HIV lymphomas in the safety-net setting: A decade of experience at a single institution.

Abstract

e19113 Background: Safety-net hospitals treat disproportionately more HIV patients than other hospitals. HIV patients are at increased risk for aggressive lymphomas requiring concurrent chemotherapy and antiretroviral therapies (ART). Trial-based data largely exclude patients with poor performance status (PS), and the proportion of patients not offered chemotherapy is underreported. We evaluated characteristics and outcomes of HIV-associated lymphomas treated at JPS Health Network, a large safety-net system in North Texas. Methods: We conducted an IRB-approved retrospective study using the JPS tumor registry and Epic EHR, including patients diagnosed with HIV-associated aggressive B-cell lymphomas between January 1, 2013, and December 31, 2022. Data regarding HIV status/treatment, stage of lymphoma, compliance with ART/chemotherapy, and survival parameters were abstracted. Cox regression analysis was used to analyze the association between variables and survival. Results: Fifty patients were included in the study. The median age was 47 years; 76% were male. Racial/ethnic distribution was 50% Black, 28% Hispanic, and 22% non-Hispanic White. Fifty percent were uninsured, and the median zip-code-based household income was $54,988 (vs 2022 US median of $74,580). Hepatitis B and C coinfection occurred in 10% and 8%, respectively; 44% had psychiatric comorbidities. Diffuse large B-cell lymphoma (DLBCL) was the most common (68%), followed by Hodgkin (14%) and Burkitt lymphomas (10%). Stage distribution for DLBCL was 11.7%, 8.8%, 20.6% and 55.9% for stages 1, 2, 3, and 4, respectively. Median International Prognostic Index was 3. Seventy-four percent had PS >1 at diagnosis. Chemotherapy was administered to 86% (n=43) of patients, 79.1% (n=34) completed the frontline regimen with 86% treatment compliance. Delays occurred in 21 patients, most commonly due to neutropenia; 27.6% (n=12) developed opportunistic infections. All patients received ART. Overall survival (OS) with 95% CI was 0.82 (0.68, 0.90) at 3 months, 0.72 (0.57, 0.82) at 1 year, 0.68 (0.53, 0.79) at 2 years, and 0.62 (0.45, 0.74) at 5 years; median OS was approximately 9 years, 3304 days. Progression-free survival (PFS) at 1 year was 0.68 (0.53, 0.79), 2 years was 0.66 (0.51, 0.77), and 5 years was 0.61 (0.46, 073); median PFS was approximately 9 years, 3289 days. The complete response rate was 76.9% for all patients and 60% for DLBCL. Four patients relapsed, two received salvage chemotherapy none received transplant or CAR T. Conclusions: Despite a high proportion of patients with poor PS, long-term outcomes for HIV-associated aggressive lymphomas at JPS are comparable to published literature. The initial 3–6 months after diagnosis are critical to overall survival, underscoring the importance of offering chemotherapy to all patients. Multidisciplinary collaboration is essential to ensure the best outcomes in resource-constrained safety-net settings.