Clinicopathological Features and Prognostic Factors of AIDS-Related Lymphoma: A Retrospective Single- Center Study

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However, comprehensive studies on ARL remain limited. This study aimed to evaluate the clinicopathological characteristics, immune status, and EBV/HIV viral loads in PLWH diagnosed with lymphoma, and to assess their prognostic significance. A retrospective analysis was conducted on 130 ARL cases diagnosed between 2017 and 2024. The cohort included 56 Burkitt lymphoma (BL), 51 diffuse large B-cell lymphoma (DLBCL), 9 Hodgkin lymphoma (HL), 8 plasmablastic lymphoma (PBL), and 6 T/NK cell lymphoma patients. The median age was 39 years, with 94.6% of patients being male. The 2-year overall survival (OS) rate was 50.6%, with HL showing the highest survival rate (85.7%) and BL the lowest (43.8%). Univariate analysis identified several factors significantly associated with poorer OS in non-Hodgkin lymphoma (NHL), including CD4 + T cell count 1, elevated lactate dehydrogenase (LDH), advanced stage, and multiple extranodal involvements (all P < 0.05). Multivariate analysis revealed CD4 + T cell count < 200 cells/µL (HR: 2.051, P = 0.029) and elevated LDH (HR: 0.383, P = 0.005) as independent prognostic factors. In conclusion, NHL, particularly BL and DLBCL, are prevalent in PLWH. Severe immunodeficiency and elevated LDH levels are key factors contributing to mortality in AIDS-related NHL. AIDS lymphoma ARL NHL HL prognostic Figures Figure 1 Figure 2 Introduction In 2023, approximately 40 million people living with human immunodeficiency virus (PLWH), and this number is expected to continue rising [ 1 ] . Prior to the advent of antiretroviral therapy (ART), PLWH faced a risk of developing non-Hodgkin lymphoma (NHL) more than 100 times higher than that of the general population, while the risk of classical Hodgkin lymphoma (HL) was approximately 7 times greater [ 2 , 3 ] . Since the introduction of ART in 1996, its widespread use has significantly extended the lifespan of PLWH; however, acquired immunodeficiency syndrome (AIDS)-related malignancies, particularly lymphoma, remain a substantial health threat [ 4 , 5 ] . Although the incidence of AIDS-related lymphoma (ARL) has declined with the widespread use of ART, ARL still accounts for more than 50% of all AIDS-related malignancies and remains a leading cause of death among PLWH [ 6 , 7 ] . Among PLWH, the most prevalent lymphoma subtypes are diffuse large B-cell lymphoma (DLBCL) and Burkitt lymphoma (BL), with other forms such as primary effusion lymphoma (PEL) and plasmablastic lymphoma (PBL) also being relatively common [ 8 ] . The complex interplay between human immunodeficiency virus (HIV) infection, immune suppression, and co-infection with Epstein-Barr virus (EBV) is thought to contribute to significant variations in the incidence and prognosis of NHL and HL, as well as differences between various NHL subtypes [ 9 ] . Research has identified several key risk factors for NHL, including low CD4 + T cell count and high HIV viral load [ 10 – 12 ] . Moreover, PLWH generally exhibit poorer outcomes for malignancies compared to their HIV-negative counterparts [ 13 ] . Current treatment guidelines advocate for the provision of the same therapeutic interventions for PLWH diagnosed with malignancies as those offered to HIV-negative patients [ 14 , 15 ] . In the United States, PLWH are more likely to be diagnosed at advanced stages of malignancy than non-PLWH [ 13 ] . Despite significant strides in understanding the relationship between HIV and lymphoma, most research has focused on specific subtypes or regions, with a lack of large-scale, population-based studies. As one of the countries with the highest number of PLWH globally, China faces a critical need for systematic research to better understand the epidemiology and clinical outcomes of ARL. Our study retrospectively examines the clinical data of ARL patients at our institution, focusing on their initial clinical presentations, immunohistochemical profiles, treatment regimens, and clinical outcomes. The aim is to elucidate the prognostic differences between lymphoma subtypes in PLWH and to identify the key factors influencing lymphoma survival outcomes. This research provides critical insights that may inform the early diagnosis, individualized treatment strategies, and prognostic management of ARL, while advancing the scientific understanding and clinical management of this devastating disease. Methods Study Design and Participants This retrospective study analyzed patients diagnosed with ARL at Beijing Youan Hospital, affiliated with Capital Medical University, from January 2017 to November 2024. To ensure diagnostic consistency and accuracy, all cases underwent a comprehensive retrospective pathological review and were independently re-evaluated by two experienced pathologists in accordance with the 2022 WHO classification criteria [ 16 ] . Patients were excluded based on the following criteria: (a) presence of concurrent malignancies; (b) missing treatment data; and (c) incomplete diagnoses or cases that did not meet the established diagnostic criteria. The patient