A prognostic score for AIDS-related diffuse large B-cell lymphoma in Brazil

Abstract

The aim of this study was to evaluate a prognostic score for aids-related lymphoma (ARL). A retrospective study of 104 patients with ARL treated between January 1999 and December 2007 was conducted. Diffuse large B-cell lymphoma (DLBC) was the most observed histological type (79.8%). The median CD4 lymphocyte count at lymphoma diagnosis was 125 cells per microliter. Treatment response could be evaluated in 83 (79.8%) patients, and 38 (45.8%) reached complete remission (CR); overall response rate was 51.8% (95 CI = 38.5-65.1%). After a median follow-up of 48 months, the 4-year overall survival (OS) rate among all patients was 35.8%, with a median survival time of 9.7 months (95% CI = 5.5-13.9 months). The survival risk factors observed in multivariate analysis (previous AIDS and high-intermediate/high international prognostic index (IPI)) were combined to construct a risk score, which divided the whole patient population in three distinct groups as low, intermediate, and high risk. When this score was applied to DLBC patients, a clear distinction in response rates and in OS could be demonstrated. Median disease-free survival (DFS) for patients that achieved CR was not reached, and DFS in 4 years was 83.0%. Our results show that the reduced OS observed could be explained by poor immune status with advanced stage of disease seen in our population of HIV-positive patients. Further studies will be needed to clarify the role of different treatment approaches for ARL in the setting of marked immunosuppression and to identify a group of patients to whom intensive therapy could be performed with a curative intent.

Expression of immunohistochemical markers in patients with AIDS-related lymphoma

“…DLBCL accounts for 70-80% of systemic AIDS-related lymphomas in most reports, including the largest Brazilian one. [13][14][15] In concordance with these series, our patients had a median age of 40 years, were male, presented with higher prevalence of extranodal disease at diagnosis and high or high-intermediate IPI. 14,15 In conclusion, the present study found AIDS-related DLBCL to be mostly of GC profile, different from the findings in HIV-negative series.…”

Treatment Outcomes in AIDS-Related Diffuse Large B-cell Lymphoma in the Setting Roll Out of Combination Antiretroviral Therapy in South Africa

“…As noted in other studies of AIDS–related lymphomas, a majority of patients presented with stage III/IV disease. 9,15,17-19,32 Additionally, 40% of patients in this study had an ECOG performance status of ≥2. Despite these high risk features and despite limited use of G-CSF, 2-year OS of 40% and 2-year PFS of 34% were comparable to other studies of CHOP from US and European centers.…”

“…In the 35 of 36 patients <60 year-old, 28 (80.0 %) patients were classified as high-intermediate or high risk compared to 7 (20.0%) low or low-intermediate risk as classified by the aaIPI. 27 By the AIDS-related lymphoma risk score, 19 12 (33.3%) patients were classified as high risk, 16 (44.4%) intermediate risk and 8 (22.2%) as low risk.…”

“…Furthermore, HIV specific risk factors may remain relevant for prognosis in AIDS-related DLBCL in South Africa. Given uncertainties regarding the optimal approach to treatment of HIV-related DLBCL in South Africa, we evaluated outcomes and prognostic factors 17-19 in patients treated with the most commonly used regimen, CHOP or a CHOP-like regimen, during the period of early cART roll-out.…”

Malignant lymphoma of the oral cavity and the maxillofacial region: Overall survival prognostic factors

“…In the Tanaka et al (30) study 104 subjects with lymphoma and HIV infection had an OS at 4 years of 35.8%, the variables with significant influence on OS: previous HIV infection and an intermediate-high risk value of the IPI. In this study, similar results were found; patients with HIV infection had a quite low OS of 25% at 2 years.…”