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Outcome of poor prognostic phenotype non-Hodgkin’s lymphoma treatment in relation to human immunodeficiency virus serostatus

Résultats du traitement du lymphome non-hodgkinien au phénotype à pronostic pauvre, associé au sérostatut du virus d’immunodéficience humaine (VIH)

  • Original Article / Article Original
  • Published:
Journal africain du cancer / African Journal of Cancer

Abstract

Background

The risk of developing aggressive phenotype non-Hodgkin’s lymphomas is high among HIV infected individuals and is associated with worse prognosis than among non-HIV infected ones. Effective antiretroviral therapy has more recently been reported to greatly improve outcome among these patients. A retrospective review of treatment outcome for aggressive and highly aggressive phenotype non-Hodgkin’s lymphoma patients was carried out.

The objective was to compare outcome of treatment for poor prognosis subtypes of non-Hodgkin’s lymphomas in relation to HIV-serostatus. The setting was Hurlingham Oncology clinic, a private oncology clinic in Nairobi, Kenya. The main study endpoints were complete remission rate and overall survival.

Results

Thirty-two patients (42.7%) were HIV-positive, 32 (42.7%) were HIV-negative and 11 (14.7%) had HIV serostatus undetermined. Seven (21.9%) of HIV positive patients achieved complete remission compared with 24 (75%) of HIV negative ones. This difference was highly significant (P < 0.0001). Five (15.6%) of HIV-positive patients died during first-line treatment compared with none of the HIV-negative counterparts. The difference again was highly significant (P < 0.0001). The median survival time was 19 months among HIV-negative patients and 6 months among positive cases.

Conclusion

Complete remission rate among HIV-negative patients in this series was the same as reported from well established centres, but the rate among HIV-positive patients was lower than expected. Patients with HIV infection were more likely to die from toxicity during induction and had inferior survival compared with HIV-negative cases.

Résumé

Contexte

Le risque de développer un lymphome non-hodgkinien au phénotype agressif est élevé chez les patients séropositifs, et est associé à un pronostic plus grave que pour les patients séronégatifs. La thérapie antirétrovirale a été présentée récemment comme étant efficace pour améliorer significativement les résultats chez ces patients. Une analyse rétrospective des résultats du traitement pour le lymphome non-hodgkinien à phénotype agressif et très agressif a été réalisée.

L’objectif était d’évaluer les résultats du traitement pour les sous-types de lymphome non-hodgkinien à pronostic pauvre associé au sérostatut du VIH. L’étude a été menée à la clinique d’oncologie de Hurlingham, un établissement privé situé à Nairobi, au Kenya. Les principaux critères d’évaluation de l’étude étaient un taux de rémission complète et une survie généralisée.

Résultats

Trente-deux patients (42,7 %) étaient séropositifs, 32 (42,7 %) étaient séronégatifs, et 11 (14,7 %) n’avaient pas de sérostatut déterminé. On a constaté une rémission complète chez sept patients séropositifs (21,9 %) et chez 24 patients séronégatifs (75 %). Cette différence était très significative (P < 0,0001). Cinq des patients séropositifs (15,6 %) sont décédés au cours du traitement de première ligne, tandis qu’aucun n’a succombé parmi les patients séronégatifs. Là encore, la différence était très significative (P < 0,0001). La durée de survie moyenne constatée était de 19 mois chez les patients séronégatifs, et de 6 mois chez les patients séropositifs.

Conclusion

Le taux de rémission complète des patients séronégatifs de cette étude était identique à celui communiqué par des centres de soins bien établis, mais le taux de rémission chez les patients séropositifs était plus faible que prévu. Le risque de mourir dû à la toxicité pendant le début du traitement était plus élevé chez les patients séropositifs, et ces derniers présentaient un taux de survie plus faible que les patients séronégatifs.

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Authors and Affiliations

  1. Department of Medicine, Section of Oncology, AgaKhan University Hospital, P.O. Box 30270, Nairobi, 00100, Kenya

    N. Anthony Othieno Abinya

  2. Department of Clinical Medicine and Therapeutics, School of Medicine, University of Nairobi, P.O. Box 19676, Nairobi, Kenya

    G. Wanjiru Kiarie

  3. Cancer Treatment Centre, Kenyatta National Hospital, P.O. Box 20723, Nairobi, 00202, Kenya

    H. Otieno Abwao

  4. Department of Haematology, College of Medicine, University of Malawi, P/Bag 360, Chichiri, Blantyre 3, Malawi

    Y. Bill Mlombe

  5. Centre for public Health Research, Kenya Medical Research Institute, P.O. Box 54840, Nairobi, Kenya

    R. Omollo

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  1. N. Anthony Othieno Abinya
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  2. G. Wanjiru Kiarie
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  3. H. Otieno Abwao
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  4. Y. Bill Mlombe
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  5. R. Omollo
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Correspondence to N. Anthony Othieno Abinya.

Additional information

The abstract of this paper was published in the Journal of Clinical Oncology, 2007 ASCO Annual Meeting Proceedings (Post-Meeting Edition), Vol. 25, No 18S9 June 20 Supplement), 2007:18535

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Anthony Othieno Abinya, N., Wanjiru Kiarie, G., Otieno Abwao, H. et al. Outcome of poor prognostic phenotype non-Hodgkin’s lymphoma treatment in relation to human immunodeficiency virus serostatus. J Afr Cancer 1, 200–206 (2009). https://doi.org/10.1007/s12558-009-0040-1

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  • DOI: https://doi.org/10.1007/s12558-009-0040-1

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