title: HIV status does not impair the outcome of patients diagnosed with diffuse large B-cell lymphoma treated with R-CHOP in the cART era.
abstract: OBJECTIVE
  To compare the outcome of patients diagnosed with HIV infection and diffuse large B-cell lymphoma (DLBCL) treated with R-CHOP in the cART era with that of a HIV-negative control group.
  
  
  METHODS
  From 2003 to 2011, 305 patients (97 HIV-positive) were diagnosed with DLBCL and treated with R-CHOP. Clinical features were compared using chi-square or Fisher's exact test. Survival analysis was performed using the Kaplan-Meier method and log-rank test. Multivariate analysis was performed using the Cox regression proportional hazards model.
  
  
  RESULTS
  HIV-positive patients had more B symptoms and extranodal sites of disease at diagnosis, but the proportion of patients with high-intermediate/high-risk disease according to the international prognostic index (IPI) was similar between groups. Response rate was 73%, both for patients with and without HIV infection. After a median follow-up of 48 months, 30 patients relapsed after achieving a complete remission, including four HIV-positive patients. Ninety-six patients have died (19 HIV-positive), 73 of them due to DLBCL. Three patients (one HIV-positive) died due to treatment toxicity. Patients with HIV infection had a significantly longer disease-free survival (DFS) (5-year: 94 vs. 77%; P = 0.03) and overall survival (OS) (78 and 64% for HIV-positive and HIV-negative patients, respectively; P = 0.03). These results were confirmed on multivariate analysis when controlled for other potential prognostic confounders.
  
  
  CONCLUSIONS
  HIV-positive patients diagnosed with DLBCL in the cART era have an excellent outcome when treated with standard immunochemotherapy. Therefore, the choice of chemotherapy in patients with lymphoma should not be influenced by HIV status.
authors.affiliation: aCentre for Haemato-Oncology, Barts Cancer Institute, QMUL bMedical Oncology, Chelsea and Westminster Hospital cHaematological Medicine, King's College Hospital dDepartment of Haematology, Royal Free Hospital eHaematology, Guys and St Thomas Hospital fDepartment of Oncology, Brighton and Sussex University Hospital, Brighton gDepartment of Sexual Health, King's College Hospital hHIV medicine, Royal Free Hospital iInfection and Immunity, Barts Health NHS Trust jHaemato-Oncology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
authors.forename: Rita
authors.initials: R
authors.lastname: Coutinho
authors.forename: Alessia D
authors.initials: AD
authors.lastname: Pria
authors.forename: Shreyans
authors.initials: S
authors.lastname: Gandhi
authors.forename: Katharine
authors.initials: K
authors.lastname: Bailey
authors.forename: Paul
authors.initials: P
authors.lastname: Fields
authors.forename: Kate
authors.initials: K
authors.lastname: Cwynarski
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilson
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Papanastasopoulos
authors.forename: Melinda
authors.initials: M
authors.lastname: Tenant-Flowers
authors.forename: Andrew
authors.initials: A
authors.lastname: Webb
authors.forename: Fiona
authors.initials: F
authors.lastname: Burns
authors.forename: Robert E
authors.initials: RE
authors.lastname: Marcus
authors.forename: Chloe
authors.initials: C
authors.lastname: Orkin
authors.forename: Silvia
authors.initials: S
authors.lastname: Montoto
authors.forename: Mark
authors.initials: M
authors.lastname: Bower
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D000069283:Rituximab; D016019:Survival Analysis; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone