834P - Treatment of DLBCL in HIV patient: Still a dilemma

Background

Treatment of Diffuse large B cell lymphoma (DLBCL) in patients with Human Immunodeficiency Virus (HIV) is still contentious. Here, we evaluate the effects of Rituximab, Cyclophosphamide, Oncovin, Hydroxydaunorubicin, Prednisone (R-CHOP) compared to addition of etoposide to above regimen (R-EPOCH) using a global population dataset.

Methods

TrinetX, a global federated research network, providing dataset of electronic medical records from different healthcare organizations (HCOs), was utilized. Initial query was made to isolate patients with HIV and DLBCL. The population was divided into two cohorts, based on the receipt of either R-CHOP or R-EPOCH. Further, propensity score matching (PSM) was carried out to match age, sex, and race. All-cause mortality, Tumor Lysis Syndrome (TLS), neutropenia and fever were evaluated as outcome. The Log-Rank test was used for survival analysis and cox regression was used for calculation of hazard ratio.

Results

930 HIV cases with DLBCL were identified, of which 46.13% (426) received R-CHOP. Cases receiving R-CHOP were older (56.7 ± 14.5 vs 49 ± 13.6, p<0.0001). Caucasians were predominant race on both population. African Americans less frequently received R-CHOP (21% vs 26%, p=0.0396), while cases with unknown race were treated more frequently treated with R-CHOP (11% vs. 6%, p=0.0048). Though not significant, all-cause mortality was less in R-CHOP cohort (28.29% vs 31.30%, p=0.3308). Difference in median survival was not significant (9.16 vs. 12.76 years, p=0.7839; HR=0.966, p=0.2269), with Log-Rank test showing no significant difference between the groups (p=0.7839). TLS (3.1% vs 7.2%, p=0.0095), and neutropenia (41.36% vs 58.85%, p<0.0001) were less likely to occur in patients receiving R-CHOP. Though not significant, cases receiving R-CHOP were less likely to get febrile episodes (36.64% vs. 38.64%, p=0.7214) and develop septic shock (20.41% vs. 25.59%, p=0.0989). After PSM, like prior, though insignificant, all-cause mortality remained less in R-CHOP group (25.65% vs 32.45%, OR=0.718, p=0.0642).

Conclusions

This study shows non-inferiority of R-CHOP in treatment of DLBCL in HIV patients, and in doing so, reduces toxicities of R-EPOCH. Further prospective studies are required to delineate this more clearly.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.