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Patients With HIV With Burkitt’s Lymphoma Have a Worse Outcome Than Those With Diffuse Large-Cell Lymphoma Also in the Highly Active Antiretroviral Therapy Era

Division of Medical Oncology A, National Cancer Institute, Aviano, Italy

Renato Talamini

Epidemiology Unit, National Cancer Institute, Aviano, Italy

Umberto Tirelli

Division of Medical Oncology A, National Cancer Institute, Aviano, Italy

To the Editor:

Recently Lim et al¹ reported that the survival of patients with HIV-related diffuse large-cell lymphoma (HIV-DLCL) has significantly improved by the widespread use of highly active antiretroviral therapy (HAART). However, they also reported that the survival of patients with HIV-related Burkitt subtype (HIV-BL) treated with chemotherapy regimens employed in HIV-DLCL remains poor. The authors concluded that the current practice of using the same chemotherapy regimens for both groups of patients should be changed.

We recently published² the final results of a phase II prospective study using the combination of Rituximab plus infusional cyclophosphamide, doxorubicin, and etoposide (R-CDE) in 74 patients with HIV-related non-Hodgkin's lymphoma (HIV-NHL), including both HIV-DLCL and HIV-BL. In multivariate analysis, a diagnosis of HIV-BL was significantly associated with a worse outcome in comparison to patients with a diagnosis of HIV-DLCL. In fact, patients with HIV-BL showed a significantly lower complete remission rate than patients with HIV-DLCL (52% versus 77%; P = .05), a significant increased risk of death (hazard ratio for death = 2.24; 95% CI 1.01 to 4.97; P = .05) and the median overall survival (OS) was significantly worse (14 months versus not reached; P = .01).

Moreover, in order to further evaluate this comparison in more patients, we retrospectively reviewed our series of 253 HIV-NHL diagnosed and treated at the National Cancer Institute of Aviano, Italy from 1984 to 2003, including 125 cases in the pre-HAART era (77 HIV-DLCL and 48 HIV-BL) and in the HAART era (93 HIV-DLCL and 35 HIV-BL). All patients with HIV-DLCL and HIV-BL were treated with the same chemotherapy regimens. The median OS of all patients was significant longer in the HAART era in comparison to that of the pre-HAART era (15 months versus 8 months, P .0001). In addition, in the pre-HAART era, the median OS was similar in patients with HIV-BL versus patients with HIV-DLCL (7 months versus 10 months, P = .11) whereas in the HAART era the median OS of patients with HIV-BL was significantly shorter than that of patients with HIV-DLCL (8 months versus 22 months).

In conclusion, our data confirms that the significant improvement of the outcome of patients with HIV-NHL is related to the positive impact of HAART on the survival of patients with HIV-DLCL whereas the prognosis of HIV-BL remains poor despite the use of HAART. Taking into consideration, that in the HAART era patients with HIV infection are likely to tolerate intensive chemotherapy regimens a more intensive approach similar to that employed in the general population should be employed also in patients with HIV-BL.

Authors' Disclosures of Potential Conflicts of Interest

The authors indicated no potential conflicts of interest.

REFERENCES

1. Lim ST, Karim R, Nathwani BN, et al: AIDS-Related Burkitt's lymphoma versus diffuse large-cell lymphoma in the pre-highly active antiretroviral therapy (HAART) and HAART eras: Significant differences in survival with standard chemotherapy. J Clin Oncol 23:4430-4438, 2005[Abstract/Free Full Text]

2. Spina M, Sparano JA, Jaeger U, et al: Rituximab plus infusional cyclophosphamide, doxorubicin, and etoposide (R-CDE) in HIV-associated non-Hodgkin's lymphoma: Pooled results from three phase II trials. Blood 105:1891-1897, 2005[Abstract/Free Full Text]

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Related Reply

• In Reply:
  Soon-Thye Lim, Roksana Karim, Bharat N. Nathwani, Anil Tulpule, and Alexandra M. Levine
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