Clinical significance of gastrointestinal involvement in human immunodeficiency virus (HIV) patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL).
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Le résumé fourni par la source
e19060 Background: DLBCL is a heterogeneous group of aggressive lymphomas with distinct subtypes, and efforts to identify patients at high risk for treatment failure and poor clinical outcomes are ongoing. Specific sites of extra nodal (EN) involvement are known to impact response rates, progression free survival (PFS), and overall survival (OS) among immune-competent patients; however, less is known regarding the same in DLBCL patients concomitantly infected with HIV (HIV-DLBCL). Methods: We studied differences in clinical outcomes of HIV-DLBCL based on EN involvement and cell of origin in patients treated at Erie County Medical Center and Roswell Park Cancer Institute (2000-2015). Results: 25 patients with HIV-DLBCL were identified. Median age was 49 years; 85% were males. Median time from HIV to DLBCL was 188 months; median CD4 count was 189/ml. Stage distribution was: I-8%, II-20%, III-16% and IV-48%. 32% were germinal center B-cell (GCB) and 24% were non-GCB, rest could not be classified. 76% had EN involvement, most common being gastrointestinal tract (GI-32%). 84% received rituximab (DA EPOCH-44%, CHOP-32%), rest died without therapy. 52% achieved a complete response. 84% received anti-retroviral therapy with front-line chemotherapy; 29% utilized a protease inhibitor (PI) containing regimen. Clinical outcomes between GCB and non-GCB DLBCL did not differ. Patients with GI involvement were older (p = 0.02); no association was seen with CD4 count, viral load, disease stage or DLBCL subtype. After adjusting for age, race and gender in multivariate analysis, GI involvement was a predictor of poor PFS (p = 0.02) and OS (p = 0.03). Concurrent use of PI showed better OS (p = 0.01) in patients with GI involvement. Conclusions: GI involvement at diagnosis is an independent predictor of adverse clinical outcomes in HIV-DLBCL patients. While endoscopic evaluation of the GI tract in asymptomatic patients may predict prognosis, it is unclear how front-line therapy can be modified to improve their clinical outcomes. Though restricted by sample size, our preliminary assessment also shows that administration of PI may benefit HIV DLBCL patients with GI involvement.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Clinical significance of gastrointestinal involvement in human immunodeficiency virus (HIV) patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL).
- Date Crossref
- 20/05/2016
- Éditeur
- American Society of Clinical Oncology (ASCO)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Roswell Park Comprehensive Cancer Center pays non établi dans la noticeStructure de recherche
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Government Medical College pays non établi dans la noticeUniversité ou école supérieure
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Erie County Medical Center pays non établi dans la noticeÉtablissement de santé
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Cornell University pays non établi dans la noticeUniversité ou école supérieure
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Weill Cornell Medical Center pays non établi dans la noticeÉtablissement de santé
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Feist-Weiller Cancer Center pays non établi dans la noticeStructure de recherche
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University at Buffalo pays non établi dans la noticeUniversité ou école supérieure
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Catholic Health /Roswell Park Cancer Institute pays non établi dans la noticeStructure de recherche
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Catholic Health/University of Buffalo pays non établi dans la noticeUniversité ou école supérieure
Roswell Park Comprehensive Cancer Center, Government Medical College et Erie County Medical Center, avec 6 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.