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June 27, 2007 EUROPEAN JOURNAL OF MEDICAL RESEARCH 53 B.3 (Poster) Regionale Unterschiede in der Inzidenz von atypischen Mykobakteriosen Salzberger B. 1 , Heindel B. 1 , Hartmann P. 1 , Ehrenstein B. 1 , Fätkenheuer G. 2 1 Universitätsklinikum Regensburg, Klinik I für Innere Medizin, Regensburg, Germany, 2 Universitätsklinikum Köln, Klinik I für Innere Medizin, Köln, Germany Ziel: Untersuchung der regionalen Unterschiede in der Inzidenz disseminierter Infektionen mit Mykobakterium avium intracellulare-complex (MAI). Methode: Analyse einer prospektiven randomisierten Studie (Pierce, NEJM, 1996) zur Prophylaxe von MAI-Infektionen auf regionale Unterschiede und andere Risikofaktoren mittels Cox-proportional- hazard-Analyse. Ergebnisse: In der analysierten Studie (n=682) zeigten sich erhebliche regionale Unterschiede in der Inzidenz von MAI- Infektionen. Die Inzidenz insgesamt in den USA war 19%, Frankreich 10% und Deutschland 8%, mit jeweils höheren Werten in der Placebo- und niedrigeren Werten in der Verum- Gruppe. Adjustiert für CD4-Zellzahl bei Baseline war das Risiko der Entwicklung einer MAI-Infektion in Deutschland und Frankreich etwa 0.25 des Risikos in den USA (p
54 EUROPEAN JOURNAL OF MEDICAL RESEARCH June 27, 2007 28 pts (82%) HAART was given prior to HD and 6/26 pts (23%) had a prior AIDS defining illness. The median CD4 counts at HD diagnosis was 300/l.. Pts received/are receiving ABVD (n=11), BEACOPP baseline-21 (n=18) or BEA- COPP-14 (n=1). Grade 3/4 peripheral neuropathy and grade 3/4 infections occurred in 6 of 21 pts each. To date response data are available in 15 pts (CR in 10 pts, PR in 4, SD in 1). 3 pts have died, all of them diagnosed with stage IVB HD. Causes of death were treatment related sepsis during the 1st course of CT (n=1), progressive HD (n=1) and both, progressive HD and HIV-infection (n=1). Conclusions: In pts with HIV-HD risk-adapted CT and concomitant HAART is safe and effective. However, hematological toxicity is considerable. These preliminary data suggest that the prognosis of HIV-HD might approach results achieved in the HIV-negative population with HD. B.6 (Vortrag) Current trends in AIDS-Related Lymphoma (ARL) – preliminary results of the German ARL Cohort Study Hoffmann C. 1 , Wyen C. 2 , Mayr C. 3 , Plettenberg A. 1 , Oette M. 4 , van Lunzen J. 5 , Rockstroh J. 6 , Esser S. 7 , Jäger H. 8 , Horst H.-A. 9 , Hentrich M. 10 , Mosthaf F. 11 , Greiffendorf I. 12 , Hammond A. 13 , Fätkenheuer G. 2 , German ARL Cohort Study Group 1 ifi Institut, Hamburg, Germany, 2 Universität Köln, Köln, Germany, 3 Ärzteforum Seestrasse, Berlin, Germany, 4 Universität Düsseldorf, Düsseldorf, Germany, 5 Universitätsklinikum Eppendorf, Hamburg, Germany, 6 Universität Bonn, Bonn, Germany, 7 Universität Essen, Essen, Germany, 8 MucResearch GmbH, München, Germany, 9 Universitätsklinikum Schleswig-Holstein, Kiel, Germany, 10 Klinikum Harlaching, München, Germany, 11 Schwerpunktpraxis, Karlsruhe, Germany, 12 Klinikum Krefeld, Krefeld, Germany, 13 Klinikum Augsburg, Augsburg, Germany Background: The incidence of ARL has decreased less profoundly than that of other AIDS-defining illnesses. Chemotherapy is hampered by toxicity and infectious complications. The German ARL Cohort Study was initiated in order to analyze the characteristics and outcome of patients (pts.) with ARL with respect to potential risk factors and to the use of specific polychemotherapy (PCT) and antiretroviral therapy (ART). Methods: This prospective multicenter cohort study includes pts with new or recurrent ARL (including Hodgkin’s Disease, HD) diagnosed since January 2005. After enrolment, pts are followed every six months. Results: As of