Human immunodeficiency virus-associated lymphomas in the antiretroviral therapy era: Analysis of the National Cancer Data Base

Abstract

Background: Antiviral therapy has altered the prognosis of patients with human immunodeficiency virus (HIV)-associated non-Hodgkin lymphoma (NHL), but patterns of lymphoma-directed therapy in the community are unknown.

Methods: The authors analyzed the National Cancer Data Base records of 10,769 patients who were diagnosed with HIV-associated lymphoma from 2004 through 2012. Changes in clinical characteristics and chemotherapy delivery over time were evaluated. Factors that were associated with not receiving chemotherapy were studied using multivariable logistic regression, reporting odds ratios (ORs) with 95% confidence intervals (CIs).

Results: The proportion of black or Hispanic patients with HIV-associated NHL increased from 41% in 2004 to 55% in 2012 (P < .0001). Chemotherapy was received by 81% of patients with diffuse large B-cell lymphoma, 90% of those with Burkitt lymphoma, 61% of those with primary effusion lymphoma (PEL), and 35% of those with primary central nervous system lymphomas (PCNSL). Between 2004 and 2012, this proportion increased only for patients with PCNSL (P < .00001). Chemotherapy was less likely to be received by patients who were older, black, or without private insurance. It was delivered more frequently in hospitals designated as academic (OR for nonreceipt, 0.68; 95% CI, 0.51-0.92) or in hospitals that had ≥3 HIV-positive cases per year (OR, 0.71; 95% CI, 0.58-0.86). Survival improved in patients with diffuse large B-cell lymphoma (P = .007), Burkitt lymphoma (P = .0002), and PCNSL (P = .019), but not in those with PEL (P = .94). Receipt of chemotherapy in patients with PEL was not associated with better survival.

Conclusions: Disparities in chemotherapy delivery need attention, because a majority of HIV-positive patients with NHL in the United States are now black or Hispanic. Higher volume centers were associated with an increased likelihood of chemotherapy administration. Survival gains in patients with PCNSL parallel an increase in chemotherapy use, supporting its role in therapy. [See Editorial on pages 000-000, this issue.] Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2689-2697. © 2016 American Cancer Society.

Keywords: National Cancer Data Base; acquired immunodeficiency syndrome (AIDS); epidemiology; human immunodeficiency virus; non-Hodgkin lymphoma; outcomes research.