ABCL-167 HIV-associated diffuse large B-Cell lymphoma: Outcome with uniform DA-EPOCH-R protocol

Abstract

Context Diffuse large B-cell lymphoma (DLBCL) is one of the most common malignancies in people living with HIV and DA-EPOCH-R (dose-adjusted etoposide, doxorubicin, cyclophosphamide, vincristine, and prednisolone + rituximab) is one of the standard chemotherapeutic regimens for HIV-associated DLBCL. Objective We aimed to analyze the clinical-pathological characteristics at presentation and outcomes of DLBCL in HIVinfected patients treated with a uniform DA-EPOCH+R protocol and antiretroviral therapy (ART). Design, Setting and Participants In this retrospective study, we analyzed consecutive patients with HIV-associated DLBCL who received a DA-EPOCH+R protocol with granulocyte-macrophage colony stimulating factor prophylaxis, central nervous system prophylaxis, and standard combined ART in the Department of Medical Oncology at All India Institute of Medical Sciences (AIIMS), New Delhi, India, from May 1, 2013 to April 30, 2023. Results Ten patients were identified, and the median age was 45 years (range, 23-69). The Ann Arbor stage distribution was stage I, 1 (10%), stage II, 2 (20%), stage III, 3 (30%), and stage IV, 4 (40%). Bulky disease was seen in 5 (50%) cases, and bone marrow was involved in 2 (20%) cases. Extranodal involvement was seen in 7 (70%) patients. B-symptoms and elevated lactate dehydrogenase were observed in 7 (70%) and 8 (80%) patients, respectively. Poor performance status (Eastern Cooperative Oncology Group >2) and high-risk International Prognostic Index were present in 50% and 70%, respectively. The cell of origin data were available in 9 patients, and 6 (66.6%) were germinal in origin, and 3 cases were found to have double hit lymphoma. The median CD4-positive T-cell count was 210 cells/μL, and all patients were on ART. After the median 5 cycles (range, 2-6) of chemotherapy, the overall response rate was 90%, and 70% of patients achieved complete remission. The maximum dose intensity was level 3 in 30% and level 2 in 60% of cases. There were no treatment-related deaths. In our study, after a median follow-up of 30 months, the 2-year event-free survival and overall survival were 70% and 80%, respectively. Conclusion The DA-EPOCH +R regimen, given concurrently with ART, is a feasible and efficacious regimen in real-world clinical practice for HIV-associated DLBCL with good outcome.