Long-Term Follow-up of Patients with HIV-Related Diffuse Large B-Cell Lymphoma (DLBCL) Treated in the Phase II Study with Rituximab and CHOP (R-CHOP)

In the highly active antiretroviral treatment (HAART) era R-CHOP based chemotherapy has proven to be feasible and effective in HIV-related DLBCL. However, the available information on long-term follow-up of patients in remission of lymphoma is scarce. In addition, solid tumors constitute an emerging cause of cancer in HIV-infected patients under HAART. The follow-up of patients in complete response (CR) included in a phase II clinical trial of R-CHOP every 21 days conducted by the Spanish PETHEMA, GESIDA, GELTAMO and GELCAB groups (Ribera JM et al. Br J Haematol 2007; 140: 411–419) has been analyzed.

Out of 81 patients included in the trial 55 patients were in CR. The following data were recorded in these patients: NHL relapse, opportunistic infections (OI) and other cancers. Cumulative probabilities of OI and second cancers, as well as overall survival (OS) and event-free survival (EFS) were calculated.

Median follow-up of alive patients was 6.4 yr (range: 4.6–9.5). One patient was lost of follow-up in CR, 8 relapsed, 5 had OI (meningoencephalitis [2], Pneumocystis jiroveci pneumonia [1], varicella pneumonia [1], pneumoccal pneumonia [1], esophageal candidiasis [1], and CMV colitis [1]; 2 patients suffered 2 OI during their evolution) and 5 developed a second cancer (invasive carcinoma of cervix [1], squamous lung cancer [1], lung adenocarcinoma [1], pancreatic adenocarcinoma [1], and metastatic sarcoma of unknown origin [1]). Eight-year cumulative probability for OI was 15% (95%CI: 7%-23%) and for second cancer was 12% (95%CI: 2%-22%). Fourteen patients have died: 5 due to lymphoma relapse, 3 due to OI, 4 due to second cancer and 2 due to other reasons (sudden death and assassinate). Eight-year OS probability for the 55 patients in first CR of the lymphoma was 67% (95%CI: 48%-86%) and EFS probability was 59% (95%CI: 42%-76%).

HIV-infected patients with DLBCL treated with R-CHOP and HAART followed for long-time have a significant frequency of OI and second cancers, with impact on their survival probability.

Supported in part with grants RD06/0020/1056 from RTICC, Instituto Carlos III, 36606/06 from FIPSE and P-EF/10 from FJC.

No relevant conflicts of interest to declare.