|The following article features coverage from the European Society for Medical Oncology (ESMO) Congress 2019. Click here to read more of Oncology Nurse Advisor‘s conference coverage.
Patients with non-Hodgkin lymphoma (NHL) who are HIV positive and have never received antiretroviral therapy should be treated with standard chemotherapy regimens according to study findings presented at ESMO Congress 2019 in Barcelona, Spain. Patients with HIV are 25-fold more likely to develop non-Hodgkin lymphoma. Antiretroviral therapy and CD4+ lymphocyte count could play significant roles in disease prognosis and patient survival.
NHL diagnosis could occur simultaneously with or after HIV diagnosis. The recent study evaluated the effect of CHOP-like chemotherapy on 11 patients with newly diagnosed HIV+/ NHL who have never received antiretroviral therapy (naïve patients) to 35 patients with HIV who developed NHL after HIV diagnosis (experienced patients).
No differences were observed between the 2 groups in terms of histologic types, T-cell NHL, frequency of B symptoms, bulky masses, central nervous system involvement, AIDS-defining diseases, HCV/HBV infection, amongst other parameters. However, naïve patients had an intermediate-higher risk prognosis than experienced patients. Naïve patients had higher CD4+ counts at NHL diagnosis (102/mcl vs 22/mcl) and experienced more infectious toxicity (50% vs 10.7%) during R-CHOP-like chemotherapy. However, at a follow-up of 12 months there was no difference in relative risk, median overall survival, or progression free survival between the naïve and experienced patients.
The comprised immune system of naïve patients may explain their higher counts at diagnosis and toxicity levels during treatment. The researchers reason that, “The immediate start of highly active antiretroviral therapy in combination with chemotherapy probably reduce the impact of these factors in terms of response to treatment and survival.”
Dalu D, Fasola C, De Francesco D, Bombonati G, Ammoni L, La Verde NM. Non-Hodgkin lymphoma in HIV-positive patients treated with antiretroviral therapy and chemotherapy: a single institution retrospective study. Presented at: ESMO Congress 2019; September 27-October 1, 2019; Barcelona, Spain. Abstract 1068PD.