Highly active antiretroviral therapy (HAART) has significantly improved survival in patients with HIV disease and diffuse large-cell non-Hodgkin's lymphoma. Kim et al identified prognostic factors affecting survival in a patient with HIV-related diffuse large-cell lymphoma. The authors are from the University of Southern California in Los Angeles and the National Cancer Center in Singapore.
Parameters:
(1) complete response to therapy for the malignant lymphoma
(2) therapy with HAART
(3) CD4 lymphocyte count (if not receiving HAART)
(4) International Prognostic Index (IPI)
|
IPI Score |
Risk Group |
|
0 or 1 |
low |
|
2 |
low-intermediate |
|
3 |
intermediate-high |
|
4 or 5 |
high |
Factors associated with decreased survival:
(1) failure to achieve a complete response to lymphoma therapy
(2) not receiving HAART
(3) CD4 lymphocyte count < 100 per µL if not receiving HAART
(4) IPI intermediate-high OR high risk
One possible way to convert this into a prognostic score.
|
Parameter |
Finding |
Points |
|
complete response to therapy |
yes |
0 |
|
|
no |
1 |
|
therapy with HAART |
no |
2 |
|
|
yes |
0 |
|
CD4 count (if not receiving HAART) |
< 100 per µL |
1 |
|
|
>= 100 per µL |
0 |
|
International Prognostic Index |
0 to 2 |
0 |
|
|
3 (intermediate-high) |
1 |
|
|
4 or 5 (high) |
2 |
number of risk factors for reduced survival =
= SUM(points for all of the parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 6
• The higher the score the worse the prognosis.
• The best survival in the HAART era is a 3 year survival rate of 64%. The worse survival in the non-HAART era is a 3 year survival of 0%.
Purpose: To evaluate a patient with HIV-related diffuse large-cell non-Hodgkin's lymphoma for factors affecting prognosis.
Specialty: Hematology Oncology
Objective: risk factors, severity, prognosis, stage
ICD-10: C85.9,
