Survival in HIV-infected patients with lymphoma according to the choice of antiretroviral treatment: an observational multicentre study

E Focà; G Cavaglià; S Rusconi; A Cascavilla; G Cenderello; A Re; S Casari; L van den Bogaart; P L Zinzani; D Caracciolo; G Di Perri; A Bonito; A Lucchini; G Cassola; P Viale; A Calcagno

doi:10.1111/hiv.12624

Survival in HIV-infected patients with lymphoma according to the choice of antiretroviral treatment: an observational multicentre study

HIV Med. 2018 Jun 4. doi: 10.1111/hiv.12624. Online ahead of print.

Authors

E Focà¹, G Cavaglià², S Rusconi³, A Cascavilla⁴, G Cenderello⁵, A Re⁶, S Casari⁷, L van den Bogaart³, P L Zinzani⁴, D Caracciolo⁸, G Di Perri², A Bonito², A Lucchini², G Cassola⁵, P Viale⁴, A Calcagno²

Affiliations

¹ Department of Infectious and Tropical Diseases, University of Brescia and Brescia Spedali Civili Hospital, Brescia, Italy.
² Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy.
³ Department of Infectious Diseases, Ospedale Luigi Sacco, University of Milan, Milan, Italy.
⁴ Department of Internal Medicine, Geriatrics and Nephrologic Diseases, Section of Infectious Diseases, S. Orsola-Malpighi Hospital, "Alma Mater Studiorum" University of Bologna, Bologna, Italy.
⁵ Department of Infectious Diseases, EO Ospedali Galliera, Genova, Italy.
⁶ Unit of Haematology, Spedali Civili, Brescia, Italy.
⁷ Unit of Infectious Diseases, Carlo Poma Hospital, Mantova, Italy.
⁸ Unit of Haematology, Department of Oncology, University of Torino, Torino, Italy.

PMID: 29862615
DOI: 10.1111/hiv.12624

Abstract

Objectives: Lymphoproliferative disorders are often observed in HIV-positive patients. Combination antiretroviral treatment (cART) during antineoplastic chemotherapy is beneficial, but little is known about the clinical outcome according to different antiretroviral combinations. The aim of the study was to address this gap in current knowledge.

Methods: A retrospective study was conducted in five large Italian centres for the period from 1998 to 2015; HIV-positive patients diagnosed with lymphoma were included and demographic, clinical and therapeutic variables were recorded and associated with clinical outcomes. Bivariate and multivariate analyses were performed, including Cox proportional hazard models for survival.

Results: A total of 399 patients were included in the study. The most common types of lymphoma were diffuse large B-cell lymphoma (DLCLB; n = 164), Hodgkin lymphoma (HL; n = 99) and Burkitt lymphoma (BL; n = 57), followed by plasmablastic lymphoma (PBL; n = 38), T-cell lymphoma (TCL; n = 17), indolent lymphoma (n = 10) and other less common types (n = 14). cART was given to 327 (out of 387 evaluable) patients: in 216 subjects it was protease inhibitor (PI)-based, in 73 it was nonnucleoside reverse transcriptase inhibitor (NNRTI)-based and in 18 it was integrase strand transfer inhibitor (INSTI)-based (the remaining 20 individuals received other regimens). The 5-year overall survival was 57.5% (52.8% for DLCLB, 67.8% for HL, 42.3% for BL, 60.6% for PBL and 64.7% for TCL). PI-based ART compared with other compounds was associated with worse survival in non-Hodgkin lymphoma (NHL) and HL patients combined (P ≤ 0.001) and in NHL patients alone (P < 0.001); grade 3-4 haematological toxicities were more commonly observed in PI-treated individuals. Lymphoma diagnosis in recent years, better immunovirological status, lower lymphoma stage and better prognostic indexes were associated with better survival.

Conclusions: PI-based cART while on chemotherapy was associated with worse overall survival and more frequent haematological complications in HIV-positive patients with lymphoma.

Keywords: HIV; drug-to-drug interactions; lymphoma; protease inhibitors; toxicity.