Challenges in HIV-diffuse large B-cell lymphoma in Afro-Caribbean patients in a NYC hospital.

Abstract

e19054 Background: Diffuse large B-cell lymphoma (DLBCL) remains a prominent cause of cancer-related mortality among HIV-infected individuals, even in the contemporary era of highly active antiretroviral therapy (HAART). Methods: We conducted a retrospective review of patients diagnosed and treated for DLBCL at New York City Health and Hospitals/Kings County from 2013 to 2023. We analyzed electronic health records for clinicopathologic and treatment utilizing descriptive statistics. Results: Within this cohort of 18 patients with HIV-DLBCL, the median age was 52.5 years. All were of Afro-Caribbean descent. Fourteen were male (77.8%). Fifteen (83.3%) had a pre-lymphoma AIDS diagnosis, and 11 (61.1%) were on HAART. Fourteen (77.8%) had CD4 T-cell <200 cells/mm³. Six (33.3%) had HIV viral load suppression (<200 copies/mL). At presentation, 17 patients (94.4%) had advanced DLBCL (Lugano modified Ann Arbor stage III-IV). Twelve patients (66.7%) had a revised International Prognostic Index (R-IPI) score of >3 and lymph node pathology proliferation index Ki-67 ≥80%. Of these 12 patients, 6 (50%) were non-GCB phenotype and 5 (41.7%) had double or triple expression of MYC and BCL2 (± BCL6) by immunohistochemistry. Among the 11 patients with FISH testing, none was double or triple-hit. Of 13 patients who received chemotherapy, 10 (76.9%) received DA-EPOCH-R and 3 (23.1%) received R-CHOP. Of these patients, 3 had opportunistic infection (OI) related deaths with CD4 T-cell <50 cells/mm 3 and HIV viral load >200 copies/mL including 1 Pneumocystis pneumonia, 1 Streptococcus viridans endocarditis, 1 Enterococcus faecium bacteremia; 3 patients experienced OI-deaths with CD4 T-cell between 50 and 200 cells/mm 3 and HIV viral load >200 copies/mL with 1 Pseudomonas bacteremia, and 2 culture-negative sepsis. One patient with CD4 T-cell count of 173 cells/mm 3 and undetectable HIV viral load died from COVID-19. Five patients were managed with supportive care due to frail performance status. The outcomes of the 13 chemotherapy-treated patients stratified by CD4 counts were as follows: 9 patients with CD4 T-cell <200 cells/mm 3 had median overall survival (mOS) of 7.5 months and 4 patients with CD4 T-cell >200 cells/mm 3 had mOS of 11 months. Within this cohort, 7 patients with OI complications had mOS of 6 months, and 6 patients without OI complication had mOS of 40 months. Five patients on best supportive care had mOS of 2 months. Conclusions: Our cohort of Afro-Caribbean patients with HIV-DLBCL at presentation had advanced HIV and DLBCL with high R-IPI and proliferation indices. Even in the contemporary era of HAART, the management of HIV-DLBCL remains challenging. Patients with poor viral control had adverse outcomes compared with patients with optimal viral control, mostly due to opportunistic infections. Our study highlights the continued importance of HIV control in achieving optimal outcomes in patients with HIV-DLBCL.