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Prognostic Factors and Outcome of Human Herpesvirus 8–Associated Primary Effusion Lymphoma in Patients With AIDS

From the Departments of Clinical Immunology, Infectious Diseases, and Biostatistics, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Department of Clinical Hematology, Hôpital La Pitié Salpêtrière, AP-HP; Department of Pneumology, Hôpital Tenon, AP-HP, Paris; Department of Infectious Diseases, Hôpital d'Instruction des Armées Bégin, Saint-Mandé; Department of Infectious Diseases, Hôpital Eugénie, Ajaccio, France

Address reprint requests to Emmanuelle Boulanger, MD, Service d'Immunopathologie Clinique, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75 475 Paris cedex 10, France; e-mail: emmanuelle.boulanger{at}sls.ap-hop-paris.fr

PURPOSE: Primary effusion lymphoma (PEL) is a rare high-grade B-cell non-Hodgkin's lymphoma associated with Kaposi sarcoma–associated herpesvirus/human herpesvirus 8 (KSHV/HHV-8) infection, and is mostly observed in the course of HIV infection. The prognosis is poor, with reported median survival time shorter than 6 months. To date, no prognostic factor has been identified in this subset of lymphoma.

PATIENTS AND METHODS: We describe here a large series of HIV-infected patients with PEL, including 28 cases diagnosed in six centers during an 11-year time period. Prognosis analysis was performed using a Cox proportional hazard regression model. Statistically significant covariates were further analyzed in a forward, stepwise multivariate model.

RESULTS: After a median follow-up of 3.8 years (range, 10 months to 10.8 years), nine patients (32%) were still alive, and eight of them remained progression free. The median survival was 6.2 months, and the 1-year overall survival rate was 39.3%. Fourteen patients (50%) achieved complete remission, with a 1-year disease-free survival rate at 78.6%. In a multivariate analysis, only a performance status more than 2 (hazard ratio, 5.84; 95% CI, 1.76 to 19.33) and the absence of highly active antiretroviral therapy (HAART) before PEL diagnosis (hazard ratio, 3.26; 95% CI, 1.14 to 9.34) were found to be independent predictors for shorter survival.

CONCLUSION: Based on a retrospective series of 28 patients, two prognostic factors were identified as being independently associated with impaired clinical outcome in HIV-related PEL—(1) a poor performance status and (2) the absence of HAART before PEL diagnosis.

Supported by the Agence Nationale de Recherche sur le SIDA (ANRS)

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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