Overall survival of Non-Hodgkin lymphoma in HIV-positive patients at Siriraj Hospital

Authors

  • Kanin Reanthonglert Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, THAILAND
  • Ployploen Phikulsod Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj hospital, Mahidol University
  • Weerapat Owattanapanich Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj hospital, Mahidol University
  • Eakkapol Utchariyaprasit Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj hospital, Mahidol University
  • Chattree Hantaweepant Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj hospital, Mahidol University
  • Ekapun Karoopongse Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj hospital, Mahidol University
  • Archrob Khuhapinant Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj hospital, Mahidol University
  • Bundarika Suwanawiboon Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj hospital, Mahidol University
  • Theera Ruchutrakool Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj hospital, Mahidol University
  • Sanan Visuthisakchai Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj hospital, Mahidol University
  • Noppadol Siritanaratanakul Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj hospital, Mahidol University
  • Yingyong Chinthammitr Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, THAILAND

Keywords:

Non-Hodgkin lymphoma, HIV, overall survival, prognosis

Abstract

Background: Although the prognosis of non-Hodgkin lymphoma (NHL) in HIV-positive patients could be predicted by clinical factors including International Prognosis Index (IPI) but few data were available among these Thai patients. The study aimed to determine the clinical characteristics, 2-year survival rate and prognostic factors among Thai HIV-positive patients with NHL.

Methods: A retrospective study among HIV-positive patients with NHL diagnosed during 2006 and 2016 and aged over 15 years old at Siriraj Hospital was conducted. Clinical and laboratory data were collected from first diagnosis of NHL to death or until the last available clinical followup. The 2-year survival rate, clinical outcomes, and prognostic factors associated with survival were analyzed. Multivariate analyses were performed calculating Kaplan-Meier estimates.

Results: A total of 120 patients (82 men) had a median age of 42 years (range 19-76). Lymphoma and HIV infection were diagnosed at the same time (within 1 month) in 63 (52.5%) patients, whereas, among the other 57 patients, lymphoma was diagnosed after HIV infection at a median time of 3.7 years (interquartile range [IQR], 1.1-5.6). The three most common subtypes of NHL included diffuse large B-cell lymphoma (66.1%), Burkitt lymphoma (11.0%) and plasmablastic lymphoma (11.0%). The median absolute CD4 count was 135 cells/μL (IQR 60-245). The most common first-line
chemotherapy was CHOP-like regimen (81.2%). Response to first-line treatment included complete response
among 41 patients (34.7%), partial response among 17 patients (14.4%), stable disease among 22 patients (18.6%), progressive disease among 16 patients (13.6%) and unknown among 22 patients (18.6%). Factors significantly associated with overall response to first-line treatment were B-cell subtype (p = 0.02; Fisher’s Exact test) and NCCN-IPI (p = 0.004; likelihood ratio). Median overall survival was not reached. Survival rates at 1 and 2 years were 75.8% and 73.2%, respectively. Using multivariate analysis, higher NCCN-IPI score was significantly associated with higher risk of death. Adjusted hazard ratio of NCCN-IPI score was 10.44 (95%CI: 1.27-86.06) for high intermediate risk groups and 28.74 (95%CI: 2.42-341.05) for high risk group.

Conclusion: Median overall survival among HIV-positive patients with NHL at Siriraj Hospital was not reached. Greater than 3 points of NCCN-IPI score was associated with poor prognosis.

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Published

2019-12-20

Issue

Vol. 29 No. 4: October-December 2019

Section

นิพนธ์ต้นฉบับ (Original article)