Clinical Characteristics And Outcomes In HIV-Associated Diffuse Large B-Cell Lymphoma In Kenya: A Retrospective Single-Centre Study

Background: There are sparse data in patients with human immunodeficiency virus related diffuse large b cell lymphoma from real-world settings, especially where access to newer targeted therapies is limited. Aim: Therefore, we analysed the characteristics and outcomes of patients with HIV-associated DLBCL from The Kenyatta National Teaching and referral Hospital, Nairobi, Kenya. Methods: This was a single institution, retrospective cohort study of patients with Diffuse Large B Cell Lymphoma in HIV diagnosed between January 2012 and December 2019 and treated with combination chemotherapy. The main objectives were to characterise the clinical-pathological features and estimate progression-free survival (PFS) and overall survival (OS) from the time of diagnosis. Results: A total of 82 patients were recruited into the study. Over half 48 (57.8%) were males, while the females were 34 (42.2%) of the study population. Age range, followed with mean. The mean age of the population was 43.9 years (SD = 13.7) interquartile range of 34-56. Median age was 43 with range between 17-71 years. The mean age for the females was 43±11 years while that for the males was 44±12years. The male to female ratio was 1.4:1. Fourt nine 49 (59.8%) were classified as Germinal Center DLBCL while 32(39.0%) were nongerminal center type. Twenty-seven patients (32.9%) had HIV-associated DLBCL; 18(21.9%) had germinal centre while 9(10.9%) were of the non-germinal centre subtype. Most patients with HIV had extranodal disease (71%) with a significant p=0.01, B-symptoms 78% p=0.003, Bone marrow involvement 63% p=0.01 and poorer ECOG performance status p=0.05. There was also a trend towards higher ki-67 at 79% in HIV associated DLBCL compared to 71 in those who were HIV negative though was not statistically significant p=0.056. In this study, patients who were HIV negative tended to have advanced disease at presentation. There was difference between disease bulk and CNS involvement at presentation between the two groups. The median CD4+ T cell count was 86/µl, and 24 patients were already on combination antiretroviral therapy (cART) treatment at diagnosis of DLBCL. Local treatment included CHOP and R-CHOP with or without intrathecal methotrexate. The second line treatment included R-ICE, ICE or DHAP. At a median follow-up of 18 months, of the 34 patients evaluated at the end of treatment, the overall mean survival time was 43.1 (95% CI 20.7 – 65.6) months, while the overall median survival time was 29.0 (95% CI 13.8 – 44.2) months. The mean survival time was 56.7 (95% CI 10.9 – 102.5) months, with the overall median survival time of 48.0 (95% CI 8.2 – 87.8) months for the HIV positive patients while the mean survival time was 30.0 (95% CI 22.9 – 37.1) months, with an overall median survival time of 28.0 (95% CI 24.1 – 31.9) months for the HIV negative patients. There were no statistical differences in the survival times between the two groups as assessed by the Log Rank test (p=0.384). Conclusion In our population, patients with HIV-associated DLBCL presented with aggressive characteristics, even in the modern cART era but exhibited no difference in survival outcomes.