Prognostic Factors in Patients with HIV-Associated Hodgkin Lymphoma: An Analysis of 199 Cases
Notice bibliographique
Résumé
Abstract Abstract 1528 Background: Hodgkin Lymphoma (HL) accounts for approximately 15% of all lymphomas. The incidence of HL is increased in HIV infection. The International Prognostic Score (IPS) is the most commonly used tool to risk-stratify patients with advanced HL but it has not been validated in HIV-associated HL (HIV-HL). We conducted a retrospective study to describe characteristics and evaluate the IPS and other prognostic factors for survival in HIV-HL. Methods: Institutions in the United States (US) and internationally submitted clinical and pathological patient-level data on HIV-positive individuals with a pathological diagnosis of HL who were treated concurrently with doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) and highly-active antiretroviral therapy (HAART). Continuous and categorical variables are presented using descriptive statistics. Univariate and multivariate analyses were performed for progression-free survival (PFS) and overall survival (OS). P-values <0.05 were considered statistically significant. Results: Data on 199 patients were obtained from 12 institutions; 148 cases (74%) were from Europe, 28 (14%) from North America (US, Canada), and 23 (12%) from South America. All patients were diagnosed between 1996 and 2010. The most common subtype was mixed cellularity (51%). Median age at diagnosis of HL was 42 years (range: 22–73 years), and 87% (n=184) were men. Median CD4+ count was 245 cells/mm3 (range: 4–1209 cells/mm3), and 51% (n=98) had a CD4+ count <200 cells/mm3. Median duration of HIV infection prior to HL diagnosis was 7 years (range: 0–30 years). In 24 patients (12%) HIV and HL were diagnosed concurrently, and 49% (n=95) had a previous diagnosis of AIDS. At presentation, 86% (n=170) of patients exhibited B symptoms, 56% (n=111) presented with stage IV disease, 79% (n=127) had albumin level <4 g/dl, 43% (n=74) had hemoglobin level <10.5 g/dl, 1% (n=1) had WBC >15,000 cells/mm3, 26% (n=44) had lymphocyte count <600 cells/mm3, and 41% (n=68) of patients had an IPS >3. All patients received concurrent HAART and ABVD chemotherapy, opportunistic infection prophylaxis was used in 89% (n=146), and 71% (n=128) received G-CSF therapy. Complete response (CR) was obtained in 82% (n=159) of patients. After a median follow-up of 5 years, the 5-year PFS and OS were 75% and 78%, respectively. In univariate analyses, adverse prognostic factors for PFS included albumin <4 g/dl (p=0.04) and CD4+ count <200 cells/mm3 (p=0.0002) while diagnosis of AIDS (p=0.03) and CD4+ count <200 cells/mm3 (p=0.002) were adversely prognostic of OS. In multivariate analyses, CD4+ count <200 cells/mm3 was the only independent adverse prognostic factor for PFS and OS (p=0.002 and p=0.004, respectively). Separately, an IPS >3 was significant for a worse PFS (p=0.04) and had a trend towards significance for a worse OS (p=0.06). When compared side-to-side, CD4+ count <200 cells/mm3 was a stronger adverse factor than IPS >3 for PFS and OS. Conclusions: HIV-HL commonly presents with high-risk features such as advanced stage, B symptoms and hypoalbuminemia. Despite high-risk presentations, we demonstrate an encouraging prognosis when these patients are treated with ABVD and concurrent HAART. Low CD4+ count was the strongest adverse predictor of prognosis in this population. Disclosures: No relevant conflicts of interest to declare.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».