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Chen J, Wu Y, Kang Z, Qin S, Ruan G, Zhao H, Tao X, Xie Z, Peng J. A promising prognostic model for predicting survival of patients with HIV-related diffuse large B-cell lymphoma in the cART era. Cancer Med 2023. [PMID: 37081761 DOI: 10.1002/cam4.5957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/25/2023] [Accepted: 04/01/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Optimization of risk stratification is important for facilitating prognoses and therapeutic decisions regarding diffuse large B-cell lymphoma (DLBCL). However, a simple and applicable prognostic tool is lacking for individuals with human immunodeficiency virus (HIV)-related DLBCL in the era of combined antiretroviral therapy (cART). METHODS This retrospective multicenter observational study included 147 HIV-related DLBCL patients with histologically confirmed DLBCL from 2013 to 2020. The total group was divided into training (n = 78) and validation (n = 69) cohorts to derive the best prognostic score. Clinicopathological and characteristic biomarkers correlated with clinical outcomes were analyzed. RESULTS Age, Ann Arbor stage, lactate dehydrogenase (LDH) ratio, bulky disease, and red blood cell distribution width (RDW) ratio retained robust independent correlations with overall survival (OS) in multivariate analysis. A new and practical prognostic model was generated and externally validated, classifying patients into three categories with significantly different survival rates. Moreover, the new index outperformed the International Prognostic Index (IPI) score (area under the curve values of 0.94 vs. 0.81 in the training cohort and 0.85 vs. 0.74 in the validation cohort, C-indices of 0.80 vs. 0.70 in the training cohort and 0.74 vs. 0.70 in the validation cohort, and integrated discrimination improvement values of 0.203 in the training cohort and 0.175 in the validation cohort) and was better at defining intermediate- and high-risk groups. The calibration curves performed satisfactorily for predicting 3-year OS in the training and validation cohorts. CONCLUSIONS We developed and validated a simple and feasible prognostic model for patients with HIV-related DLBCL that had more discriminative and predictive accuracy than the IPI score for risk stratification and individualized treatment in the cART era.
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Affiliation(s)
- Juanjuan Chen
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yihua Wu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zixin Kang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shanfang Qin
- Guangxi AIDS Diagnosis and Treatment Quality Control Center, Longtan Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Guangjing Ruan
- Guangxi AIDS Clinical Treatment Center, The Fourth People's Hospital of Nanning, Nanning, China
| | - Han Zhao
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Infectious Diseases Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xin Tao
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhiman Xie
- Guangxi AIDS Clinical Treatment Center, The Fourth People's Hospital of Nanning, Nanning, China
| | - Jie Peng
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Casimiro LC, Mauro GP, Medici CTM, Weltman E. Survival and consolidative radiotherapy in patients living with HIV and treated for diffuse large B-cell lymphoma. Rep Pract Oncol Radiother 2020; 25:956-960. [PMID: 33100911 DOI: 10.1016/j.rpor.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/28/2020] [Accepted: 09/16/2020] [Indexed: 11/19/2022] Open
Abstract
Objectives Current guidelines tend to treat HIV positive (HIV+) patients as their seronegative counterparts with diffuse large B-cell lymphoma (DLBCL) but little is known about their radiotherapy responses differences. Patients and Methods A retrospective cohort of all consecutive HIV+ DBCL patients treated with chemotherapy between 2004 and 2018 was assessed. All patients had biopsy-proven lymphomas. They were included if the proposed radical treatment was done without progression or death during chemotherapy and had at least 6 months of follow-up or were followed until death. Results Fifty-three (53) patients were selected, with a median age at diagnosis of 41.39 years (20-65 years). Median follow-up of 35.16 months (1.4-178.7 months). Male patients accounted for 54.7% and most had a good performance in the ECOG scale at diagnoses (81.1% are ECOG 0-1). Median overall survival was not reached. Mean OS was 41.5 months with 16 deaths. Age had an impact on OS, with patients older than 60 years at more risk (p = 0.044), as did longtime use of HAART, with those that started antiretroviral therapy within the diagnose of the lymphoma at greatest risk (p = 0.044). RT did not have an impact on OS (p = 0.384) or PFS (p = 0.420), although survival curves show better OS in the radiotherapy group. Toxicities were rare, since none of the patients had grade 3 or superior toxicity. Conclusion RT did not impact survival or progression in our limited sample, but a longer OS may occur after the first-year post RT. RT should be tested in prospective data in the HIV+ population with DLBCL.
