Evaluation of the therapeutic results of NHL-BFM-90 and R-CHOEP in HIV-associated burkitt's lymphoma

Abstract Introduction. Patients with HIV infection have a higher risk of developing malignant neoplasms, including aggressive lymphoproliferative diseases, compared with the general population. Even with modern personalized highly specific antiretroviral therapy (ART), which has significantly improved the prognosis of HIV-positive patients, the incidence of non-Hodgkin's lymphomas (NHL) remains 11-200 times higher than in the general population. Among HIV-associated lymphomas, the leading place is occupied by Burkitt's lymphoma (BL), a highly aggressive tumor characterized by an extremely unfavorable course and worse outcomes than diffuse large B-cell lymphoma (DLBCL). This is due to the high proliferative activity of tumor cells, frequent involvement of the central nervous system and resistance to standard chemotherapy. HIV infection indicators - low CD4+ level and high viral load (VL) are negative factors during program chemotherapy of HIV-associated lymphomas. Objective: To evaluate the therapeutic results and compare the toxicity profile of the NHL BFM-90 and RCHOEP protocols in the treatment of LB in HIV-infected patients for the period from 2012 to 2024. Materials and methods: For the period from 2012 to 2024, the State Budgetary Healthcare Institution Loginov Moscow Medical Scientific Center of the Moscow Health Department analyzed the treatment results of 50 HIV-infected patients with Burkitt's lymphoma (LB). The 1st comparative group (R-CHOEP) - 23 patients, the 2nd group - (according to the R-NHL-BFM-90 protocol) - 27 patients. Median age: 35 years and 30 years, respectively. 27 patients had a preserved immune status (CD4+> 200 cells / μl, no viral load), which determined their distribution into the second group. Results and discussion. The 3-year overall survival (OS) for the R-CHOEP program was 40%, for the R-NHL BFM-90 program - 85%. The frequency of early relapses and disease progression in group 1 reached 65%. The use of anti-relapse courses in this cohort of patients was ineffective (further disease progression in 98% of cases). In the second group of patients, the frequency of early relapses is up to 5% and is associated with late stages of the disease, involvement of the central nervous system and bone marrow. At the same time, high-dose therapy is often associated with high risks of complications: hematological, infectious (including reactivation of opportunistic infections), which is associated with high mortality in patients with uncontrolled HIV infection, which in turn limits the use of this protocol. Conclusion. In the treatment of LB in HIV-infected patients, high-dose chemotherapy according to the NHL BFM-90 program has an advantage in terms of OS with controlled toxicity compared with less toxic CT according to the R-CHOEP program. The number of severe complications did not correlate with the choice of chemotherapy regimen, but was directly dependent on the duration of HIV infection, the level of CD4+ lymphocytes and the viral load.