title: Treatment factors affecting outcomes in HIV-associated non-Hodgkin lymphomas: a pooled analysis of 1546 patients.
abstract: Limited comparative data exist for the treatment of HIV-associated non-Hodgkin lymphoma. We analyzed pooled individual patient data for 1546 patients from 19 prospective clinical trials to assess treatment-specific factors (type of chemotherapy, rituximab, and concurrent combination antiretroviral [cART] use) and their influence on the outcomes complete response (CR), progression free survival (PFS), and overall survival (OS). In our analysis, rituximab was associated with a higher CR rate (odds ratio [OR] 2.89; P < .001), improved PFS (hazard ratio [HR] 0.50; P < .001), and OS (HR 0.51; P < .0001). Compared with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), initial therapy with more dose-intense regimens resulted in better CR rates (ACVBP [doxorubicin, cyclophosphamide, vindesine, bleomycin and prednisolone]: OR 1.70; P < .04), PFS (ACVBP: HR 0.72; P = .049; "intensive regimens": HR 0.35; P < .001) and OS ("intensive regimens": HR 0.54; P < .001). Infusional etoposide, prednisone, infusional vincristine, infusional doxorubicin, and cyclophosphamide (EPOCH) was associated with significantly better OS in diffuse large B-cell lymphoma (HR 0.33; P = .03). Concurrent use of cART was associated with improved CR rates (OR 1.89; P = .005) and trended toward improved OS (HR 0.78; P = .07). These findings provide supporting evidence for current patterns of care where definitive evidence is unavailable.
authors.affiliation: Albert Einstein Cancer Center, Bronx, NY;
authors.forename: Stefan K
authors.initials: SK
authors.lastname: Barta
authors.forename: Xiaonan
authors.initials: X
authors.lastname: Xue
authors.forename: Dan
authors.initials: D
authors.lastname: Wang
authors.forename: Roni
authors.initials: R
authors.lastname: Tamari
authors.forename: Jeannette Y
authors.initials: JY
authors.lastname: Lee
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mounier
authors.forename: Lawrence D
authors.initials: LD
authors.lastname: Kaplan
authors.forename: Josep-Maria
authors.initials: JM
authors.lastname: Ribera
authors.forename: Michele
authors.initials: M
authors.lastname: Spina
authors.forename: Umberto
authors.initials: U
authors.lastname: Tirelli
authors.forename: Rudolf
authors.initials: R
authors.lastname: Weiss
authors.forename: Lionel
authors.initials: L
authors.lastname: Galicier
authors.forename: Francois
authors.initials: F
authors.lastname: Boue
authors.forename: Wyndham H
authors.initials: WH
authors.lastname: Wilson
authors.forename: Christoph
authors.initials: C
authors.lastname: Wyen
authors.forename: Albert
authors.initials: A
authors.lastname: Oriol
authors.forename: José-Tomás
authors.initials: JT
authors.lastname: Navarro
authors.forename: Kieron
authors.initials: K
authors.lastname: Dunleavy
authors.forename: Richard F
authors.initials: RF
authors.lastname: Little
authors.forename: Lee
authors.initials: L
authors.lastname: Ratner
authors.forename: Olga
authors.initials: O
authors.lastname: Garcia
authors.forename: Mireia
authors.initials: M
authors.lastname: Morgades
authors.forename: Scot C
authors.initials: SC
authors.lastname: Remick
authors.forename: Ariela
authors.initials: A
authors.lastname: Noy
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Sparano
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D002986:Clinical Trials as Topic; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005047:Etoposide / Q000627:therapeutic use; D006678:HIV / Q000187:drug effects; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D006801:Humans; D007262:Infusions, Intravenous; D016483:Lymphoma, AIDS-Related / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D008228:Lymphoma, Non-Hodgkin / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D011241:Prednisone / Q000627:therapeutic use; D000069283:Rituximab; D016019:Survival Analysis; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone