Outcomes of treatment with CHOP and EPOCH in patients with HIV associated NHL in a low resource setting
- PDF / 685,610 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 89 Downloads / 196 Views
RESEARCH ARTICLE
Open Access
Outcomes of treatment with CHOP and EPOCH in patients with HIV associated NHL in a low resource setting Clement D. Okello* , Abrahams Omoding, Henry Ddungu, Yusuf Mulumba and Jackson Orem
Abstract Background: The optimal chemotherapy regimen for treating HIV associated NHL in low resource settings is unknown. We conducted a retrospective study to describe survival rates, treatment response rates and adverse events in patients with HIV associated NHL treated with CHOP and dose adjusted-EPOCH regimens at the Uganda Cancer Institute. Methods: A retrospective study of patients diagnosed with HIV and lymphoma and treated at the Uganda Cancer Institute from 2016 to 2018 was done. Results: One hundred eight patients treated with CHOP and 12 patients treated with DA-EPOCH were analysed. Patients completing 6 or more cycles of chemotherapy were 51 (47%) in the CHOP group and 8 (67%) in the DAEPOCH group. One year overall survival (OS) rate in patients treated with CHOP was 54.5% (95% CI, 42.8–64.8) and 80.2% (95% CI, 40.3–94.8) in those treated with DA-EPOCH. Factors associated with favourable survival were BMI 18.5–24.9 kg/m2, (p = 0.03) and completion of 6 or more cycles of chemotherapy, (p < 0.001). The overall response rate was 40% in the CHOP group and 59% in the DA-EPOCH group. Severe adverse events occurred in 19 (18%) patients in the CHOP group and 3 (25%) in the DA-EPOCH group; these were neutropenia (CHOP = 13, 12%; DAEPOCH = 2, 17%), anaemia (CHOP = 12, 12%; DA-EPOCH = 1, 8%), thrombocytopenia (CHOP = 7, 6%; DA-EPOCH = 0), sepsis (CHOP = 1), treatment related death (DA-EPOCH = 1) and hepatic encephalopathy (CHOP = 1). Conclusion: Treatment of HIV associated NHL with curative intent using CHOP and infusional DA-EPOCH is feasible in low resource settings and associated with > 50% 1 year survival. Keywords: Treatment outcome, DA-EPOCH CHOP, HIV associated NHL, Low resource settings
Background Globally, the estimated incidence of non-Hodgkin’s lymphoma (NHL) was 5/100,000 in 2012 [1]. In Uganda, the incidence of NHL was 1426/100,000 from the year 1991–2010 [2]. In 2016, an estimated 1.4 million people in Uganda were living with HIV [3]. The incidence of NHL remains significantly higher in HIV-positive patients compared with the HIV negative patients, even in * Correspondence: [email protected] Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda
the era of combination antiretroviral therapy (ART) [4– 7]. The outcomes for patients with HIV-associated NHL and non-HIV associated NHL treated with chemotherapy in resource limited settings is still disappointingly low [8]. Notwithstanding, the introduction of combination ART resulted in reduced morbidity and mortality from HIV infection [9–11], and improved NHL specific outcomes [12]. The optimal chemotherapy regimen for the treatment of HIV associated NHL in low resource settings is still unclear. First line chemotherapy regimens used to treat
© The Author(s). 2020 Open Access This article is licensed under
Data Loading...
