June 26, 2009

Improving Survival From Non-Hodgkin’s Lymphoma

Survival among people with HIV who are diagnosed with non-Hodgkin’s lymphoma (NHL) continues to improve, according to an encouraging reported published online June 15 in AIDS. The study found two thirds of people diagnosed with the cancer survived at least one year after diagnosis.

Lymphomas are cancers of the immune system, with NHL being one of the more common types. In the early years of the HIV epidemic, death within the first year of an NHL diagnosis was commonplace.

Some studies have suggested that NHL is becoming less common and more survivable since the introduction of effective combination antiretroviral (ARV) therapy in the mid-1990s. Most of these studies, however, were small in size and not conclusive.

To further explore modern-day rates of survival with NHL among people living with HIV, researchers with the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study examined the medical records of all of their patients who were 16 or older, who started ARV therapy at some point after January 1998, and who also developed NHL after January 1998.

Of 67,659 patients who were followed, 1,176 developed lymphoma. The average age of the patients was 40, most were men, and the majority had a CD4 count less than 200 at the time of their NHL diagnosis.

The COHERE group found that of 763 patients who had advanced NHL—cancer spread throughout the body—66 percent were alive one year after diagnosis, and 55 percent were still alive five years following their diagnosis. Survival in people with central nervous system (CNS) lymphoma was poorer, however. Survival after one year was 54 percent, and too few were alive after five years to allow an analysis.

When the researchers conducted an analysis that included all the factors that could influence NHL survival, the primary risk factor for death was a lower CD4 count. The lower the CD4 count at the time of diagnosis, the more likely a person was to die. Injection drug users also had poorer survival.

In people who were diagnosed with NHL while taking ARV therapy, the sooner they received their diagnosis, the more likely they were to have long-term survival than people who were diagnosed late during the course of the disease. People diagnosed at the age of 50 or older also had poorer survival.

The authors comment that their study is the largest so far to look at NHL since the introduction of combination ARV therapy. Though their study didn’t find a benefit associated with a specific HIV drug regimen, they conclude that survival following an NHL diagnosis is now getting much closer to that seen in HIV-negative patients.

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