A promising prognostic model for patients with AIDS-related lymphoma in the combination antiretroviral therapy era.

Abstract

Objective: For patients with AIDS-related lymphoma (ARL), optimizing risk stratification is crucial to creating customized therapy regimens and enhancing their prognosis. This study aims to develop a more precisely predicted prognostic model for ARL patients.

Design: A 7-year retrospective cohort study (2016-2023) of 136 ARL patients at a single institution randomly allocated training ( n  = 109) and validation ( n  = 27) cohorts.

Methods: We assessed the relationship between HIV, lymphoma, and patient-specific factors and overall survival (OS) and progression-free survival (PFS) by univariate and multivariate analyses.

Results: The median age was 48 (IQR: 40-56) years, 76.5% were men. The overall 2-year OS and PFS were 52.9 and 48.5%, respectively. In the multivariate analysis, Eastern Cooperative Oncology Group performance status (ECOG-PS), central nervous system (CNS) involvement, elevated lactate dehydrogenase (LDH), Hemoglobin (Hb), neutrophil-lymphocyte ratio (NLR), and chemotherapy cycles were independently related to OS. A new prognosis score was generated with these variables, including ECOG at least 2, CNS involvement, elevated LDH, Hb less than 130 g/l, NLR more than 5, and not exceeding 5 chemotherapy cycles, with 1 point for each variable, for a maximum of 6. The area under the curve and C-index of the new model were 0.79 and 0.76, respectively. Our model showed better risk stratification in ARL patients than aaIPI, NCCN-IPI, and ARL-IPI.

Conclusion: In this study, we created a prognostic model for ARL patients that is clinically straightforward, feasible, and has good predictive power. Compared to the NCCN-IPI and the aaIPI, this model is more discriminative and predictively accurate in risk stratification and high-risk population identification.