Publication Date:
2012-11-16
Description:
Abstract 3682 Background: Non-Hodgkin Lymphoma (NHL) remains the most common malignancy in patients with HIV infection, but there are few randomized phase II or III trials that provide level 1 evidence regarding the optimal treatment. We previously reported a pooled analysis of 16 trials including 1,144 patients with HIV–associated NHL (ASCO 2012, abstract 8005), and herein report the updated final analysis of 1,546 patients enrolled on 19 trials. Our objective was to assess lymphoma-, HIV-, and treatment-specific factors and their influence on response and survival. Methods: We performed a systematic review to search for prospective clinical phase II or III trials that assessed therapeutic interventions for HIV-associated NHL and assembled individual patient data from 19 trials published between 1993 and 2011 including 1,546 patients (median N=61/trial, range 14–467). Treatment factors included rituximab use (N=542) and type of chemotherapy (CHOP, N=632; EPOCH, N=166; CDE, N=191; dose-intense (intensive) regimens, N=155; ABCVP-based regimens, N=158; low-dose CHOP, N=165; VS, N=41; oral regimens, N=38). Endpoints included complete response (CR), progression-free survival (PFS), and overall survival (OS). We used logistic regression and Cox proportional hazard models adjusted for age, sex, histological subtype, age-adjusted international prognostic index (aaIPI), CD4 count at baseline, prior history of AIDS, type of chemotherapy, use of rituximab, concurrent use of GCSF and combination antiretroviral therapy (cART) with chemotherapy, and enrollment period. Results: The majority of patients were enrolled in the cART era (75%), were male (84%), had DLBLC (69%; BL/BLL 26%; other 6%), had high risk disease (aaIPI≥2; 59%) and a baseline CD4 count ≥50 cells/μl (86%). CHOP was the most commonly prescribed regimen (41%). Among the lymphoma- and HIV-specific covariates evaluated, lower baseline CD4 count and higher aaIPI score were associated with inferior CR rates (CD4: p
Print ISSN:
0006-4971
Electronic ISSN:
1528-0020
Topics:
Biology
,
Medicine
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