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ed two selected groups: patients with DLBCL receiving R- CHOP-based regimens and patients with BL receiving the GMALL-regimen (see also Figure 1). In patients with DLBCL who received a R-CHOP-based treatment, a high IPI, an elevated LDH, stage III or IV according to the Ann Arbor Staging System, and bone marrow involvement at first diagnosis were associated with a significantly increased risk of relapse (Online Supplementary Table S4). However, none of these parameters turned out to be an independent risk factor in the Cox proportional hazards model. Of note, chemotherapy dose reductions, treatment delays or a reduced number of R-CHOP-cycles given did not adversely affect 5yRFS (Online Supplementary Table S4).
By univariate analysis, patients with BL who underwent GMALL-chemotherapy had a significantly increased risk of relapse if the following factors were present: diagnosis of another AIDS-defining disease prior to BL diagnosis, CNS-involvement, failure of cART defined as measurable viral loads despite concomitant cART, concomitant cART during chemotherapy, and reduced numbers of chemotherapy cycles administered (Online Supplementary Table S4). However, none of these factors remained signif- icant in the Cox proportional hazards model.
Discussion
In this large prospective cohort study of 254 ARL patients who had achieved a CR with first-line chemotherapy (64% of all cases), the total relapse rate was 11% after a median follow up of 4.6 years. Patients with DLBCL who were mainly treated with R-CHOP-based regimens had a relapse rate of 11%. These rates are in line with the 6-10% relapse rates reported in HIV-negative DLBCL in first CR.6,8 Notably, the 10% relapse rate of patients with BL who were mainly treated with the GMALL protocol compares favorably with the 12% relapse rate reported in the HIV-negative setting.10
Outcome of patients with ARL in which histology was not further classifiable was poor with a 5yRFS of only 57%. There was no difference in type and intensity of chemotherapy to that used in DLBCL (data not shown), therefore these cases may represent a subgroup of highly aggressive lymphomas that may benefit from intensive chemotherapyregimens.
Even though the overall survival of patients with PBL was shown to be significantly worse than that in DLBCL and BL,16,17 there was no difference in relapse rates
AB
CD
EF
Figure 3. Kaplan-Meier estimates for aggressive non-Hodgkin lymphoma (NHL) that achieved complete remission (CR) after first-line chemotherapy. (A) Overall survival of all AIDS-related lymphomas (ARL) and of (B) different subtypes (Log rank test: P=0.982). (C) Relapse-free survival of all ARL and of (D) different subtypes (P=0.064). (E) Relapse-free survival of different subtypes treated with R-CHOP-based regimens (rituximab, cyclophosphamide, adriamycin, vincristine, and pred- nisone) and (F) GMALL-based chemotherapeutic regimens (P=0.006 and P=0.79, respectively). DLBCL: diffuse-large B-cell lymphoma; BL: Burkitt-lymphoma; PBL: plasmablastic lymphoma. Dotted line indicates 3 months.
haematologica | 2018; 103(5)