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Prognostic factors after non‐Hodgkin lymphoma in patients infected with the human immunodeficiency virus
Author(s) -
Thiessard Frantz,
Morlat Philippe,
Marimoutou Catherine,
Labouyrie Eric,
Ragnaud JeanMarie,
Pellegrin JeanLuc,
Dupon Michel,
Dabis François
Publication year - 2000
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(20000401)88:7<1696::aid-cncr25>3.0.co;2-l
Subject(s) - medicine , lymphoma , hazard ratio , proportional hazards model , gastroenterology , confidence interval , non hodgkin's lymphoma , chemotherapy , working formulation , cohort , surgery
BACKGROUND The prognosis for survival of patients infected with the human immunodeficiency virus (HIV) who develop non‐Hodgkin lymphoma (NHL) usually is considered to be poor. To the authors' knowledge the impact of highly active antiretroviral therapy, recently introduced in HIV disease case management, has not yet been studied in such circumstances. METHODS All cases of NHL prospectively diagnosed between January 1986 and December 1997 among patients followed in the Aquitaine Cohort were reviewed. The Kaplan–Meier method and the proportional hazards model were used for statistical analysis. RESULTS One hundred one NHL diagnoses were validated during the 12‐year study period. The median proportional hazards cell count at the time of diagnosis of NHL was 112/mm 3 . Histologic findings (Working Formulation classification) were: intermediate grade (N = 23), high grade (N = 61), other (N = 7), and undetermined (N = 10). In 56% of cases, staging classification was Ann Arbor Stage IV. Approximately 73% of patients received a specific NHL chemotherapy. During follow‐up, 44% were treated with nucleoside reverse transcriptase inhibitors (NRTIs) alone and 18% with triple therapy including a protease inhibitor (PI). The median survival was 6.0 months. In multivariate analysis, after adjusting for age, year of NHL diagnosis, histologic type, medical center, and transmission category, the following factors recorded at the time of diagnosis of NHL were indicative of an increasing risk of death: CD4+ count ≤ 50/mm 3 (relative hazard [RH: 2.4, 95% confidence interval [95% CI], 1.2–4.7), hemoglobin ≤ 10 g/dL (RH: 2.1, 95% CI, 1.1–4.0), and Ann Arbor Stage IV (RH: 2.0, 95% CI, 1.2–3.6). Antiretroviral therapy after the diagnosis of NHL was associated with survival: NRTIs (RH: 0.27, 95% CI, 0.13–0.53) and NRTIs plus PI (RH: 0.08, 95% CI, 0.03–0.21). CONCLUSIONS Although recently introduced and prescribed, antiretroviral therapy including PIs already has improved the survival of HIV‐infected patients with NHL significantly. Cancer 2000;88:1696–702. © 2000 American Cancer Society.