selection process is illustrated in Fig. 1 . A total of 130 lymphoma patients were included, consisting of 51 cases of DLBCL, 56 cases of BL, 8 cases of PBL, 6 cases of T/NK cell lymphoma, and 9 cases of HL. This study was conducted in accordance with the Declaration of Helsinki and approved by our Institutional Review Board (reference number: Jing You Ke Lun Zi 107). Informed consent was waived due to the retrospective nature of the study. All patient data were handled with strict confidentiality and anonymization. Data Collection Blood samples and tumor tissue specimens were collected from all patients prior to treatment. Demographic characteristics (gender and age), HIV-related factors (duration from HIV infection to lymphoma diagnosis, date of initiation of ART, CD4 + T cell count, and HIV viral load at lymphoma diagnosis), lymphoma-related factors (cell of origin subtype, Eastern Cooperative Oncology Group (ECOG) performance status, serum lactate dehydrogenase (LDH), B symptoms, extranodal involvement, Ann Arbor staging, bone marrow and central nervous system involvement, immunohistochemical markers (Ki-67, MYC, BCL2, MUM1, CD38 expression, and Epstein-Barr virus-encoded RNA (EBER)), and other characteristics (EBV viral load)) were collected. For patients who died during hospitalization, the date of death was retrieved from medical records. For those who survived or died after discharge, the last follow-up date was used as the endpoint for survival data. The primary endpoint of this study was overall survival (OS). OS was defined as the time from diagnosis to death from any cause or to the last follow-up for surviving patients. Histopathological, Immunohistochemical, and EBER In Situ Hybridization Analysis Hematoxylin and eosin (HE) staining was performed to evaluate the morphological characteristics of the tumors. Immunohistochemical (IHC) analysis was conducted on formalin-fixed, paraffin-embedded (FFPE) tissue samples, using antibodies targeting Ki-67, CD10, BCL6, BCL2, MYC, MUM1, and CD38. The positivity thresholds for CD10, BCL-6, MUM1, and CD38 were set at 30%, for MYC at 40%, and for BCL2 at 50%. Ki-67 expression was quantified in 10% increments, with ≥ 80% staining classified as "positive/high." EBER was detected using the EBV probe in situ hybridization kit (ISH-6021, Zhongshan Golden Bridge Biotechnology Co., Ltd., Beijing, China) according to the manufacturer’s instructions, with positive signals appearing brownish yellow in the cell nucleus. Terminology Definitions The Ann Arbor staging was determined based on pre-treatment computed tomography (CT) or positron emission tomography/computed tomography (PET/CT) scans of the chest, abdomen, and pelvis, in conjunction with bone marrow biopsy results [ 17 ] . Patients were defined as having B symptoms if they met any of the following criteria: (a) unexplained weight loss of more than 10% of the body weight during the 6 months before initial staging investigation; (b) unexplained, persistent, or recurrent fever with temperatures above 38°C during the previous month; and (c) recurrent drenching night sweats during the previous month [ 18 ] . Lymphoma Chemotherapy Treatment information for patients was collected from hospital records and pharmacy archives. ARL patients received chemotherapy regimens, including CHOP regimen (cyclophosphamide, doxorubicin, vincristine, and prednisone) [ 19 ] , EPOCH (etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone) [ 20 ] , the Hyper-CVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone) [ 21 ] , and the ABVD regimen (Doxorubicin, Bleomycin, Vinblastine, and Dexamethasone) [ 22 ] , with some patients also undergoing surgical treatment. Statistical Analysis Statistical analyses were performed using SPSS version 26.0. For continuous variables, intergroup comparisons were conducted using the Mann-Whitney U test, while categorical variables were analyzed using the chi-square test. Survival curves were constructed using the Kaplan-Meier method, with group differences evaluated by the log-rank test. Patients who remained alive at the last follow-up were censored at that time, whereas those lost to follow-up were censored at the date of last contact, assuming no further events occurred beyond that point. Univariate and multivariate analyses were performed using the Cox proportional hazards model to calculate hazard ratios (HR) and 95% confidence intervals (95% CI). Variables with a P -value < 0.05 in univariate analysis were included in the multivariate model. A two-tailed P -value of < 0.05 was considered statistically significant for all tests. Results Patient Characteristics This study included a total of 130 patients, and the baseline characteristics of HIV-related factors for all patients are shown in Table 1 . Among the histologically confirmed ARL, BL and DLBCL were the most prevalent subtypes, accounting for 43.1% and 39.2% of cases, respectively. This was followed by HL at 6.9%, PBL at 6.2%, and T/NK cell lymphoma, which was the least common, comprising 4.6% of the cohort. The median age of the patients was 39 years (range: 17–75), with a male predominance (94.6%). At the time of lymphoma diagnosis, 51.5% of patients had