Comparison Of Treatment Outcomes Between Epoch And Chop Regimens In Patients With Hiv Associated Nhl In A Low Resource Setting

Abstract Background: The optimal chemotherapy regimen for treating HIV associated NHL in low resource settings is unknown. We conducted a retrospective study to describe survival rates, treatment response rates and adverse events in patients with HIV associated NHL treated with EPOCH and CHOP regimens at the Uganda Cancer Institute.Methods: A retrospective study of patients diagnosed with HIV and lymphoma and treated at the Uganda Cancer Institute from 2016 – 2018 was done.Results: One hundred eight patients treated with CHOP and 12 patients treated with EPOCH were analysed. Patients completing 6 or more cycles of chemotherapy were 51 (47%) in the CHOP group and 8 (67%) in the EPOCH group. One year overall survival (OS) rate in patients treated with CHOP was 54.5% (95% CI, 42.8 – 64.8) and 80.2% (95% CI, 40.3 – 94.8) in those treated with EPOCH. The observed survival rates differences were not statistically different between the two groups; hazard ratio, 0.43 (95% CI, 0.10 - 1.78; p=0.24). Factors associated with favourable survival were BMI 18.5-24.9 kg/m2, (p=0.03) and completion of 6 or more cycles of chemotherapy, (p<0.001). The overall response rate was 40% in the CHOP group and 59% in the EPOCH group. Severe adverse events occurred in 19 (18%) patients in the CHOP group and 3 (25%) in the EPOCH group; these were neutropenia (CHOP=13, 12%; EPOCH=2, 17%), anaemia (CHOP=12, 12%; EPOCH=1, 8%), thrombocytopenia (CHOP=7, 6%; EPOCH=0), sepsis (CHOP=1), treatment related death (EPOCH=1) and hepatic encephalopathy (CHOP=1).Conclusion: Treatment of HIV associated NHL with curative intent using CHOP and infusional EPOCH is feasible in low resource settings and associated with >50% one year survival.