title: Changes in the influence of lymphoma- and HIV-specific factors on outcomes in AIDS-related non-Hodgkin lymphoma.
abstract: BACKGROUND
  We undertook the present analysis to examine the shifting influence of prognostic factors in HIV-positive patients diagnosed with aggressive non-Hodgkin lymphoma (NHL) over the last two decades.
  
  
  METHODS
  We carried out a pooled analysis from an existing database of patients with AIDS-related lymphoma. Individual patient data had been obtained prior from prospective phase II or III clinical trials carried out between 1990 until 2010 in North America and Europe that studied chemo(immuno)therapy in HIV-positive patients diagnosed with AIDS-related lymphomas. Studies had been identified by a systematic review. We analyzed patient-level data for 1546 patients with AIDS-related lymphomas using logistic regression and Cox proportional hazard models to identify the association of patient-, lymphoma-, and HIV-specific variables with the outcomes complete response (CR), progression-free survival, and overall survival (OS) in different eras: pre-cART (1989-1995), early cART (1996-2000), recent cART (2001-2004), and contemporary cART era (2005-2010).
  
  
  RESULTS
  Outcomes for patients with AIDS-related diffuse large B-cell lymphoma and Burkitt lymphoma improved significantly over time, irrespective of baseline CD4 count or age-adjusted International Prognostic Index (IPI) risk category. Two-year OS was best in the contemporary era: 67% and 75% compared with 24% and 37% in the pre-cART era (P < 0.001). While the age-adjusted IPI was a significant predictor of outcome in all time periods, the influence of other factors waxed and waned. Individual HIV-related factors such as low CD4 counts (<50/mm(3)) and prior history of AIDS were no longer associated with poor outcomes in the contemporary era.
  
  
  CONCLUSIONS
  Our results demonstrate a significant improvement of CR rate and survival for all patients with AIDS-related lymphomas. Effective HIV-directed therapies reduce the impact of HIV-related prognostic factors on outcomes and allow curative antilymphoma therapy for the majority of patients with aggressive NHL.
authors: Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia. Electronic address: stefan.barta@fccc.edu.
authors: S K
authors: SK
authors: Barta
authors: Department of Medical Oncology, Montefiore Medical Center, Bronx.
authors: M S
authors: MS
authors: Samuel
authors: Department of Epidemiology and Population Health, Albert Einstein Cancer Center, Bronx.
authors: X
authors: X
authors: Xue
authors: Department of Epidemiology and Population Health, Albert Einstein Cancer Center, Bronx.
authors: D
authors: D
authors: Wang
authors: Department of Biostatistics, University of Arkansas, Little Rock, USA.
authors: J Y
authors: JY
authors: Lee
authors: Groupe d'Etude des Lymphomes de l'Adulte (GELA), France.
authors: N
authors: N
authors: Mounier
authors: ICO-Hospital Germans Trias i Pujol, Jose Carreras Research Institute and PETHEMA Group, Badalona, Spain.
authors: J-M
authors: JM
authors: Ribera
authors: Department of Medical Oncology, National Cancer Institute, Aviano, Italy.
authors: M
authors: M
authors: Spina
authors: Department of Medical Oncology, National Cancer Institute, Aviano, Italy.
authors: U
authors: U
authors: Tirelli
authors: Private Practice for Hematology and Oncology, Bremen, Germany.
authors: R
authors: R
authors: Weiss
authors: Department of Immunology, Hopital St Louis, Assistance Publique-Hopitaux de Paris, Paris.
authors: L
authors: L
authors: Galicier
authors: Department of Internal Medicine and Immunology, Hopital Antoine Beclere, Clamart, France.
authors: F
authors: F
authors: Boue
authors: Clinical Investigations Branch.
authors: R F
authors: RF
authors: Little
authors: Department of Medical Oncology, National Cancer Institute, Bethesda, USA.
authors: K
authors: K
authors: Dunleavy
authors: Department of Medical Oncology, National Cancer Institute, Bethesda, USA.
authors: W H
authors: WH
authors: Wilson
authors: Department of Internal Medicine, University Hospital Cologne, Cologne, Germany.
authors: C
authors: C
authors: Wyen
authors: Mary Babb Randolph Cancer Center, West Virginia University, Morgantown.
authors: S C
authors: SC
authors: Remick
authors: Department of Hematology and Oncology, University of California San Francisco, San Francisco.
authors: L D
authors: LD
authors: Kaplan
authors: Division of Oncology, Washington University School of Medicine, St Louis.
authors: L
authors: L
authors: Ratner
authors: Memorial Sloan-Kettering Cancer Center and Weill Cornell, Lymphoma Service, New York, USA.
authors: A
authors: A
authors: Noy
authors: Department of Medical Oncology, Montefiore Medical Center, Bronx.
authors: J A
authors: JA
authors: Sparano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D016208:Databases, Factual; D018450:Disease Progression; D018572:Disease-Free Survival; D005060:Europe; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007167:Immunotherapy / Q000009:adverse effects / Q000379:methods*; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D016483:Lymphoma, AIDS-Related / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009656:North America; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D000970:Antineoplastic Agents
keywords: AIDS; Burkitt lymphoma; HIV; IPI; diffuse large B-cell lymphoma; lymphoma
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