been living with HIV for more than 6 months; however, only 35.4% had received ART for more than 6 months prior to the ARL diagnosis. Upon diagnosis, the median CD4 + T cell count was 140 cells/µl (range: 4–593), with 62.3% of patients presenting with a CD4 + T cell count < 200 cells/µl. Among the 116 patients who underwent HIV viral load testing, 64.7% had a viral load ≥ 40 copies/µl. Of the 120 patients tested for EBV viral load, 42.5% exhibited a viral load ≥ 500 copies/µl. Notably, when comparing AR-DLBCL and BL, BL patients were significantly younger ( P = 0.001), had higher CD4 + T cell count ( P = 0.035), and were more likely to have a positive HIV viral load ( P = 0.002). Table 1 Baseline Characteristics of Patients with AIDS-related lymphoma (n = 130). All (n = 130) DLBCL (n = 51) BL (n = 56) PBL (n = 8) T/NK CL(n = 6) HL (n = 9) P -value Median age (range) (years) 39 (17–75) 46 (22–75) 37 (22–57) 35 (27–59) 36 (17–54) 36 (25–47) 0.001 Gender, n (%) Male 123 (94.6) 48 (94.1) 54 (96.4) 8 (100) 5 (83.3) 8 (88.9) Female 7 (5.4) 3 (5.9) 2 (3.6) 0 (0) 1 (16.7) 1 (11.1) Time from HIV diagnosis to lymphoma (months) 0.802 Median (range) 6 (0-144) 4 (0-144) 2.5 (0-122) 8.5 (1–72) 90 (2-144) 36 (6–96) < 6, n (%) 63 (48.5) 27 (52.9) 31 (55.4) 3 (37.5) 2 (33.3) 0 (0) ≥ 6, n (%) 67 (51.5) 24 (47.1) 25 (44.6) 5 (62.5) 4 (66.7) 9 (100) Time from ART initiation to lymphoma diagnosis (months) 0.343 Median (range) 1 (0-144) 1 (0-144) 0 (0-120) 2 (0–36) 13 (0–60) 36 (6–96) < 6, n (%) 84 (64.6) 34 (66.7) 42 (75.0) 5 (62.5) 3 (50.0) 0 (0) ≥ 6, n (%) 46 (35.4) 17 (33.3) 14 (25) 3 (37.5) 3 (50.0) 9 (100) CD4 + T cell count (cells/ul) 0.035 Median (range) 140 (4-593) 106 (5-535) 144 (9-576) 106 (14–570) 139 (135–593) 353 (4-547) < 200, n (%) 81 (62.3) 39 (76.5) 32 (57.1) 6 (75.0) 2 (33.3) 2 (22.2) ≥ 200, n (%) 49 (37.7) 12 (23.5) 24 (42.9) 2 (25.0) 4 (66.7) 7 (77.8) HIV viral load (copies/ul), n/N (%) 0.002 Median (range) 1566 (0-1170821) 306 (0-1170821) 18790 (0-996948) 0 (0-1170820) 4773 (0-516305) 0 (0-2831) < 40 41/116 (35.3) 23/50 (46.0) 9/51 (17.6) 4/7 (57.1) 1/3 (33.3) 4/5 (80) ≥ 40 75/116 (64.7) 27/50 (54.1) 42/51 (82.4) 3/7 (42.9) 2/3 (66.7) 1/5 (20) EBV viral load copies/ul, n/N (%) 0.567 Median (range) 0 (0-1.8×10 8 ) 0 (0-1.87×10 7 ) 0 (0-1.8×10 8 ) 2.145×10 4 (0-1.18×10 6 ) 0 (0-4.22×10 3 ) 1.49×10 3 (0-1.03×10 5 ) < 500 69/120 (57.5) 29/48 (60.4) 33/50 (66.0) 1/8 (12.5) 4/5 (80) 2/9 (22.2) ≥ 500 51/120 (42.5) 19/48 (39.6) 17/50 (34.0) 7/8 (87.5) 1/5 (20) 7/9 (77.8) Abbreviation : NHL, non-Hodgkin lymphoma; DLBCL, diffuse large B-cell lymphoma; BL, Burkitt lymphoma; PBL, plasmablastic lymphoma; T/NK CL, T/NK cell lymphoma; HL, Hodgkin lymphoma; HIV, human immunodeficiency virus; ART, antiretroviral therapy; EBV, Epstein‐Barr virus. P -values were calculated comparing DLBCL and BL groups and statistically significant P -values are highlighted. Immunohistochemistry Table 2 summarizes the immunohistochemical characteristics of the various ARL subtypes. In patients with DLBCL, approximately half (46.9%) were of germinal center B-cell-like ( GCB ) origin. Ki-67 expression was notably high, with 76.5% of patients showing ≥ 80% staining. A majority of DLBCL cases were positive for BCL2 (67.3%), MUM1 (73.5%), and CD38 (61.4%), while 43.1% exhibited positivity for EBER via in situ hybridization. For BL, all cases demonstrated ≥ 80% Ki-67 staining, with high positivity for MYC (85.7%) and CD38 (71.7%), but relatively low expression of BCL2 (16.4%) and MUM1 (37.5%). The EBER positivity rate in BL was 30.4%. Given the limited number of PBL, T/NK cell lymphoma, and HL cases, the statistical significance of their immunohistochemical results was less robust. Nonetheless, it is noteworthy that nearly all HIV-infected PBL and HL cases were EBER positive. When comparing DLBCL with BL, BL patients had significantly higher rates of Ki-67 ≥ 80% ( P < 0.001) and MYC positivity ( P < 0.001), while BCL2 and MUM1 expression were lower ( P < 0.001). Table 2 Immunohistochemistry of AIDS-related lymphoma (n = 130). DLBCL (n = 51) BL (n = 56) PBL (n = 8) T/NK CL(n = 6) HL (n = 9) P -value COO GCB 23/49 (46.9) - - - - - Non-GCB 26/49 (53.1) - - - - - Ki 67%, n/N < 0.001 < 80 12/51 (23.5) 0/56 (0) 0/8 (0) 1/6 (16.7) 0/9 (0) ≥ 80 39/51 (76.5) 56/56 (100) 8/8 (100) 5/6 (83.3) 9/9 (100) MYC, n (%) < 0.001 < 40 28/51 (54.9) 8/56 (14.3) 0/6 (0) 0 0/2 (0) ≥ 40 23/51 (45.1) 48/56 (85.7) 6/6 (100) 0 2/2 (100) BCL2, n (%) < 0.001 < 50 16/49 (32.7) 46/55 (83.6) 3/5 (60) 1/5(20) 4/4 (100) ≥ 50 33/49 (67.3) 9/55 (16.4) 2/5 (40) 4/5 (80) 0/4 (0) MUM1, n/N (%) < 0.001 < 30 13/49 (26.5) 35/56 (62.5) 2/8 (25.0) 0/4 (0) 0/7 (0) ≥ 30 36/49 (73.5) 21/56 (37.5) 6/8 (75.0) 4/4 (100) 7/7 (100) CD38, n (%) 0.281 < 30 17/44 (38.6) 15/53 (28.3) 1/8 (12.5) 2/3 (76.7) 2/2 (100) ≥ 30 27/51 (61.4) 38/53 (71.7) 7/8 (87.5) 1/3 (33.3) 0/2 (0) EBER, n (%) 0.170 Positive 22/51 (43.1) 17/56 (30.4) 8/8 (100) 3/8 (50) 9/9 (100) Negative 29/51 (56.9) 39/56 (69.6) 0/0 (0) 3/8 (50) 0/0 (0) Abbreviation : DLBCL, diffuse large B-cell lymphoma; BL, Burkitt lymphoma; PBL, plasmablastic lymphoma; T/NK CL, T/NK cell lymphoma; HL, Hodgkin lymphoma; EBER, Epstein-Barr virus-encoded RNA. P -values were calculated