Leucémie aiguë chez les patients VIH+ : épidémiologie, prise en charge thérapeutique et pronostic

Abstract : HIV (human immunodeficiency virus) infected patients can develop tumor or infectious complications. Data on HIV patients (HIVP) with acute leukemia (AL, acute myeloid leukemia (AML) or non Burkitt acute lymphoid leukemia (ALL)) are very poor especially on their outcome. Our aim was to precise the epidemiology, the best therapeutic strategies as well as patient’s prognostics, and to compare their outcome to those of seronegative patients with AL. Our retrospective, national, multicentric study shows that AL incidence is not different than in general population but AL occurred earlier (49.29 years [44.21 ; 57.47]) and secondary AL are more frequent (42.55%). With a global and multidisciplinary approach these patients can be treated with intensive chemotherapy resulting on good efficiency (complete remission (CR)=84.38%)) and tolerance. Based on a multivariable model, only absence of CR was associated with hazard of death (p=0.01). HIVP’s 2 years overall survival (OS) was 29% CI95% [15 ; 54] for AML and 40% CI95% [14 ; 100] for ALL. There was no difference in OS between our HIVP and seronegative controls with AL after propensity score matching (HR=1.347 [0.6486-2.796]; p=0,42). Patients were completely matched except for HIV status so HIV status has no prognostic impact on AL patient’s outcome. HIVP with acute leukemia should thus be included in clinical trials to improve and standardize their therapeutic management.
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Master Thesis
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Florence Rabian. Leucémie aiguë chez les patients VIH+ : épidémiologie, prise en charge thérapeutique et pronostic. Médecine humaine et pathologie. 2016. ⟨dumas-01633895⟩



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