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Affiliation(s)
- Lucas Coelho Casimiro
- Department of Radiation Oncology, Instituto do Câncer do Estado de São Paulo (ICESP), University of São Paulo Medical School, Brazil
| | - Geovanne Pedro Mauro
- Department of Radiology and Oncology, University of Sao Paulo Medical School, School of Medicine, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
- Department of Radiology and Oncology, University of Sao Paulo Medical School, Brazil
| | | | - Eduardo Weltman
- Department of Radiation Oncology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Department of Radiology and Oncology, University of Sao Paulo Medical School, Brazil
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Tanaka PY, Ohshima K, Matsuoka M, Sabino EC, Ferreira SC, Nishya AS, de Oliveira Costa R, Calore EE, Perez NM, Pereira J. Epstein-Barr Viral Load is Associated to Response in AIDS-Related Lymphomas. Indian J Hematol Blood Transfus 2014; 30:191-4. [PMID: 25114406 DOI: 10.1007/s12288-014-0345-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 01/22/2014] [Indexed: 11/28/2022] Open
Abstract
AIDS-related lymphoma (ARL) development is associated to immunodeficiency state with proliferation of B-cells driven by HIV itself and EBV infection. However, Epstein-Barr DNA is not detected in malignant cells of all ARL subtypes. A prospective and controlled study to analyze EBV viral load (VL) in plasma and peripheral blood mononuclear cells (PBMC) of ARL patients was performed to analyze if Epstein-Barr VL could be related to response in these patients. Fifteen patients with ARL were included in this study with measurement of EBV VL at three different periods of time: at lymphoma diagnosis, upon completion of chemotherapy, and 3 months after. Two control groups composed by HIV-negative and HIV-positive patients were also evaluated for EBV VL comparison. In situ hybridization for EBER was performed on diagnostic samples of all ARL patients. Median EBV VL in PBMC and plasma had a significant decrease (p = 0.022 and p = 0.003, respectively) after ARL treatment. EBER was positive in 7 (46.7 %) cases. Median EBV VL in PBMC before lymphoma treatment in patients positive for EBER was significantly higher compared to EBER negative cases (p = 0.041). Reduction of EBV viral load during treatment of lymphoma could be predictive of response. EBER expression was associated to advanced stages of disease and worse immune status. Our study suggests that measurement of EBV VL during ARL treatment could be used as a marker for response, but further studies are needed to validate this association.
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Affiliation(s)
- Paula Yurie Tanaka
- Faculdade de Medicina - Programa de Ciências Médicas, Universidade de São Paulo, Av. Dr. Arnaldo, 455, São Paulo, Brazil
| | - Kouichi Ohshima
- Department of Pathology, School of Medicine, Kurume University, 67 Asahi-machi, Kurume-shi, Fukuoka-ken Japan
| | - Masao Matsuoka
- Institute for Virus Research, Kyoto University, 53 Asahi-machi, Kurume-shi, Fukuoka-ken Japan
| | - Ester Cerdeira Sabino
- Laboratório de biologia molecular -Fundação pró-sangue, Av. Dr. Enéas de Carvalho Aguiar, 155, São Paulo, Brazil
| | - Suzete Cleusa Ferreira
- Laboratório de biologia molecular -Fundação pró-sangue, Av. Dr. Enéas de Carvalho Aguiar, 155, São Paulo, Brazil
| | - Anna Shoko Nishya
- Laboratório de biologia molecular -Fundação pró-sangue, Av. Dr. Enéas de Carvalho Aguiar, 155, São Paulo, Brazil
| | | | - Edenilson Eduardo Calore
- Pathology Section - Instituto de Infectologia Emílio Ribas, Av. Dr. Arnaldo, 165, São Paulo, Brazil
| | - Nilda Maria Perez
- Pathology Section - Instituto de Infectologia Emílio Ribas, Av. Dr. Arnaldo, 165, São Paulo, Brazil
| | - Juliana Pereira
- Faculdade de Medicina - Programa de Ciências Médicas, Universidade de São Paulo, Av. Dr. Arnaldo, 455, São Paulo, Brazil ; Instituto do Câncer do Estado de São Paulo, Av. Dr. Arnaldo, 251, São Paulo, Brazil ; Laboratório de Imunopatologia, Prédio de Ambulatórios do Hospital das Clinicas, Av. Dr. Enéas de Carvalho Aguiar, 255, 1º.andar, bloco 12 sala 61, Cep: 05403 - 001, São Paulo, Brazil
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de Witt P, Maartens DJ, Uldrick TS, Sissolak G. Treatment outcomes in AIDS-related diffuse large B-cell lymphoma in the setting roll out of combination antiretroviral therapy in South Africa. J Acquir Immune Defic Syndr 2013; 64:66-73. [PMID: 23797692 PMCID: PMC3797444 DOI: 10.1097/qai.0b013e3182a03e9b] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Long-term survival for patients with AIDS-related diffuse large B-cell lymphoma (DLBCL) is feasible in settings with available combination antiretroviral therapy (cART). However, given limited oncology resources, outcomes for AIDS-associated DLBCL in South Africa are unknown. METHODS We performed a retrospective analysis of survival in patients with newly diagnosed AIDS-related DLBCL treated at a tertiary teaching hospital in Cape Town, South Africa, with cyclophosphamide, doxorubicin, vincristine, and oral prednisone (CHOP) or CHOP-like chemotherapy (January 2004 until December 2010). HIV-related and lymphoma-related prognostic factors were evaluated. RESULTS Thirty-six patients evaluated; median age 37.3 years, 52.8% men, and 61.1% black South Africans. Median CD4 count 184 cells per microliter (in 27.8% this was <100 cells/μL), 80% high risk according to the age-adjusted International Prognostic Index. Concurrent Mycobacterium tuberculosis in 25%. Two-year overall survival (OS) was 40.5% (median OS 10.5 months, 95% confidence interval: 6.5 to 31.8). Eastern Cooperative Oncology Group performance status of 2 or more (25.4% vs 50.0%, P = 0.01) and poor response to cART (18.0% vs 53.9%, P = 0.03) predicted inferior 2-year OS. No difference in 2-year OS was demonstrated in patients coinfected with M. tuberculosis (P = 0.87). CONCLUSIONS Two-year OS for patients with AIDS-related DLBCL treated with CHOP like regimens and cART is comparable to that seen in the United States and Europe. Important factors effecting OS in AIDS-related DLBCL in South Africa include performance status at presentation and response to cART. Patients with comorbid M. tuberculosis or hepatitis B seropositivity seem to tolerate CHOP in our setting. Additional improvements in outcomes are likely possible.