comparing DLBCL and BL groups and statistically significant P-values are highlighted. Clinical Analysis, Treatment, and Survival Outcomes Table 3 provides a comprehensive summary of the clinical staging, prognosis, treatment, and outcomes of ARL. The majority of patients in this study were young, with only six DLBCL patients exceeding 60 years of age. At the time of diagnosis, most patients exhibited poor performance status, particularly those with DLBCL, who had elevated ECOG scores. Most patients were diagnosed at advanced stages (III-IV), with widespread extranodal involvement. Bone marrow infiltration was observed across all ARL subtypes, with the highest frequencies in BL and T/NK cell lymphomas (46.4% and 50%, respectively), whereas the incidence in DLBCL was comparatively lower (21.7%). Central nervous system (CNS) involvement was also documented in patients with DLBCL, BL, and PBL. Additionally, over half of the patients had elevated LDH levels and presented with B symptoms. Compared with DLBCL, BL was characterized by a younger age at diagnosis ( P = 0.026), lower ECOG performance status scores ( P = 0.009), and a significantly higher frequency of bone marrow involvement ( P = 0.007). Additionally, risk stratification was conducted for each lymphoma subtype, classifying patients into low-, intermediate-, and high-risk categories. The International Prognostic Index (IPI) was used for DLBCL and PBL, while the BL-IPI score was applied to BL. T/NK-cell lymphomas were assessed using the Prognostic Index for T-cell lymphoma (PIT), and the International Prognostic Score (IPS) was employed for HL. Table 3 Clinical staging, prognosis, treatment, and outcomes of AIDS-related lymphoma (n = 130). DLBCL (n = 51) BL (n = 56) PBL (n = 8) T/NK CL(n = 6) HL (n = 9) P -value Age (years), n (%) 0.026 < 60 45 (88.2) 56 (100) 8 (100) 6 (100) 9 (100) ≥ 60 6 (11.8) 0 (0) 0 (0) 0 (0) 0 (0) ECOG score, n (%) 0.009 0–1 19 (37.3) 35 (62.5) 4 (50) 5 (83.3) 6 (66.7) ≥ 2 32 (62.7) 21 (37.5) 4 (50) 1 (16.7) 3 (33.3) Ann Arbor stage, n (%) 0.478 Ⅰ/Ⅱ 5 (9.8%) 8 (14.3) 1 (12.5) 3 (50) 5 (55.6) Ⅲ/Ⅳ 46 (90.2) 47 (85.7) 7 (87.5) 3 (50) 4 (44.4) Extranodal involved sites, n (%) 0.562 0–1 21 (41.2) 20 (35.7) 1 (12.5) 4 (66.7) 7 (77.8) ≥ 2 30 (58.8) 36 (64.3) 7 (87.5) 2 (33.3) 2 (22.2) LDH, n (%) 0.343 ≤ 1×ULN 17 (33.3) 14 (25) 5 (62.5) 4 (66.7) 7 (77.8) > 1×ULN 34 (66.7) 42 (75) 3 (37.5) 2 (33.3) 2 (22.2) B symptoms, n (%) 0.311 Yes 34 (66.7) 32 (57.1) 4 (50) 5 (83.3) 4 (44.4) No 17 (33.3) 24 (42.9) 4(50) 1 (16.7) 5 (55.6) Bone marrow involvement, n (%) 11 (21.7) 26 (46.4) 3 (37.5) 3 (50) 3 (33.3) 0.007 CNS involvement, n (%) 6 (11.8) 8 (14.3) 1 (12.5) 0 0 0.699 Risk stratification, n (%) - low 1 (2.0) 15 (26.8) 1 (12.5) 3 (50) 5 (55.6) intermediate 47 (92.2) 19 (33.9) 5 (62.5) 2 (33.3) 2 (22.2) high 3 (5.9) 22 (39.3) 2 (25) 1 (16.7) 2 (22.2) Initial chemotherapy regimen for lymphoma, n (%) CHOP 23 (45.1) 18 (32.1) 4 (50) 0 0 EPOCH 21 (41.2) 16 (28.6) 4 (50) 3 (50) 0 Hyper-CVAD 3 (5.9) 10 (17.9) 0 0 0 ABVD 0 0 0 0 7 (77.8) Other regimens 1 (2.0) 5 (8.9) 0 0 0 No regimen 3 (5.9) 7 (12.5) 0 3 (50) 2 (22.2) Regimen with R 42 (82.4) 34 (60.7) 3 (37.5) 0 0 Survival 0.401 Median survival (months) 18 11 28 14 33 2-year OS, (%) 51.7 43.8 58.3 50 85.7 Abbreviation : DLBCL, diffuse large B-cell lymphoma; BL, Burkitt lymphoma; PBL, plasmablastic lymphoma; T/NK CL, T/NK cell lymphoma; HL, Hodgkin lymphoma; ECOG, Eastern Cooperative Oncology Group; LDH, lactate dehydrogenase; ULN, upper limit of normal; CNS, central nervous system; CHOP, cyclophosphamide, doxorubicin, vincristine, and prednisone; EPOCH, etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone; Hyper-CVAD, hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone; ABVD, Doxorubicin, Bleomycin, Vinblastine, and Dexamethasone; R, Rituximab; OS, overall survival. The risk stratification systems for different lymphoma subtypes are as follows: DLBCL and PBL, the International Prognostic Index (IPI) was applied, categorizing patients as low risk (0–1 points), intermediate risk (2–3 points), or high risk (4–5 points); BL, assessed using the BL-IPI, with risk groups defined as low (0 points), intermediate (1 point), and high (≥2 points); T/NK-cell lymphomas, stratified according to the Prognostic Index for T-cell lymphoma (PIT) into low (0 points), intermediate (1–2 points), and high-risk (≥3 points) groups; HL, the International Prognostic Score (IPS) was used to define low (0–2 points), intermediate (3–4 points), and high-risk (5–7 points) categories. P -values were calculated comparing DLBCL and BL groups and statistically significant P -values are highlighted. In terms of treatment, 45.1% of DLBCL patients received the CHOP regimen, 41.2% received the EPOCH regimen, and 82.4% were treated with rituximab. Some patients were unable to initiate timely treatment due to rapid disease progression or financial constraints. Among BL patients, 32.1% were treated with CHOP, 28.6% with EPOCH, and 17.9% with Hyper-CVAD, with 60.7% receiving rituximab. In the PBL cohort, 50% received either CHOP or EPOCH, and 37.5% were treated with rituximab. Among NK/T-cell lymphoma patients, 50% received EPOCH and the other 50% underwent