SAN FRANCISCOAdministering highly active
antiretroviral therapy (HAART) to HIV-positive patients during and after
treatment for non-Hodgkin’s lymphoma (NHL) can significantly reduce the risk
of NHL relapse and death.
Jean-Yves Blay, MD, of Hôpital Ed Herriot, Lyon, France, and
his colleagues presented results of their retrospective analysis of a series of
100 HIV-positive NHL patients at a poster session of the 42nd Annual Meeting of
the American Society of Hematology (ASH).
Independent Prognostic Factor
HAART during and after NHL treatment was shown to be an
independent prognostic factor and the most significant prognostic indicator for
both progression-free survival and overall survival in HIV-positive patients.
The median overall survival for patients receiving HAART was
1,913 days vs 131 days for others. The median progression-free survival was
1,755 days for patients receiving HAART vs 77 days for others.
The outcome for HIV-positive patients has been dramatically
improved in the last several years by the introduction of HAART, the
These improvements include a reduction in risk of opportunistic
infection and probably the incidence of malignant tumors associated with HIV
since 1995, they said. Yet a significant proportion of HIV-positive patients
are still expected to develop NHL.
The retrospective analysis of patients treated at five centers
in Lyon, France, between September 1986 and June 2000, investigated responses
to chemotherapy in patients with HIV-related NHL before and after the
introduction of HAART.
Patients were predominantly male (89) and had a median age of
40 (range, 22 to 77). Thirty-two patients had been previously classified as
having AIDS. The median CD4 count was 157/µL; 22 patients had primary cerebral
First-line chemotherapy treatment had been administered to 73
patients. For systemic NHL, the complete response rate was 49% and the partial
response rate was 10%. For primary cerebral NHL, the complete response rate was
9% and partial response rate was 0%.
Median progression-free survival was 150 days, and median
overall survival was 207 days, Dr. Blay said. For patients achieving a complete
response to first-line chemotherapy, median overall survival was 955 days.
A univariate analysis of prognostic factors for overall
survival found favorable factors to be performance status (PS) less than 1,
normal lactic dehydrogenase level (LDL), low International Prognostic Index
(IPI) score, no primary cerebral NHL, CD4 count greater than 200/µL, no prior
AIDS, and HAART during and after treatment for NHL.
In multivariate analysis using the Cox model, Dr. Blay said,
only CD4 count greater than 200/µL and use of HAART during and after treatment
for NHL held up as independent prognostic factors for overall survival.
Prognostic factors significantly correlating to better
progression-free survival on univariate analysis were performance status less
than 1, low IPI, no primary cerebral NHL, CD4 count greater than 200/µL, no
prior AIDS, and HAART administration during and after treatment for NHL.
Using the Cox model, only CD4 count greater than 200/µL, no
prior AIDS, and HAART administration during and after treatment for NHL were
independent prognostic factors for progression-free survival, Dr. Blay said.