Volume 5 Supplement 1

Proceedings of the 12-th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies (ICMAOI)

Open Access

Pooled analysis of AIDS Malignancy Consortium (AMC) trials evaluating rituximab plus either CHOP or infusional EPOCH chemotherapy in HIV-associated non-Hodgkin’s lymphoma

  • Stefan K Barta1Email author,
  • Jeannette Y Lee2,
  • Joseph A Sparano1,
  • Lawrence D Kaplan3 and
  • Ariela Noy4
Infectious Agents and Cancer20105(Suppl 1):A63

DOI: 10.1186/1750-9378-5-S1-A63

Published: 11 October 2010

Background

Two consecutively performed randomized studies by the AMC evaluating chemoimmunotherapy for the treatment of HIV-associated NHL include AMC010 [1] (Concurrent Rituximab [R] + CHOP vs. CHOP, N=150) and AMC034 [2] (Concurrent R+EPOCH vs. Sequential EPOCH →R; N=106). In AMC010, the addition of Rituximab to CHOP was associated with an increased risk of infectious death (15% vs. 2%, p=0.035) without a significant improvement in complete response (CR) rate (58% vs. 47%; p=0.147), event-free survival (EFS), or overall survival (OS). In AMC034, the CR rate met its primary efficacy endpoint in the concurrent arm (73%; 95% confidence intervals [CI] 58%, 85%) but not the sequential arm (55%; 95% CI 41%, 68%).

Methods

We performed a pooled analysis of these two consecutive trials including patients treated with R-CHOP and concurrent R-EPOCH in order to determine the influence of the age-adjusted International Prognostic Index (aaIPI), CD4 count (<100/μL vs. >100/μL), and treatment (CHOP vs. EPOCH) as variables.

Results

The characteristics and outcomes of the study populations are shown in table 1. Patients treated with R-EPOCH tended to have better outcomes in both the low and high-risk IPI groups.
Table 1

Patient characteristics and outcomes.

 

R-CHOP

R-EPOCH

No.

99

51

CD4<100/μL

41%

31%

High aaIPI risk (2-3 factors)

59%

69%

Mean age (years +/- standard deviation)

43.5 (+ 8.3)

42.6 (+8.4)

CR rate

Low risk aaIPI (0-1 factors)

High risk aaIPI (2-3 factors)

76% (60%, 88%)

45% (32%, 58%)

88% (62%, 98%)

60% (42%, 76%)

2 year EFS

Low risk aaIPI (0-1 factors)

High risk IPI (2-3 factors)

57% (36%, 73%)

30% (18%, 43%)

81% (51%, 93%)

59% (41%, 74%)

2 year OS

Low risk aaIPI (0-1 factors)

High risk aaIPI (2-3 factors)

66% (43%, 82%)

36% (23%, 50%)

87% (57%, 97%)

62%, (44%, 76%)

In a multivariate analysis that included pooled data from both consecutive studies, features that were significantly associated with improved EFS, OS, and CR rate included low aaIPI score and baseline CD4 count of at least 100/μl. Additionally patients treated with concurrent R-EPOCH exhibited improved EFS and OS even when adjusted for prognostic covariates including aaIPI score and CD4 count (Table 2).
Table 2

Multivariate analysis regarding the outcomes event-free survival (EFS), overall survival (OS) and rate of complete or unconfirmed complete remission (CR/CRu).

 

EFS p-value HR (95% CI)

OS p-value HR (95% CI)

CR/Cru p-value OR (95% CI)

aaIPI score (0-1 vs. 2-3)

<0.001 0.32 (0.17, 0.57)

<0.001 0.28 (0.14, 0.56)

<0.001 4.58 (1.96, 10.69)

CD4 (≥100 vs. < 100/μL

<0.001 0.42 (0.26, 0.69)

<0.001 0.37 (0.22, 0.63)

<0.05 2.70 (1.26, 5.79)

R-EPOCH vs. R-CHOP

<0.01 0.40 (0.23,0.69)

<0.01 0.38 (0.21, 0.69)

0.117 1.90 (0.85, 4.22)

Conclusions

These findings suggest that treatment outcomes may be superior with concurrent R-EPOCH compared with R-CHOP, and support the design of an ongoing Phase III trial comparing concurrent R-EPOCH with R-CHOP in immunocompetent patients with diffuse, large B-cell lymphoma (NCT00118209). This analysis provides additional level 2 evidence supporting the use of concurrent R-EPOCH in patients with HIV-associated lymphoma.

Declarations

Acknowledgements

This article has been published as part of Infectious Agents and Cancer Volume 5 Supplement 1, 2010: Proceedings of the 12th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies (ICMAOI).The full contents of the supplement are available online at http://www.biomedcentral.com/1750-9378/5?issue=S1.

Authors’ Affiliations

(1)
Montefiore-Einstein Cancer Center
(2)
University of Arkansas
(3)
University of California
(4)
Memorial Sloan-Kettering Cancer Center

Copyright

© Barta et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd.

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