TY - JOUR
T1 - Treatment factors affecting outcomes in HIV-associated non-Hodgkin lymphomas
T2 - A pooled analysis of 1546 patients
AU - Barta, Stefan K.
AU - Xue, Xiaonan
AU - Wang, Dan
AU - Tamari, Roni
AU - Lee, Jeannette Y.
AU - Mounier, Nicolas
AU - Kaplan, Lawrence D.
AU - Ribera, Josep Maria
AU - Spina, Michele
AU - Tirelli, Umberto
AU - Weiss, Rudolf
AU - Galicier, Lionel
AU - Boue, Francois
AU - Wilson, Wyndham H.
AU - Wyen, Christoph
AU - Oriol, Albert
AU - Navarro, José Tomás
AU - Dunleavy, Kieron
AU - Little, Richard F.
AU - Ratner, Lee
AU - Garcia, Olga
AU - Morgades, Mireia
AU - Remick, Scot C.
AU - Noy, Ariela
AU - Sparano, Joseph A.
PY - 2013/11/7
Y1 - 2013/11/7
N2 - Limited comparative data exist for the treatment of HIV-associated non-Hodgkin lymphoma. We analyzed pooled individual patient data for 1546 patients from 19 prospective clinical trials to assess treatment-specific factors (type of chemotherapy, rituximab, and concurrent combination antiretroviral [cART] use) and their influence on the outcomes complete response (CR), progression free survival (PFS), and overall survival (OS). In our analysis, rituximab was associated with a higher CR rate (odds ratio [OR] 2.89; P <.001), improved PFS (hazard ratio [HR] 0.50; P <.001), and OS (HR 0.51; P <.0001). Compared with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), initial therapy with more dose-intense regimens resulted in better CR rates (ACVBP [doxorubicin, cyclophosphamide, vindesine, bleomycin and prednisolone]: OR 1.70; P <.04), PFS (ACVBP: HR 0.72; P 5.049; "intensive regimens": HR 0.35; P <.001) and OS ("intensive regimens": HR 0.54; P <.001). Infusional etoposide, prednisone, infusional vincristine, infusional doxorubicin, and cyclophosphamide (EPOCH) was associated with significantly better OS in diffuse large B-cell lymphoma (HR 0.33; P 5.03). Concurrent use of cART was associated with improved CR rates (OR 1.89; P 5.005) and trended toward improved OS (HR 0.78; P 5.07). These findings provide supporting evidence for current patterns of care where definitive evidence is unavailable.
AB - Limited comparative data exist for the treatment of HIV-associated non-Hodgkin lymphoma. We analyzed pooled individual patient data for 1546 patients from 19 prospective clinical trials to assess treatment-specific factors (type of chemotherapy, rituximab, and concurrent combination antiretroviral [cART] use) and their influence on the outcomes complete response (CR), progression free survival (PFS), and overall survival (OS). In our analysis, rituximab was associated with a higher CR rate (odds ratio [OR] 2.89; P <.001), improved PFS (hazard ratio [HR] 0.50; P <.001), and OS (HR 0.51; P <.0001). Compared with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), initial therapy with more dose-intense regimens resulted in better CR rates (ACVBP [doxorubicin, cyclophosphamide, vindesine, bleomycin and prednisolone]: OR 1.70; P <.04), PFS (ACVBP: HR 0.72; P 5.049; "intensive regimens": HR 0.35; P <.001) and OS ("intensive regimens": HR 0.54; P <.001). Infusional etoposide, prednisone, infusional vincristine, infusional doxorubicin, and cyclophosphamide (EPOCH) was associated with significantly better OS in diffuse large B-cell lymphoma (HR 0.33; P 5.03). Concurrent use of cART was associated with improved CR rates (OR 1.89; P 5.005) and trended toward improved OS (HR 0.78; P 5.07). These findings provide supporting evidence for current patterns of care where definitive evidence is unavailable.
UR - http://www.scopus.com/inward/record.url?scp=84888214986&partnerID=8YFLogxK
U2 - 10.1182/blood-2013-04-498964
DO - 10.1182/blood-2013-04-498964
M3 - Article
C2 - 24014242
AN - SCOPUS:84888214986
SN - 0006-4971
VL - 122
SP - 3251
EP - 3262
JO - Blood
JF - Blood
IS - 19
ER -