surgery. The majority of HL patients (77.8%) received the ABVD regimen, with the remaining patients undergoing surgery. As of the last follow-up on November 31, 2024, 60 patients (46.2%) had died, 69 (53.1%) were alive, and 2 were lost to follow-up. The median follow-up duration was 15 months (range: 1–94 months), with a 2-year OS rate of 50.6% (Fig. 2 a). The 2-year OS rates for DLBCL, BL, PBL, T/NK cell lymphoma, and HL were 51.7%, 43.8%, 58.3%, 50%, and 85.7%, respectively. Notably, HL patients had the best prognosis, while BL patients had the worst (Fig. 2 b). Univariate and Multivariate Analysis of NHL Univariate analysis identified several factors significantly associated with poor OS, including a CD4 + T cell count 1 ( P = 0.001), Ann Arbor stage > 2 (P = 0.014), extranodal involvement in more than one site ( P < 0.001), and elevated LDH levels ( P < 0.001), and bone marrow involvement ( P = 0.033). Multivariate analysis revealed that a CD4 + T cell count < 200 cells/µl (HR: 2.085, 95% CI: 1.094–3.974, P = 0.026) and elevated LDH levels (HR: 0.378, 95% CI: 0.192–0.746, P = 0.005) were independent prognostic factors for poor survival. Although EPOCH treatment was associated with improved prognosis compared to CHOP ( P = 0.057), this finding did not reach statistical significance. Moreover, high-risk IPI stage (III/IV) ( P < 0.001) was also correlated with worse survival outcomes (Table 4 ). Table 4 Univariate and multivariate analysis of OS in patients with AR-NHL (n = 121) Univariate analysis Multivariate analysis HR (95% CI) P -value HR (95% CI) P -value Time from HIV diagnosis to lymphoma (months) < 6 mon vs. ≥ 6 mon 0.962 (0.582–1.590) 0.880 Time from ART initiation to lymphoma diagnosis (months) < 6 mon vs. ≥ 6 mon 1.039 (0.609–1.774) 0.888 CD4 + T cell count (cells/µl) < 200 vs. ≥ 200 2.734 (1.480–5.049) 0.001 2.085 (1.094–3.974) 0.026 HIV viral load (copies/ul) < 40 vs. ≥ 40 0.853 (0.487–1.495) 0.579 EBV viral load (copies/ul) < 500 vs. ≥ 500 0.761 (0.450–1.288) 0.309 B symptoms Yes vs. No 0.557 (0.321–0.966) 0.037 1.056 (0.569–1.960) 0.864 Age (years) < 60 vs. ≥ 60 0.845 (0.265–2.699) 0.776 ECOG score < 2 vs. ≥ 2 0.427 (0.254–0.718) 0.001 0.671 (0.378–1.192) 0.174 Ann Arbor stage I/II vs. III/IV 0.280 (0.102–0.773) 0.014 1.002 (0.293–3.426) 0.998 Extranodal involved sites < 2 vs. ≥ 2 0.373 (0.208–0.668) < 0.001 0.609 (0.300-1.236) 0.170 Elevated LDH Yes vs. No 0.295 (0.154–0.568) < 0.001 0.378 (0.192–0.746) 0.005 Bone marrow involvement Yes vs. No 1.735 (1.046–2.877) 0.033 1.194 (0.687–2.073) 0.530 CNS involvement Yes vs. No 0.530 (0.276–1.018) 0.057 IPI score 0-2 vs. 3‐5 4.425 (2.242–8.731) < 0.001 Regimen CHOP vs. EPOCH 0.536 (0.285–1.011) 0.054 KI67% < 80% vs. ≥ 80% 1.244 (0.613–2.525) 0.546 MYC < 40% vs. ≥ 40% 0.719 (0.399–1.295) 0.272 BCL2 < 50% vs. ≥ 50% 0.849 (0.502–1.437) 0.542 MUM1 < 30% vs. ≥ 30% 0.986 (0.586–1.658) 0.957 CD38 < 30% vs. ≥ 30% 1.140 (0.645–2.014) 0.653 EBER Positive vs. Negative 1.007 (0.601–1.687) 0.979 Abbreviation : HR, hazard ratio; CI, confidence interval; HIV, human immunodeficiency virus; ART, antiretroviral therapy; EBV, Epstein‐Barr virus; ECOG, Eastern Cooperative Oncology Group; LDH, lactate dehydrogenase; IPI, International Prognostic Index; CHOP, cyclophosphamide, doxorubicin, vincristine, and prednisone; EPOCH, etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone; EBER, Epstein-Barr virus-encoded RNA. Statistically significant P -values are highlighted. Discussion HIV infection increases the risk of malignant tumors through various mechanisms, including systemic immune impairment, genetic alterations, susceptibility to oncogenic viral infections, and chronic B-cell activation [ 23 ] . Since the introduction of ART in 1996, the immune function of PLWH has significantly improved, and their survival has been prolonged [ 24 ] . However, despite the substantial reduction in HIV-induced immune deficiency by ART, its impact on the incidence of ARL has not been as pronounced. In PLWH, the distribution of lymphoma subtypes differs significantly from that in the general population. A study by Surabhi et al. involving 4115 non-ARL patients reported that HL accounted for 30.35%, while NHL constituted 69.65%. Among NHL cases, B-cell lymphomas made up 84.08%, while T-cell and NK-cell lymphomas represented 15.38% [ 25 ] . In contrast, in the present study, BL accounted for 43%, DLBCL for 39%, PBL for 6%, peripheral T/NK-cell lymphoma for 5%, and HL for 7%. Overall, ARL is predominantly composed of NHL, with higher incidences of BL and DLBCL, and lower incidences of other subtypes. This difference highlights the significant impact of HIV infection on lymphoma subtype distribution. Furthermore, the median age of ARL patients in our study was relatively young, with only a few patients older than 60, all of whom had DLBCL [ 26 ] . HIV-related factors play a crucial role in the development and progression of lymphoma, and their impact varies across different lymphoma subtypes. In this study, approximately 51.5% of patients had been diagnosed with HIV for more than six months at the time of lymphoma diagnosis, yet only 35.5% had received ART for more than six months. This proportion