Clinical Features, Phenotypic Markers and Outcomes of Diffuse Large B-Cell Lymphoma between HIV-Infected and HIV-Uninfected Chinese Patients

Simple Summary Diffuse large B-cell lymphoma (DLBCL) frequently occurs in HIV-infected patients. However, the effect of HIV infection on the outcome of the DLBCL population remains controversial. The aim of the present retrospective study was to compare clinical features, phenotypic markers and outcomes of BLBCL between HIV-infected and HIV-uninfected Chinese patients. Our study indicated HIV-infected DLBCL patients displayed high EBER expression but low CD20 and CD79a expression on histopathology. The overall response rate at end of chemotherapy and 1-year overall survival (OS) were low in HIV-infected patients, which may be associated with the higher incidence of leukopenia, neutropenia, thrombocytopenia and hypoalbuminemia, as well as high involvement of the central nervous system (CNS), gastrointestinal tract and bone marrow. Hypoalbuminemia and CNS involvement were independent risk factors for 1-year OS. HIV-infected DLBCL patients without CNS involvement had a favorable outcome if rituximab was included in the chemotherapy regimen. Background: The effect of HIV infection on the clinicopathological characteristics of diffuse large B-cell lymphoma (DLBCL) remains debatable. Methods: Fifty-three HIV-infected and ninety-three HIV-uninfected DLBCL patients were enrolled in the retrospective study by propensity score matching for sex, age, body mass index and international prognostic index (IPI) at a ratio of 1:2. The clinicopathological characteristics were compared between the two groups. Results: HIV-infected DLBCL patients had lower white blood cell counts [x10(9)/L; 4.4 (3.4-5.6) vs. 6.1 (4.2-8.2), p < 0.001], platelet counts (x10(9)/L; 184.7 +/- 89.3 vs. 230.0 +/- 113.9, p = 0.014) and serum albumin (g/L; 37.3 +/- 6.9 vs. 41.3 +/- 6.2, p < 0.001) but higher incidences of central nervous system (CNS) involvement (9.4% vs. 1.1%, p = 0.014), bone marrow involvement (24.5% vs. 11.5%, p = 0.044) and Epstein-Barr viremia (61.1% vs. 26.7%, p = 0.002) than HIV-uninfected patients. In terms of histopathology, HIV-infected patients had higher positivity of Epstein-Barr virus-encoded small RNA (EBER) (41.7% vs. 6.7%, p = 0.002), but lower CD20 (90.2% vs. 98.7%, p= 0.029) and CD79a (23.1% vs. 53.7%, p < 0.001) expression. The overall response rate (ORR) at the end of chemotherapy (70.2% vs. 87.8%, p= 0.012) and 1-year overall survival (OS) (61.7% vs. 84.2%, log-rank p = 0.006) in HIV-infected patients were significantly lower than those in HIV-uninfected patients. Multivariate analysis suggested IPI <= 2.0 [adjusted odds ratio (AOR) (95% confidence interval): 5.0 (1.2-21.2), p = 0.030] was associated with ORR, hypoalbuminemia [AOR: 3.3 (1.3-9.1), p = 0.018] and CNS involvement [AOR: 3.3 (1.0-10.5), p = 0.044] were associated with reduced 1-year OS in HIV-infected patients. Conclusion: HIV-infected DLBCL patients have unique blood profiles and phenotypic markers. Low ORR and 1-year OS were observed in HIV-infected DLBCL patients in our study, even in the HAART era.