CROI 2018 Abstract eBook

Abstract eBook

Poster Abstracts

Background: HIV-infected (HIV+) people have elevated risk of several non-Hodgkin lymphoma (NHL) subtypes due to loss of immune control of Epstein-Barr virus (EBV) infection. HIV+ people reportedly have a high risk for anaplastic large cell lymphoma (ALCL), a rare CD30+ T-cell NHL. However, ALCL is morphologically similar to variants of diffuse large B-cell and Hodgkin lymphoma, which may be misclassified as ALCL. Herein, we evaluated pathology reports of ALCL cases in HIV+ people to confirm the diagnosis and determined risk factors for ALCL. Methods: We used data from the HIV/AIDS Cancer Match Study (HACM) (1996- 2012), which links US HIV and cancer registries. When available, deidentified pathology reports of ALCL cases were acquired by participating cancer registries and evaluated by a hematopathologist. Immunohistochemistry or flow cytometry results for expression of CD30, T and B cell surface markers, anaplastic lymphoma kinase (ALK) protein, and EBV status of tumors were extracted. Risk of confirmed ALCL in HIV+ people relative to the general population was calculated as a standardized incidence ratio (SIR). ALCL risk factors among HIV+ people were evaluated using Poisson regression. Results: We identified 132 ALCL cases in HIV+ people. Based on review of 39 pathology reports, 35 (90%) were confirmed as ALCL. All confirmed ALCL cases were CD30+, none was positive for any B-cell marker, and 22 (63%) were positive for at least one T-cell marker (see Figure). Only 8 cases (33%) were ALK+ ALCLs. EBV was detected in 1 of only 6 tumors tested (17%). Risk of confirmed ALCL was strongly elevated among HIV+ people compared to the general population (SIR=6.9; 95%CI=5.4-8.6). ALCL incidence was highest among 40-49-year-olds (adjusted incidence rate ratio [aIRR]=3.8 vs. 0-29-year-olds), lower among females (aIRR=0.7), and was lower among non-Hispanic blacks compared to whites (aIRR=0.6). Risk was also significantly higher among HIV+ people who had AIDS compared to those who did not (aIRR=2.2). ALCL incidence declined sharply with increasing CD4+ T-cell count (aIRR=0.18 for CD4+ T-cell count ≥500 cells/μL vs. <200 cells/μL). Conclusion: Our pathology review confirmed the diagnosis of ALCL for most cases identified in cancer registries. ALCL is rare, but risk is highly elevated among HIV+ people and is especially increased among those with AIDS or a low CD4+ T-cell count, supporting a role for immunosuppression. Based on limited data, EBV does not appear to contribute to ALCL in HIV+ individuals.

1 San Gerardo Hospital, Monza, Italy, 2 Luigi Sacco University Hospital, Milan, Italy, 3 University of Milan, Milan, Italy, 4 Sant’Anna Hospital, Como, Italy, 5 Ospedale Civile di Legnano, Legnano, Italy, 6 Ospedale di Circolo di Busto Arsizio, Busto Arsizio, Italy, 7 University of Milano–Bicocca, Milan, Italy Background: CNS relapse is an important and most often fatal event in patients (pts) affected by Diffuse Large B cell lymphoma (DLBCL). Recently, a risk score (CNS-IPI) predicting CNS relapse has been validated in HIV-negative population with DLBCL. Aim of our study was to evaluate the rate of CNS relapse in HIV+ pts as regard to CNS-IPI score. Methods: Observational, multicenter, cohort study involving 6 centres in Lombardia, Italy. HIV+ pts with DLBCL diagnosis observed from 2009 to 2015 were included. CNS-IPI was estimated including IPI score plus kidney and/ or adrenal glands involvement (scored 1 point if present or 0 if absent). Three levels of CNS relapse risk were defined: low risk (LR: 0-1 points), intermediate risk (IR: 2-3 points), high risk (HR: 4-6 points). Chi-square or Fisher’s exact test and Kruskal-Wallis test were used for comparison of discrete and continuous variables, respectively. Results: Sixty-one HIV+ pts with DLBCL were included. Characteristics of pts at lymphoma diagnosis: 90%male; median age 49 years; median CD4+ T cells 224 cells/mm 3 ; 70.5% on antiretroviral treatment (ART); 93.4% treated with R-CHOP regimen; 54%with IPI ≥3; 19.7% pts underwent intratechal (IT) prophylaxis. According to CNS-IPI, we defined 13 pts (21.3%) at HR, 38 pts (62.3%) at IR and 10 pts (16.4%) at LR of CNS relapse. Pts belonging to HR group displayed significantly higher number of extranodal sites (84.6% showing 2-4) as compared to IR and LR groups (20% and 0% showing 2-4, respectively, p=0.03). In addition, pts with HR score showed a poor ECOG PS (61.5%with > 2) as compared to intermediate and low CNS relapse risk (20% and 20%with ECOG PS > 2, respectively, p=0.01). No significant associations emerged among HIV-related factors (current and nadir CD4+ T cells, HIV-RNA, use of ART) and CNS-IPI. After a median follow-up of 28 months (range 4-96), 6 pts (9.8%) displayed CNS relapse. CNS relapse was significantly more frequent in CNS-IPI HR pts (4/13, 30.8%) as compared to CNS-IPI IR or LR pts (2/30, 6.7% and 0/10, 0%, respectively, p=0.049) (figure 1). Risk of death was also significantly higher in CNS-IPI HR group (69.2%) as compared to IR and LR groups (33.3% and 0%, respectively; p<0.0001). Conclusion: Our data support the use of CNS-IPI score as a valuable prognostic tool of CNS relapse in HIV+ pts with DLBCL. CNS directed-investigations and prophylactic interventions could be tailored according to this risk model in future interventional studies.

Poster Abstracts

669 PRESENTATION AND OUTCOME OF BIOPSY-PROVEN HEPATOCELLULAR CARCINOMA BY HIV STATUS Jessie Torgersen 1 , Lesley Park 2 , Tamar Taddei 3 , Dena M. Carbonari 1 , Michael J. Kallan 1 , Kisha Mitchell-Richards 4 , Xuchen Zhang 3 , Kathryn D’Addeo 3 , Rajni Mehta 3 , Farah Kidwai-Khan 3 , Amy C. Justice 3 , Vincent Lo Re 1 1 University of Pennsylvania, Philadelphia, PA, USA, 2 Stanford University, Stanford, CA, USA, 3 Yale University, New Haven, CT, USA, 4 Greenwich Hospital, Greenwich, CT, USA Background: HIV+ patients have a two- to four-fold higher risk of hepatocellular carcinoma (HCC) than uninfected individuals. Despite the

668 CNS-IPI AS RISK MODEL FOR CNS RELAPSE IN HIV-ASSOCIATED DIFFUSE LARGE B-CELL LYMPHOMA Alessandra Bandera 1 , Davide Dalu 2 , Ilaria De Benedetto 1 , Elisa Colella 1 , Gaia Bombonati 2 , Elisa Doni 1 , Fulvio Crippa 3 , Omar Giglio 4 , Maurizio Mena 5 , Elisa Suardi 3 , Paola Vitiello 6 , Carlo Gambacorti Passerini 7 , Andrea Gori 7 , Luisa Verga 1

CROI 2018 248