is significantly lower than previously reported in the literature. For example, one study found that the median time since HIV diagnosis prior to DLBCL diagnosis was 15 years, with nearly 80% of patients already receiving ART [ 27 ] . In contrast, our patient population exhibited delayed HIV diagnosis and limited exposure to ART. This discrepancy may reflect inadequate awareness of HIV testing and associated health risks, as well as barriers to healthcare access and intervention programs among high-risk populations. Notably, many patients were diagnosed with HIV only after presenting with lymphoma-related symptoms, missing the critical window for early diagnosis and appropriate treatment. NHL patients demonstrated similar patterns of delayed HIV diagnosis and shorter ART exposure compared to the overall cohort. However, HL patients had a longer duration of HIV infection, with all patients being infected for over six months. We observed that, among PLWH, patients with BL were significantly younger ( P < 0.001), had higher CD4 + T cell counts ( P = 0.035), and exhibited higher HIV viral loads ( P = 0.002) compared to those with DLBCL. This aligns with previous findings, indicating that, compared to DLBCL, AIDS-related BL is more prevalent in patients with higher CD4 + T cell counts and is strongly associated with cumulative HIV viremia [ 28 , 29 ] . Additionally, most PLWH contract EBV during childhood or adolescence [ 30 ] . Studies suggest that, in the absence of intervention, the risk of lymphoma in PLWH with EBV infection is more than 60 times higher than in the general population [ 31 ] . Despite the widespread use of ART, which has significantly reduced the incidence of AIDS-related malignancies in PLWH, EBV-associated cancers remain prevalent in this group [ 32 , 33 ] . In PLWH, the association between different lymphoma types and EBV infection varies: 30%-90% of DLBCL (depending on the subtype), 30%-60% of BL, 70%-80% of PBL, and 100% of HL cases are associated with EBV infection [ 34 ] . In our cohort, we found that PBL and HL had high EBV viral loads, with positivity rates of 87.5% and 77.8%, respectively, while T/NK cell lymphoma had lower EBV viral loads. Immunohistochemistry further confirmed the close relationship between lymphoma in PLWH and EBV infection. Notably, the EBER positivity rate was 100% in HL and 87.5% in PBL, compared to approximately 20% in HL. These differences suggest that EBV plays a more crucial role in the pathogenesis of lymphoma in PLWH, particularly in HL and PBL. Ki-67 is a commonly used proliferation marker in oncology, often reflecting tumor cell proliferative activity [ 35 ] . In the general population, Ki-67 expression in DLBCL typically ranges from 40–90%, while BL generally shows nearly 100% Ki-67 positivity [ 36 ] . Our findings are consistent with these reports. Notably, there is a significant difference in Ki-67 expression between BL and DLBCL ( P < 0.001), suggesting that Ki-67 could serve as an important marker for distinguishing between BL and DLBCL, with potential diagnostic value. Furthermore, DLBCL in PLWH showed higher rates of MYC and BCL-2 expression (MYC: 45.1%, BCL-2: 67.3%) [ 37 , 38 ] , indicating that HIV-associated lymphoma is more aggressive, particularly with features of double-hit or triple-hit lymphoma. In this study, we found that CD38 was highly expressed in B-cell NHL, with particularly elevated levels observed in patients with PBL and BL. CD38 is a transmembrane glycoprotein that serves as a marker for GCB subtype, in addition to marking mature plasma cells and plasma cell tumors [ 39 ] . Within the tumour microenvironment, CD38⁺ cells may contribute to immune evasion through the secretion of immunosuppressive mediators [ 40 ] . Interestingly, in PLWH without lymphoma, an increased proportion of circulating CD8+/CD38 + T cells is predictive of AIDS progression, CD4 + T cell decline and elevated viral load [ 41 ] . Additionally, co-expression of CD38 and HLA-DR on CD4+/CD45RO + T cells correlates with disease activity, while high CD38 expression on CD4 + T cells, indicative of chronic immune activation, is associated with poor prognosis in advanced HIV infection. Despite these associations, anti-CD38 therapies have not been systematically evaluated in AIDS-related DLBCL, HL or BL. Nevertheless, some studies have reported CD38 expression in all cases of ARL, with significant variation in expression levels depending on the histological subtype [ 42 ] . Daratumumab, a CD38-targeting monoclonal antibody approved for the treatment of multiple myeloma, has shown encouraging safety and efficacy in hematologic malignancies, and may represent a promising therapeutic approach for ARL, particularly in PBL and BL [ 43 ] . In terms of clinical presentation, our patients were often diagnosed at advanced stages, with significant extranodal involvement and frequent B symptoms [ 44 ] . In terms of treatment, For B-cell-origin NHL, CHOP or EPOCH regimens are commonly used, with most patients also receiving rituximab. previous studies have indicated that EPOCH is one of the first-line treatment options for AR- DLBCL, HHV8-positive DLBCL, and primary effusion lymphoma (PEL), and it is