Treatment outcomes in AIDS-related diffuse large B-cell lymphoma in the setting roll out of combination antiretroviral therapy in South Africa

Abstract

Background: Long-term survival for patients with AIDS-related diffuse large B-cell lymphoma (DLBCL) is feasible in settings with available combination antiretroviral therapy (cART). However, given limited oncology resources, outcomes for AIDS-associated DLBCL in South Africa are unknown.

Methods: We performed a retrospective analysis of survival in patients with newly diagnosed AIDS-related DLBCL treated at a tertiary teaching hospital in Cape Town, South Africa, with cyclophosphamide, doxorubicin, vincristine, and oral prednisone (CHOP) or CHOP-like chemotherapy (January 2004 until December 2010). HIV-related and lymphoma-related prognostic factors were evaluated.

Results: Thirty-six patients evaluated; median age 37.3 years, 52.8% men, and 61.1% black South Africans. Median CD4 count 184 cells per microliter (in 27.8% this was <100 cells/μL), 80% high risk according to the age-adjusted International Prognostic Index. Concurrent Mycobacterium tuberculosis in 25%. Two-year overall survival (OS) was 40.5% (median OS 10.5 months, 95% confidence interval: 6.5 to 31.8). Eastern Cooperative Oncology Group performance status of 2 or more (25.4% vs 50.0%, P = 0.01) and poor response to cART (18.0% vs 53.9%, P = 0.03) predicted inferior 2-year OS. No difference in 2-year OS was demonstrated in patients coinfected with M. tuberculosis (P = 0.87).

Conclusions: Two-year OS for patients with AIDS-related DLBCL treated with CHOP like regimens and cART is comparable to that seen in the United States and Europe. Important factors effecting OS in AIDS-related DLBCL in South Africa include performance status at presentation and response to cART. Patients with comorbid M. tuberculosis or hepatitis B seropositivity seem to tolerate CHOP in our setting. Additional improvements in outcomes are likely possible.

Figure 1. A-D Survival outcomes of 36 patients with AIDS-related diffuse large B-cell lymphoma

A: 2-year OS was 40.5%; median survival was 10.5 months (95% CI 6.5 –31.8). 2-year PFS was 34.0%; median PFS time of 6.1 months (95% CI 3.8 – 30.3). B: 2-year OS was 50.0% for ECOG score < 2 and 25.4% for ≥ 2 (p = 0.02). C: Patients that had a response to cART showed significantly improved survival compared to those not responding (53.9% versus 18.0%; p = 0.03). D: 2-year OS was 72.9% for low risk, 33.5% for intermediate risk and 27.8% for high risk (p = 0.18). Median follow up period was 6.9 months. Patient follow up at 1 year: 13 out of 18 (72.2%) at 2 years: 9 out of 17 (52.9%) and at 3 years: 3 out of 16 (18.8%)