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Affiliation(s)
- Pieter de Witt
- Department of Internal Medicine, Stellenbosch University, Cape Town, South Africa, USA
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Guevara-Canales JO, Morales-Vadillo R, Sacsaquispe-Contreras SJ, Barrionuevo-Cornejo C, Montes-Gil J, Cava-Vergiú CE, Soares FA, Chaves-Netto HDDM, Chaves MDGAM. Malignant lymphoma of the oral cavity and the maxillofacial region: overall survival prognostic factors. Med Oral Patol Oral Cir Bucal 2013; 18:e619-26. [PMID: 23722134 PMCID: PMC3731090 DOI: 10.4317/medoral.18903] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 01/09/2013] [Indexed: 12/26/2022] Open
Abstract
Objective: To identify the overall survival and prognostic factors of malignant lymphoma of the oral cavity and the maxillofacial region.
Study Design: Clinical records data were obtained in order to determine overall survival at 2 and 5 years, the individual survival percentage of each possible prognostic factor with the actuarial technique, and the survival regarding the possible prognostic factors with the actuarial technique and the Log-rank and Cox’s regression tests.
Results: Of 151 subjects, an overall survival was 60% at 2 years, and 45% at 5 years. The multivariate analysis demonstrated statistically significant differences for clinical stage (p=0.002), extranodal involvement (p=0.030), presence of human immunodeficiency virus (p=0.032), and presence of Epstein-Barr virus (p=0.010).
Conclusion: The advanced clinical stage and the larger number of involved extranodular sites are related to a lower overall survival, as well as, the presence of previous infections such as the human immunodeficiency and the Epstein-Barr virus.
Key words:Lymphoma, oral cavity, survival.
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Barreto L, Azambuja D, Morais JCD. Expression of immunohistochemical markers in patients with AIDS-related lymphoma. Braz J Infect Dis 2012; 16:74-7. [PMID: 22358360 DOI: 10.1016/s1413-8670(12)70278-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 10/08/2011] [Indexed: 10/27/2022] Open
Abstract
AIDS-related lymphomas (ARL) present high biological heterogeneity. For better characterization of this type of lymphoma, the objectives of the present study were to evaluate the expression of immunohistochemical markers of cell differentiation (CD10, Bcl-6, MUM-1) and determine cell origin profile according to Hans' classification of diffuse large B-cell lymphoma in AIDS patients. This study included 72 consecutive patients with ARL diagnosed at the University Hospital, Universidade Federal do Rio de Janeiro (UFRJ) and at the Brazilian Instituto Nacional de Câncer (INCA) from 2000 to 2006. The morphologic distribution of the lymphomas was the following: 61% were diffuse large B-cell lymphomas (DLBCLs), 15% were Burkitt's lymphomas, 13% were plasmablastic lymphomas, 10% were high-grade lymphomas and 1% was follicular lymphoma. The positivity for each immunohistochemical marker in DLBCLs, Burkitt's lymphoma and plasmablastic lymphoma was respectively: CD20, 84%, 100%, and 0; CD10, 55%, 100%, and 0; Bcl-6, 45%, 80%, and 0; MUM-1, 41%, 20%, and 88%. A higher positivity of CD20 (84% x 56%, p = 0.01) was found in DLBCL compared to non-DLBCL; in Burkitt's lymphomas a higher positivity of CD10 (100% x 49%, p = 0.04) and Bcl-6 (80% x 39%, p = 0.035) were found compared to non-Burkitt's lymphomas. Germinal center (GC) profile was detected in 60% of DLBCLs. Our study suggests particular findings in ARL, as the most frequent phenotype was GC, different from HIV-negative patients.
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Affiliation(s)
- Luciana Barreto
- Hematology, Oncology and Pathology Services, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
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