the preferred regimen for AIDS-related BL according to the 2019 NCCN guidelines [ 14 ] . These recommendations are based on phase II trial results of EPOCH in AR-DLBCL and high-grade lymphomas, as well as a large meta-analysis indicating that EPOCH is more effective than CHOP in ARL [ 45 ] . Our study found that EPOCH treatment was superior to CHOP for NHL, although this trend did not reach statistical significance. Rituximab is a monoclonal antibody targeting CD20, and it is routinely recommended in combination with standard chemotherapy for the treatment of B cell NHL in PLWH, regardless of HIV status [ 46 ] . In recent years, the prognosis of ARL patients treated with rituximab-based regimens has significantly improved in economically developed countries [ 47 ] . However, in China, due to the lack of medical insurance coverage for rituximab, and the higher proportion of low- and middle-income patients in this study, many patients may be unable to afford the cost of the drug due to financial constraints, and some have poor compliance, failing to complete the treatment as recommended. Furthermore, the use of rituximab has been associated with an increased risk of infection-related mortality. Accordingly, careful monitoring for infectious complications is essential throughout the course of treatment, particularly in patients with CD4 counts below 50 cells/µl [ 48 ] . Current studies have shown that for patients with extranodal T/NK cell lymphoma, those treated with asparaginase (Asp)-containing chemotherapy regimens achieve significantly higher complete remission rates compared to those receiving non-Asp-based regimens [ 49 , 50 ] . However, in our cohort, T/NK cell lymphoma patients primarily received anthracycline-based chemotherapy or surgical treatment. This treatment pattern may introduce bias related to treatment-associated mortality. A comprehensive database study highlights that HIV infection remains an independent risk factor for mortality in patients with lymphoma [ 5 ] . In Western countries, the prognosis of lymphoma among PLWH is similar to that of the general population [ 51 ] . However, in developing countries, including China, remain markedly inferior, particularly among patients with BL [ 52 ] . Early retrospective analyses indicated that, even in the era of ART, BL outcomes lagged behind those of DLBCL [ 53 ] . A subsequent German study reported improved survival for both HIV-associated BL and DLBCL, with no significant difference between the two subtypes [ 54 ] . In our cohort, the prognosis of BL was notably poorer, likely due to the higher incidence of bone marrow involvement in BL patients ( P = 0.007). BL is characterized by an exceptionally high proliferative index and aggressiveness, underscoring the importance of timely intervention. However, many of our BL patients were diagnosed during the COVID-19 pandemic, and delays in treatment often resulted in missed opportunities for early therapeutic intervention. Furthermore, despite the need for intensified chemotherapy in BL, limitations in economic and healthcare resources prevented access to these regimens, thereby compromising treatment outcomes. Despite these challenges, it is encouraging that HL outcomes in our study were comparable to those seen in HIV-negative populations [ 55 ] . IPI is currently the most widely used risk assessment tool for lymphoma patients. However, the applicability of IPI to ARL remains controversial [ 56 ] . Some studies have shown that aaIPI or IPI are strongly correlated with the prognosis of AR-NHL [ 57 – 59 ] . However, a study by Stefan et al. found that IPI has no prognostic value for ARL [ 60 ] . In contrast, our study demonstrates that IPI is effective in predicting the prognosis of AR-NHL patients. Barta SK et al. developed a new prognostic tool, the ARL-IPI, which stratifies patients into low-, intermediate-, and high-risk groups [ 60 ] . The ARL-IPI incorporates baseline factors such as ECOG performance status, LDH level, disease stage, number of extranodal sites involved, and an HIV score that includes baseline CD4 + T cell count, HIV viral load, and prior AIDS history. Barta SK et al. demonstrated that the ARL-IPI outperformed the aa-IPI in predicting OS [ 60 ] . In this study, multivariate Cox analysis revealed that a CD4 + T cell count < 200 cells/µl (HR: 2.051, 95% CI: 1.078–3.901, P = 0.029) and elevated LDH levels (HR: 0.383, 95% CI: 0.194–0.754, P = 0.005) were independent adverse prognostic factors for OS in patients with AR-NHL. This study has several limitations. First, the retrospective design may introduce selection and data collection biases, which limit the generalizability of the findings. Second, the small sample size, particularly for certain lymphoma subtypes, may result in insufficient statistical power, affecting the stability and accuracy of the results. Third, treatment heterogeneity introduced additional confounding factors that may have influenced the study's outcomes. For instance, while the majority of T/NK cell lymphoma patients in our cohort were treated with anthracycline-based regimens or surgery, prevailing treatment practices increasingly favor asparaginase- or gemcitabine-based