January 2007, 103 patients (93 males, 10 females) from 16 centers were included in the cohort. The most common histological diagnosis was diffuse large B-cell lymphoma (40 %), followed by Burkitt lymphoma (19 %) and HD (15 %). Mean age at ARL diagnosis was 44.5 years (range, 23.0–72.5). Median CD4 count was 211 cells/ul and 35 % of the patients had a prior AIDS-defining illness. In 30 %, HIV was diagnosed at the time of ARL diagnosis. Only 51 % were treated with HAART, and 22 % had a plasma viremia below 50 copies/ml. There were more HD cases in virologically suppressed pts. than in pts with detectable viremia (30 % vs 10 %, p=0.03). Sixty-two pts (60 %) received a CHOP-based PCT while 11 pts (11 %) received a protocol of short and intensified PCT which was adapted from the German multicenter study group for adult acute lymphoblastic leukemia. The remaining 30 pts received other or no PCT. In 41 %, immunotherapy with rituximab was added to PCT. Of the 48 pts with available staging after completion of PCT, 29 (60 %) pts achieved complete remission of ARL. After a median followup of 5.9 months, 27 pts had died, among them 13 from progressive lymphoma. There were 6 treatment-related deaths (bloodstream infections) which were not related to specific PCT regimens. Conclusions: Preliminary data of this ongoing, prospective study suggest that many of ARL pts. do not receive ART at the time of diagnosis. HD seems to be more frequent in patients on ART. The high mortality and the relatively low rates of complete remission observed in this cohort underline the need for intensive efforts to improve treatment concepts of pts with ARL. B.7 (Vortrag) Second line chemotherapy with IMVP16 after failure of CHOP in patients with HIV-related Non-Hodgkin-Lymphomas Müller M. 1 , Kölsche F. 1 , Marretta L. 1 , Träder C. 1 , Weiss R. 2 , Zwingers T. 3 , Kowol S. 1 , Arasteh K. 1 1 Vivantes Auguste-Viktoria-Klinikum Berlin, Department of Gastroenterology / Infectious Diseases, Berlin, Germany, 2 Private Praxis, Bremen, Germany, 3 Estimate GmbH, Augsburg, Germany Objective: Since decades the CHOP regimen is a well established first line therapy for NHL. In former days HIV-patients with NHL had a poor prognosis. The introduction of HAART improved the overall survival. The impact of immunotherapy (Rituximab) in HIV-related NHL is under investigation. However, it is not clear as to how non-responders should be managed further. Method: Retrospective analysis of a single centre cohort of 140 HIV-patients with NHL, between 1/1989 and 10/2005. After failure of standard CHOP regimen (relapse or insufficient response) some patients received IMVP-16, a second line regimen, which is used in HIV-negative patients with lymphomas. Results: 29 patients with at least one cycle of IMVP-16 were identified with a median follow up of 26,2 months. Characteristics at NHL diagnosis: Median age: 41,9 years (range: 31- 75years), median CD4: 180/l, (range 20-560), HIV-stage (CDC) "C": 15 patients "B": 10 patients "A": 4 patients. NHL-stage (Ann-Arbor) I+II: 7 patients, III+IV: 22 patients. NHL-histology: DLBCL: 18 patients, Burkitt/Burkitt-like lymphomas: 5 patients, others: 6 patients. 2 patients were treated before 1997, 27 patients after 1997 (HAART era). 9 patients are still alive with a median follow up of 52 months (range 35-92 months), 20 patients died after a median survival-time of 11 months (range 4-22 months). Conclusion: There is no standard second line chemotherapy in patients with relapsed or progressive HIV-related NHL´s. High dose chemotherapy and autologous stem-cell transplantation should be discussed in all patients. IMVP-16 might be a less invasive option.
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