A RETRO-PROSPECTIVE STUDY IN HIV+ PATIENTS AFFECTED BY LYMPHOMA: THE MUSTHAL MULTICENTER EXPERIENCE IN NORTHERN ITALY

Introduction: HIV+ people carry a higher risk of developing lymphomas. Combined antiretroviral therapy (cART) improves survival, but HIV+ patients (pts) with lymphoma are still considered poorly treatable. Our aim was to describe biopathological features of a cohort of HIV+ pts affected by lymphoma and their clinical implications. Methods: we conducted a retrospective and prospective multicentre study collecting clinical and immunovirological data in HIV+ pts affected by non-Hodgkin lymphoma (NHL) from 2003 and 2017 in six centres in Northern Italy, to evaluate overall (OS) and progression-free survivals (PFS). We collected biopathological data in 50 NHLs to better define the differences in term of outcome among diffuse large B-cell lymphomas (DLBCL) not otherwise specified (NOS), DLBCL double/triple expressors (DE/TE) and high grade B-cell lymphomas (HGBL). Differences in survival were tested with χ2 or Mann-Withney tests. OS was estimated by Kaplan Meyer. Hazard ratios (HR) for mortality for each biopathological subtype were corrected for IPI score and T CD4+ lymphocyte count (CD4+) at diagnosis. Results: 127 pts were enrolled: 86 DLBCL, 18 Burkitt lymphomas (BL), 6 primary central nervous system lymphomas (PCNSL), 11 plasmablastic lymphomas (PBL), 3 primary effusive lymphomas (PEL) and 3 anaplastic large T-cell lymphoma (ALCL). Median age was 48.9 years. 30% of the pts were on cART at NHL diagnosis. The burden of disease was usually high at diagnosis. 80/127pts received R-CHOP and 40/127 pts R-DA-EPOCH or more intensive regimens. Median follow up is 28 months. 2-years OS and PFS were 69.3% and 61.3%, respectively. No differences in OS among different lymphoma subtypes were noted. We observed 33 progressions and 3 relapses after 1° line treatment (36/127, 28.3%). Factors significantly associated with a worse survival in multivariate analysis were Age, high IPI score and CD4+ < 200/μl at diagnosis. Pts with CD4+ < 200 cells/μl at diagnosis had a significantly higher HR for lymphoma-related deaths, especially those with a low disease burden (HR 4,136 if IPI ≤ 3). The use of cART at diagnosis had no impact on OS. The 50 pts screened for biopathological features resulted in 36 DLBCL NOS, 8 DLBCL DE/TE and 6 HGBL. HGBL showed a particularly high risk of poor response and early mortality as 6/6 pts died within 13 months, despite aggressive treatment schedules (Figure 1). Keywords: high-grade B-cell lymphoma with or without rearrangement of MYC and BCL2 and/or BCL6; human immunodeficiency virus (HIV).