Changing Incidence and Prognostic Factors of Survival in AIDS-related Non-Hodgkin's Lymphoma in the HAART Era

Non-Hodgkin's lymphoma is an AIDS-defining disease. The impact of HAART on the epidemiology and prognosis of the disease is not yet clear. A retrospective analysis has been performed in order to determine the influence of HAART.

German Researchers at the University Hospital of Frankfurt Germany collected data of 214 cases of AIDS-related Lymphoma (ARL) treated at their center from January 1984 until May 2003 and analysed them using the Kaplan-Meier-, log rank- and Cox proportional hazard-model.

The incidence of ARL increased between 1991 and 1994 up to a peak of 14.83 per 1000 patient years. In the subsequent periods from 1995 onwards however, it decreased to 3.7 in 1000 patient years.

The incidence of AIDS-related primary CNS lymphomas (PCNSL) took a comparable, yet more pronounced development. Using the univariate Kaplan-Meier analysis prolonged survival was significantly associated with the achievement of a complete remission as well as with a favourable virological response to HAART.

No significant differences could be shown for the use of protease inhibitors as well as for virological response being achieved before the diagnosis of NHL. Using the Cox model, complete remission overrides viral response and thus remained the only independent prognostic factor.

Classical prognostic factors (CD4 count, prior Kaposi Sarcoma, extranodal manifestation, staging and histological subtype of NHL) were no longer significant for HAART patients in the multivariate analysis.

In conclusion, the authors write, “These results illustrate the requirement for new prospective studies in order to determine the best options and ideal timing of co-administration of chemotherapy and the type of HAART.”

“Furthermore this study demonstrates that HAART decreases the incidence of ARL, and that achievement of a complete remission in patients suffering from ARL is--according to the multivariate analysis--the single most important prognostically relevant factor with respect to the time of survival.”

01/07/05

Reference
T Wolf and others. Changing incidence and prognostic factors of survival in AIDS-related non-Hodgkin's lymphoma in the era of highly active antiretroviral therapy (HAART). Leukemia and  Lymphoma 46(2): 207-215. February 2005.