History of HIV infection Pre-HAART era (up to 1996-1997) HAART eraHAART era (1997-...)

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Presentation transcript:

History of HIV infection Pre-HAART era (up to ) HAART eraHAART era ( )

Impact of HAART on natural history of HIV infection  incidence opportunistic infections  incidence Kaposi’s sarcoma  incidence carcinoma of cervix  incidence of primary CNS lymphoma  incidence (significant in recent studies) of the remaining NHL ↑ incidence Hodgkin’s lymphoma

Biggar, R. J. et al. J. Natl. Cancer Inst : Incidence of major AIDS-associated cancers by CD4 count category in persons with AIDS, by calendar-year period

Biggar RJ, et al. Blood 2006; 108: Incidence of HL and NHL by CD4 lymphocyte count at diagnosis of HIV infection

HAART before lymphoma N=31 No HAART before lymphoma N=100 P CNS involvement1/3125/ PCNSL*1/3113/ Leptomeningeal spread in systemic NHL 0/3012/ CNS infiltration and HAART JT Navarro et al. Haematologica 2008; 93:

Hodgkin’s (N=20 ) Non Hodgkin’s (N=101) Outcome of lymphomas in Pre-HAART era ICO-HGTP experience

Impact of HAART in response and survival in HIV-related lymphomas HAART use HAART response Author (yr) CROSCROS Antinori (2001)+ + Navarro (2001)+ + Tam (2002) + Gerard (2002)* + + Navarro (2002) + Vaccher (2003) + + Hoffmann (2003)+ + Ribera (2002)*+ + Hoffmann (2004)* + Oriol (2005)** + Xicoy (2007)* + Ribera (2008) + *Hodgkin’s lymphoma. **Burkitt’s lymphoma

Diffuse large-B-cell lymphoma JT Navarro, JM Ribera, A Oriol, et al. Br J Haematol 2001; 112: Navarro JT, Ribera JM, Oriol A, et al. Leuk Lymphoma 2002; 43:

Burkitt’s lymphoma/leukemia Response, 85±24%, n=7 No resp./No HAART, 27±22%, n= 11 P=0.04 A Oriol et al. Haematologica 2005; 90: 990-2

Hodgkin’s lymphoma JM Ribera et al. AIDS 2002; 16:

Current approach of the treatment of HIV-related lymphomas in Spain Diffuse large B-cell lymphomas –CHOP –R-CHOP-21 –R-CHOP-14 –R-CHOP-21+ HDT/ASCT Burkitt’s lymphoma/leukemia –PETHEMA ALL3/97 –BURKIMAB Hodgkin’s lymphoma –ABVD

Diffuse large B-cell lymphoma CHOP R-CHOP-21 R-CHOP-14 R-CHOP-21 + HDT/ASCT

Diffuse large B-cell lymphoma CHOP JT Navarro, JM Ribera, A Oriol, et al. Br J Haematol 2001; 112: JT Navarro et al. Haematologica, 2005; 90: HIV+ and HAART vs. HIV-

Immunochemotherapy Author (yr) Schedule N CR(%) DFS(%) OS(%) Boue (2006) R-CHOP Ribera (2008) R-CHOP Kaplan (2005) R-CHOP** wk* 139wk* Spina (2005) R-CDE 74 70*** 89*** 64*** *Median. **R-CHOP arm of the randomized study *** Better results than those from historic control with CDE (CR 45%, OS 38%)

Boue, F. et al. J Clin Oncol; 24: R-CHOP (DLBCL & BL) OS PFS

Spina, M. et al. Blood 2005;105: R-CDE OSPFS

Ribera et al. Br J Haematol 2008; 140: DFS OS Diffuse large B-cell lymphoma Rituximab+CHOP-21

LNH-VIH R-CHOP vs. CHOP AMC010 Study Kaplan LD, et al. Blood 2005; 106:

AMC: Randomized Lymphoma Studies StudyArmNo.Median CD4 CR1 YR EFS AMC010CHOP % (22,62%) 50% (39,61%) AMC010R-CHOP % (47, 67%) 48% (32,64%) AMC034 EPOCH  R % (41,64%) 68% (55,81%) AMC034R-EPOCH % (56, 79%) 78% (66,90%) Sparano JA. Blood 2010; 115:

AMC 034 Study