Lymphoma-associated mortality in the German HIV- lymphoma cohort study

Background: Since the introduction of combination antiretroviral therapy (ART) the outcome of HIV-associated lymphoma has significantly improved. However, aggressive lymphomas remain the most frequent AIDS-defining event leading to death. We aimed to analyse lymphoma-related mortality in the German HIV-Lymphoma Cohort Study. Methods: This prospective multicenter cohort study includes adult HIV- 1 infected patients with biopsy or cytologically proven HIV-related lymphoma diagnosed at 33 participating centers in Germany and Austria since January 2005. Data on HIV-infection and lymphoma characteristics, treatments and outcomes recorded until December 2014 were analyzed. Pts with T-cell lymphomas, indolent lymphomas and primary central nervous system lymphomas were excluded from the present analysis. Results: Of 499 pts (463 males, 36 females) 394 had aggressive NHL and 105 HL. At the time of lymphoma diagnosis the median age was 44.7 years (range, 22-74.7) and the median CD4-cell count was 210/μl (0-1586). 344 of 499 pts (69%) were diagnosed with advanced stage (III/IV) disease. 214 pts (43%) were ART-naïve, 175 pts (35%) had a viral load below the detection limit of < 50 HIV RNA copies/ml at lymphoma diagnosis while on ART, and 110 pts (22%) had a viral load > 50 copies/ml while on ART or while discontinuing ART. After a median follow-up of 1.8 years 25 of 105 HL (24%) and 122 of 394 NHL pts (31%) have died with an overall death rate of 30% (147/499). 84 of 147 pts (57%) died of relapsed/refractory lymphoma, 75 of 122 pts with NHL (62%) and 9 of 25 pts with HL (36%). In 30 of 147 pts (20%) the cause of death were infections during or shortly after primary chemotherapy (7/25 pts with HL [28%] and 23/122 of pts with NHL [19%]). CD4-cell count was 164/μl in pts who died of infections compared to 293/μl in pts alive (P< 0.001). Further causes of death were secondary malignancies (n = 6; 4%), AIDS-defining events other than NHL (n = 6; 4%) including 4 cases of progressive multifocal leukoencephalopathy, and miscellaneous (n = 21; 14%). Conclusions: HIV-related lymphomas mainly occur in ART-naïve or insufficiently treated patients. The major cause of death is relapsed/refractory lymphoma followed by infections during or shortly after primary chemotherapy.