Rituximab in combination with chemotherapy versus chemotherapy alone in HIV-associated non-Hodgkin lymphoma: a pooled analysis of 15 prospective studies.
In HIV-positive patients with non-Hodgkin lymphoma (NHL), no benefit of adding rituximab to chemotherapy was seen in a randomized controlled trial (RCT). We performed a meta-analysis of prospective studies to ascertain outcomes in HIV-positive NHL patients treated with chemotherapy (chemo) versus rituximab and chemo (R-chemo). A literature search through September 2011 was performed using the key search "(HIV OR AIDS) AND lymphoma". The main outcomes were overall response rate (ORR), complete response rate (CRR) and 2-year overall survival (OS) and are reported as non-adjusted odds ratio (OR). We identified 15 prospective studies including 1,060 HIV-positive NHL patients, 675 treated with chemo and 385 with R-chemo. There was a higher proportion of HAART in R-chemo patients (82% vs. 68%; p < 0.01) but there were no differences in proportion of patients with advanced stage or high/high-intermediate age-adjusted International Prognostic Index (aaIPI) scores. Meta-analysis showed the OR for ORR, CRR and 2-year OS in patients treated with R-chemo was 1.39 (95% CI 0.79-2.47; p = 0.26), 1.66 (95% CI 0.98-2.82; p = 0.06) and 2.19 (95% CI 1.68-2.86; p < 0.001), respectively. HIV-positive lymphoma patients treated with R-chemo had higher odds for CR and 2-year OS when compared to chemo but also had a higher proportion of HAART usage.
Department of Medicine and Division of Hematology and Oncology, The Warren Alpert Medical School of Brown University, The Miriam Hospital, Providence, Rhode Island, USA. jcastillo@lifespan.org
Jorge J
JJ
Castillo
Ignacio A
IA
Echenique
D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000188:drug therapy*; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011241:Prednisone / Q000008:administration & dosage; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D000069283:Rituximab; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
D058846:Antibodies, Monoclonal, Murine-Derived; D016179:Granulocyte Colony-Stimulating Factor; D000069283:Rituximab; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone