Blood. 2013 Sep 6.

Treatment factors affecting outcomes in HIV-associated non-Hodgkin lymphomas: a pooled analysis of 1,546 patients.

Barta SK, Xue X, Wang D, Tamari R, Lee JY, Mounier N, Kaplan LD, Ribera JM, Spina M, Tirelli U, Weiss R, Galicier L, Boue F, Wilson WH, Wyen C, Oriol A, Navarro JT, Dunleavy K, Little RF, Ratner L, Garcia O, Morgades M, Remick SC, Noy A, Sparano JA.
SourceAlbert Einstein College of Medicine, Bronx, NY, United States;

Abstract
Limited comparative data exists for the treatment of HIV-associated Non-Hodgkin Lymphoma (NHL). We analyzed data from 1,546 patients to assess treatment-specific factors and their influence on outcomes. We performed a systematic review of prospective clinical trials for HIV-associated NHL and assembled individual patient data from 19 trials. Treatment factors included type of chemotherapy, rituximab, and concurrent combination antiretroviral (cART) use. Endpoints included complete response (CR), progression-free survival (PFS), and overall survival (OS). Logistic regression and Cox proportional hazard models adjusted for known prognostic factors and enrollment period were used. Rituximab was associated with a higher CR rate (Odds Ratio [OR] 2.89, p<0.001), improved PFS (Hazard Ratio [HR] 0.50, p<0.001) and OS (HR 0.51, p<0.0001). When compared to CHOP, initial therapy with more intensive therapy resulted in better CR rates (ACVBP: OR 1.70, p=0.04), PFS (ACVBP: HR 0.72, p=0.049; "intensive regimens": HR 0.35, p<0.001) and OS ("intensive regimens": HR 0.54, p<0.001), and infusional EPOCH was associated with significantly better OS in DLBCL (HR 0.33, p=0.03). Concurrent use of cART was associated with improved CR rates (OR 1.89, p=0.005), and trended toward improved OS (HR 0.78, p=0.07). These findings provide supporting evidence for current patterns of care where definitive evidence is unavailable.

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