Treatment outcomes of HIV infected patients with Non-Hodgkin’s Lymphoma treated with standard dose compared with dose-modified chop chemotherapy at Uganda Cancer Institute

Abstract

Introduction: Despite the increased access to effective combination ART, there is still significant mortality associated with malignancies in HIV-positive patients. Because majority of patients present late especially with advanced disease, Uganda Cancer Institute (UCI) still uses both standard dose and dose-modified CHOP chemotherapy for HIV-related NHL. In this study, we evaluated HIV patients with NHL treated with standard dose or dose-modified CHOP with the aim of assessing treatment outcomes. Study objective: To describe treatment outcomes of HIV positive patients with NHL treated with either standard or dose-modified CHOP at UCI. Methodology: A retrospective cohort study among HIV-related NHL patients attending the UCI was conducted between March to May 2017. Four hundred and ten eligible patients were reviewed and information on demographics, clinical characteristics, chemotherapy regimens, treatment outcomes and vital status at 6-months after completion of chemotherapy Results: Overall 410 charts for patients with HIV-related NHL were analyzed with 291 receiving standard dose and 119 received dose-modified CHOP chemotherapy. Most patients were male; 59.8% and 50.4% in standard dose and dose-modified group respectively. Of the patients with advanced disease, 83.2% were in the standard dose group and 79.8% in the dose-modified group. A complete response was achieved in 67 of the 291 (23%) patients assigned to the standard dose group and in 32 of the 119 (27%) patients assigned to the dose-modified group. The survival in the standard dose group was higher at 62% after 27 months compared to 56% after 31 months in the dose-modified group however this was not significant (p=0.770). The overall mortality was (18/202) 8.9% (p=0.997); 13/143 (9.1%) in the standard dose group and 5/59 (8.5%) in the dose-modified group. On multivariate analysis, female gender (OR 1.71, 95% CI 1.02-2.85, at least 6 cycles of chemotherapy received (OR 0.31, 95% CI 0.11-0.87), chemotherapy received on schedule (OR 0.52, 95% CI 0.30-0.90) and disease progression (OR 3.58, 95% CI 1.01-12.63) were significantly associated with mortality. Conclusion: The complete response rates and mortality were not different; thus, the recommendation is to consider dose-modified therapy because of the fewer associated Side effects and lesser chemotherapy associated toxicities. Although, this was not statistically significant.