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Abstract：
BACKGROUND: Burkitt lymphoma (BL) accounts for 10-35% of AIDS-defining lymphoma in people with HIV (PWH). Previous research consisting of smaller cohorts has shown decreased survival for HIV-associated BL. This study aims to compare overall mortality in BL patients with and without HIV, while investigating impact of treatment modalities in HIV-associated BL.
METHODS: Using the 2004-2019 NCDB, we identified 4312 patients with stage 3 or 4 BL who had a known HIV status and received either chemotherapy alone or chemotherapy and immunotherapy. Time to death was evaluated using Kaplan-Meier survival estimates. Risk of death was evaluated using an extended multivariable Cox model adjusted for multiple factors and with a Heaviside function for HIV status by time period (0-3 month vs. 3-60 month).
RESULTS: Of the 4312 patients included, 1514 (35%) had HIV. For months 0-3 from time of diagnosis, HIV status was not associated with a statistically significant increase in risk of death (HR = 1.04, 95% CI: 0.86, 1.26, p = 0.6648). From month 3to 60, positive HIV status was associated with a 55% increase in risk of death compared to those without HIV (95% CI: 1.38, 1.75, p < 0.0001). Further, this difference in hazard rates (0-3 vs. 3-60) was statistically significant (HR = 1.49, 95% CI: 1.22-1.82, p < 0.001).
CONCLUSIONS: There is an increased mortality rate from months 3 to 60 in BL patients with HIV compared to patients without HIV. Additionally, risk of death in the first 3 months is significantly decreased by 45% in patients with HIV treated with combination chemotherapy and immunotherapy compared to patients without HIV receiving combination chemotherapy and immunotherapy, providing valuable clinical insight into treatment decision making in the care of HIV-associated BL.
METHODS: Using the 2004-2019 NCDB, we identified 4312 patients with stage 3 or 4 BL who had a known HIV status and received either chemotherapy alone or chemotherapy and immunotherapy. Time to death was evaluated using Kaplan-Meier survival estimates. Risk of death was evaluated using an extended multivariable Cox model adjusted for multiple factors and with a Heaviside function for HIV status by time period (0-3 month vs. 3-60 month).
RESULTS: Of the 4312 patients included, 1514 (35%) had HIV. For months 0-3 from time of diagnosis, HIV status was not associated with a statistically significant increase in risk of death (HR = 1.04, 95% CI: 0.86, 1.26, p = 0.6648). From month 3to 60, positive HIV status was associated with a 55% increase in risk of death compared to those without HIV (95% CI: 1.38, 1.75, p < 0.0001). Further, this difference in hazard rates (0-3 vs. 3-60) was statistically significant (HR = 1.49, 95% CI: 1.22-1.82, p < 0.001).
CONCLUSIONS: There is an increased mortality rate from months 3 to 60 in BL patients with HIV compared to patients without HIV. Additionally, risk of death in the first 3 months is significantly decreased by 45% in patients with HIV treated with combination chemotherapy and immunotherapy compared to patients without HIV receiving combination chemotherapy and immunotherapy, providing valuable clinical insight into treatment decision making in the care of HIV-associated BL.
摘要：
背景：伯基特淋巴瘤（BL）占HIV感染者（PWH）中定义为AIDS的淋巴瘤的10-35％。先前由较小的队列组成的研究表明，与HIV相关的BL的生存率降低。这项研究旨在比较有和没有HIV的BL患者的总死亡率。同时调查治疗方式对HIV相关BL的影响。
方法：使用2004-2019年NCDB，我们确定了4312例HIV感染状态已知的3期或4期BL患者,他们接受了单独化疗或化疗和免疫治疗.使用Kaplan-Meier生存估计值评估死亡时间。使用扩展的多变量Cox模型评估死亡风险，该模型针对多个因素进行了调整，并通过Heaviside功能按时间段（0-3个月与3-60个月）。
结果：在4312名患者中，1514（35％）患有艾滋病毒。从诊断开始的0-3个月，HIV感染与死亡风险的统计学显著增加无关(HR=1.04,95%CI:0.86,1.26,p=0.6648)。从3个月到60个月，与没有HIV的人相比，HIV阳性状态与死亡风险增加55％相关（95％CI：1.38，1.75，p<0.0001）。Further,这种危险率的差异(0-3与3-60）具有统计学意义（HR=1.49，95％CI：1.22-1.82，p<0.001）。
结论：与未感染HIV的患者相比，感染HIV的BL患者的死亡率从3个月增加到60个月。此外,与没有接受联合化疗和免疫治疗的HIV患者相比，接受联合化疗和免疫治疗的HIV患者在前3个月的死亡风险显着降低了45％，为HIV相关BL的治疗决策提供有价值的临床见解。
方法：使用2004-2019年NCDB，我们确定了4312例HIV感染状态已知的3期或4期BL患者,他们接受了单独化疗或化疗和免疫治疗.使用Kaplan-Meier生存估计值评估死亡时间。使用扩展的多变量Cox模型评估死亡风险，该模型针对多个因素进行了调整，并通过Heaviside功能按时间段（0-3个月与3-60个月）。
结果：在4312名患者中，1514（35％）患有艾滋病毒。从诊断开始的0-3个月，HIV感染与死亡风险的统计学显著增加无关(HR=1.04,95%CI:0.86,1.26,p=0.6648)。从3个月到60个月，与没有HIV的人相比，HIV阳性状态与死亡风险增加55％相关（95％CI：1.38，1.75，p<0.0001）。Further,这种危险率的差异(0-3与3-60）具有统计学意义（HR=1.49，95％CI：1.22-1.82，p<0.001）。
结论：与未感染HIV的患者相比，感染HIV的BL患者的死亡率从3个月增加到60个月。此外,与没有接受联合化疗和免疫治疗的HIV患者相比，接受联合化疗和免疫治疗的HIV患者在前3个月的死亡风险显着降低了45％，为HIV相关BL的治疗决策提供有价值的临床见解。
