Treatment Outcomes in AIDS-Related Diffuse Large B-cell Lymphoma in the Setting Roll Out of Combination Antiretroviral Therapy in South Africa

de Witt, Pieter MBChB, MMedSc, MMed*; Maartens, Deborah J. MBChB, MMed†,‡; Uldrick, Thomas S. MD, MS§; Sissolak, Gerhard MBChB, MMed, MD*

JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0b013e3182a03e9b
Clinical Science
Abstract

Background: Long-term survival for patients with AIDS-related diffuse large B-cell lymphoma (DLBCL) is feasible in settings with available combination antiretroviral therapy (cART). However, given limited oncology resources, outcomes for AIDS-associated DLBCL in South Africa are unknown.

Methods: We performed a retrospective analysis of survival in patients with newly diagnosed AIDS-related DLBCL treated at a tertiary teaching hospital in Cape Town, South Africa, with cyclophosphamide, doxorubicin, vincristine, and oral prednisone (CHOP) or CHOP-like chemotherapy (January 2004 until December 2010). HIV-related and lymphoma-related prognostic factors were evaluated.

Results: Thirty-six patients evaluated; median age 37.3 years, 52.8% men, and 61.1% black South Africans. Median CD4 count 184 cells per microliter (in 27.8% this was <100 cells/μL), 80% high risk according to the age-adjusted International Prognostic Index. Concurrent Mycobacterium tuberculosis in 25%. Two-year overall survival (OS) was 40.5% (median OS 10.5 months, 95% confidence interval: 6.5 to 31.8). Eastern Cooperative Oncology Group performance status of 2 or more (25.4% vs 50.0%, P = 0.01) and poor response to cART (18.0% vs 53.9%, P = 0.03) predicted inferior 2-year OS. No difference in 2-year OS was demonstrated in patients coinfected with M. tuberculosis (P = 0.87).

Conclusions: Two-year OS for patients with AIDS-related DLBCL treated with CHOP like regimens and cART is comparable to that seen in the United States and Europe. Important factors effecting OS in AIDS-related DLBCL in South Africa include performance status at presentation and response to cART. Patients with comorbid M. tuberculosis or hepatitis B seropositivity seem to tolerate CHOP in our setting. Additional improvements in outcomes are likely possible.

Author Information

*Department of Internal Medicine, Stellenbosch University, Cape Town, South Africa;

Department of Anatomical Pathology and National Health Laboratory Services (NHLS), Stellenbosch University, Cape Town, South Africa;

Faculty of Health Sciences, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa; and

§HIV& AIDS Malignancy Branch, National Cancer Institute (NCI), Bethesda, MD.

Correspondence to: Dr G. Sissolak, Consultant Physician and Clinical Hematologist, Department of Medicine, Division of Clinical Hematology, PO Box 19063, Tygerberg, 7505, Cape Town, South Africa (e-mail: sissolak1@telkomsa.net).

Supported in part by the Intramural Research Program of the National Institutes of Health, National Cancer Institute.

The authors have no conflicts of interest to disclose.

Received April 05, 2013

Accepted June 10, 2013

© 2013 by Lippincott Williams & Wilkins