.lastname: Leger
authors.forename: L
authors.initials: L
authors.lastname: Zypchen
authors.forename: H A
authors.initials: HA
authors.lastname: Leitch
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D012189:Retrospective Studies; D000069283:Rituximab; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab