HAART Improves Survival in HIV-Positive NHL Patients

SAN FRANCISCO—Administering highly active antiretroviral therapy (HAART) to HIV-positive patients during and after treatment for non-Hodgkin’s lymphoma (NHL) can significantly reduce the risk of NHL relapse and death.

Jean-Yves Blay, MD, of Hôpital Ed Herriot, Lyon, France, and his colleagues presented results of their retrospective analysis of a series of 100 HIV-positive NHL patients at a poster session of the 42^nd Annual Meeting of the American Society of Hematology (ASH).

Independent Prognostic Factor

HAART during and after NHL treatment was shown to be an independent prognostic factor and the most significant prognostic indicator for both progression-free survival and overall survival in HIV-positive patients.

The median overall survival for patients receiving HAART was 1,913 days vs 131 days for others. The median progression-free survival was 1,755 days for patients receiving HAART vs 77 days for others.

The outcome for HIV-positive patients has been dramatically improved in the last several years by the introduction of HAART, the researchers noted.

These improvements include a reduction in risk of opportunistic infection and probably the incidence of malignant tumors associated with HIV since 1995, they said. Yet a significant proportion of HIV-positive patients are still expected to develop NHL.

Retrospective Analysis

The retrospective analysis of patients treated at five centers in Lyon, France, between September 1986 and June 2000, investigated responses to chemotherapy in patients with HIV-related NHL before and after the introduction of HAART.

Patients were predominantly male (89) and had a median age of 40 (range, 22 to 77). Thirty-two patients had been previously classified as having AIDS. The median CD4 count was 157/µL; 22 patients had primary cerebral NHL.

First-line chemotherapy treatment had been administered to 73 patients. For systemic NHL, the complete response rate was 49% and the partial response rate was 10%. For primary cerebral NHL, the complete response rate was 9% and partial response rate was 0%.

Median progression-free survival was 150 days, and median overall survival was 207 days, Dr. Blay said. For patients achieving a complete response to first-line chemotherapy, median overall survival was 955 days.

A univariate analysis of prognostic factors for overall survival found favorable factors to be performance status (PS) less than 1, normal lactic dehydrogenase level (LDL), low International Prognostic Index (IPI) score, no primary cerebral NHL, CD4 count greater than 200/µL, no prior AIDS, and HAART during and after treatment for NHL.

In multivariate analysis using the Cox model, Dr. Blay said, only CD4 count greater than 200/µL and use of HAART during and after treatment for NHL held up as independent prognostic factors for overall survival.

Prognostic factors significantly correlating to better progression-free survival on univariate analysis were performance status less than 1, low IPI, no primary cerebral NHL, CD4 count greater than 200/µL, no prior AIDS, and HAART administration during and after treatment for NHL.

Using the Cox model, only CD4 count greater than 200/µL, no prior AIDS, and HAART administration during and after treatment for NHL were independent prognostic factors for progression-free survival, Dr. Blay said.