AIDS-related lymphoma responds best to chemotherapy/HAART combination

In patients with AIDS-related lymphoma, a good response to highly active antiretroviral therapy (HAART) predicts a better response to chemotherapy and longer survival, according to a report in the August 17th issue of AIDS.

“We now routinely combine HAART and chemotherapy in clinical practice, ” Dr. Andrea Antinori from National Institute for Infectious Diseases Lazzaro Spallanzani in Rome told Reuters Health.

Although previous data suggested higher remissions and improved survival rates with non-Hodgkin lymphoma (NHL) during the HAART era, the authors point out that no longitudinal data are available yet.

Dr. Antinori and colleagues evaluated the impact of response to HAART on the response of NHL to chemotherapy in 44 patients during a 27-month longitudinal study at two AIDS clinical centres in Italy.

Twenty-four of the 36 patients who received HAART as prescribed had a virological response, the report indicates, and 18 patients also experienced at least a 30% increase in CD4 cell counts.

Twenty-three patients (52.2%) achieved a complete remission and five patients (11.4%) had a partial remission in response to chemotherapy, the authors report, whereas 16 patients (36.4%) showed progressive disease.

Complete remission was six times more likely among HAART virological responders, the results indicate, and any chemotherapy response was nearly 26 times more likely. In fact, virological response to HAART was the only variable independently associated with complete remission.

During their combination HAART-chemotherapy, patients experienced a mean -1.61 log10 copies/mL in plasma HIV RNA, the researchers note. Each log10 fall brought a 1.7-fold increase in the probability of achieving complete remission.

Overall 1-year survival probability was 49%, the investigators report, but the probability was 78% among HAART virological responders and 84% among those who achieved immunological restoration.

Toxicities from chemotherapy and HAART did not differ between virological responders and virological nonresponders or HAART-naïve patients, the report indicates.

“The main message, ” Dr. Antinori said, “is that the combination of HAART and chemotherapy, which is tolerable and feasible, is warranted for a better response to chemotherapy and to improve the survival of patients.”

“Another important point is that the chemotherapy itself does not negatively affect virological response during HAART and does not cause an irretrievable decline of the immune system, ” Dr. Antinori concluded.

Antinori A et al. Better response to chemotherapy and prolonged survival in AIDS-related lymphomas responding to highly active antiretroviral therapy. AIDS 2001;15:1483-1491.
http://www.ncbi.nlm.nih.gov/pubmed/11504980?dopt=Abstract