LONG-TERM SURVIVAL OF PATIENTS WITH HIV-RELATED SYSTEMIC NON-HODGKINS-LYMPHOMAS

Background: the overall outcome of patients with HIV-related non-Hodgk in's lymphomas (HIV-NHL) is poor because of the adverse clinico-pathol ogical features of HIV-NHL and of the underlying HIV infection. Howeve r, the experience of physicians in the management of HIV-NHL has incre ased, in particular in the use of intensive chemotherapy regimens, lea ding to an improvement in the prognosis of some of these neoplasms. Be cause some patients with AIDS may survive up to 5 years, it is possibl e to evaluate the long-term efficacy of the treatment of patients with HIV-NHL. In the general population, aggressive NHL, that are those oc curring in HIV patients, may be considered cured after 2 years of last ing complete remission (CR) after chemotherapy. Patients and methods: we reviewed our monoinstitutional case-series of 73 HIV-infected patie nts with systemic NHL, observed between April 1985 and February 1993. Two groups of patients were arbitrarily identified, the first one (gro up A) including patients with a CR lasting for at least 2 years (N=13) and the other including all remaining patients (group B) (N=60). Resu lts: the 13 patients of group A differed significantly from the other patients in terms of higher CD4+ cell count and performance status (PS ) at the time of diagnosis of NHL. There was no significant difference in the histological subtypes of the HIV-NHLs. The overall survival of the 73 patients was 8 months. In a separate analysis on all patients, age less than 30 years, PS less or equal to 1, a CD4+ cell count equa l to or higher than 100/mm(3) and the absence of B symptoms were signi ficantly associated with a longer survival. The median survival in pat ients of group A was 42 months, however none of these patients relapse d during a median observation time of 42 months (range, 24-90). Conclu sions: long-term survival and possibly cure can be obtained in some pa tients with HIV-NHL, in particular in those with a better PS and a les s advanced immune dysfunction. In fact some of these patients are aliv e without evidence of disease 4 to 7 years after therapy, and others d ied of causes related to underlying HIV infection, in particular oppor tunistic infections, rather than relapse of NHL.