protocols. Moreover, the relatively low proportion of BL patients who received intensive chemotherapy in our study could have impacted treatment efficacy. Similarly, despite widespread recommendations for rituximab use in all B cell NHL patients, limited access due to financial constraints in certain cases may have further compromised the reliability of survival analyses. Finally, the lack of molecular mechanisms and genomic data limits a comprehensive understanding of the complex relationship between HIV infection and lymphoma development. Future studies integrating molecular biology data will help clarify the underlying mechanisms and provide a basis for precision medicine. Conclusion This study provides a comprehensive analysis of the clinicopathological features, prognostic factors, and treatment outcomes of NHL and HL in PLWH. Our findings emphasize that low CD4 + T cell counts and elevated LDH levels are independent risk factors for AR-NHL. Additionally, IPI is effective for prognostic evaluation of AR-NHL. Notably, the EPOCH chemotherapy regimen shows a trend toward improved outcomes compared to CHOP, although statistical significance was not reached. This study underscores the critical role of EBV infection and high-proliferative tumor characteristics in the pathogenesis of ARL. Future research should focus on expanding sample sizes, integrating molecular mechanisms, optimizing prognostic scoring systems, and exploring more targeted therapeutic strategies to improve survival and quality of life for patients with ARL. Declarations Competing Interests: The authors declare no competing interests. Acknowledgments We would like to thank all the patients and their families. A special thanks to the staff of the Department of Infectious Diseases and Immunology, as well as the Pathology Department. Authors’ contributions Y.L. and J.C. co-wrote the initial draft of the manuscript and prepared the accompanying figures and tables. Y.G., L.S., Z.Y., and L.M. contributed to the study's concept and design. J.C. secured the funding. C.G. and Y.Z. provided critical intellectual contributions and supervised the overall process. All authors reviewed and approved the final manuscript. Funding This work is supported by the Beijing Research Ward Excellence Program, BRWEP (BRWEP2024W042180111). Ethics approval and consent to participate This study was approved by the Ethics Committee of Beijing Youan Hospital and performed in accordance with the 1975 Declaration of Helsinki. Informed consent was obtained from all individual participants included in the study. Data availability The data set used and/or analyzed during the current study is available from the corresponding author on reasonable request. Conflict of Interest Statement No conflicts of interest to disclose. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. References UNAIDS. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5998165","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":444556478,"identity":"b0cff19d-f6ef-4840-af71-10d578b78c8c","order_by":0,"name":"Ying Liang","email":"","orcid":"","institution":"Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing 100069","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Liang","suffix":""},{"id":444556479,"identity":"d125fbb1-76e3-44e5-b38b-cdee576aef90","order_by":1,"name":"Jing Chang","email":"","orcid":"","institution":"Department of Pathology, Beijing Youan Hospital, Capital Medical University, Beijing 100069","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Chang","suffix":""},{"id":444556480,"identity":"77f41f7e-a5ff-486b-b1ca-1d5da87fe749","order_by":2,"name":"Yuxue Gao","email":"","orcid":"","institution":"Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing 100069","correspondingAuthor":false,"prefix":"","firstName":"Yuxue","middleName":"","lastName":"Gao","suffix":""},{"id":444556481,"identity":"f7db48d9-75cc-49e6-a364-b631c805ea91","order_by":3,"name":"Lin Sun","email":"","orcid":"","institution":"Department of Pathology, Beijing Youan Hospital, Capital Medical University, Beijing 100069","correspondingAuthor":false,"prefix":"","firstName":"Lin","middleName":"","lastName":"Sun","suffix":""},{"id":444556482,"identity":"af40dbfc-da22-4cf6-bc52-77233a847d53","order_by":4,"name":"Zhujun Yue","email":"","orcid":"","institution":"Department of Pathology, Beijing Youan Hospital, Capital Medical University, Beijing 100069","correspondingAuthor":false,"prefix":"","firstName":"Zhujun","middleName":"","lastName":"Yue","suffix":""},{"id":444556483,"identity":"2bc64248-71b3-4bfc-9828-5ca06cacbb3d","order_by":5,"name":"Lingjia Meng","email":"","orcid":"","institution":"Department of Pathology, Beijing Youan Hospital, Capital Medical University, Beijing 100069","correspondingAuthor":false,"prefix":"","firstName":"Lingjia","middleName":"","lastName":"Meng","suffix":""},{"id":444556485,"identity":"651ba579-6bde-4d50-aef6-d8b0d1d7b5c0","order_by":6,"name":"Caiping Guo","email":"","orcid":"","institution":"Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing 100069","correspondingAuthor":false,"prefix":"","firstName":"Caiping","middleName":"","lastName":"Guo","suffix":""},{"id":444556487,"identity":"6c94e714-c572-4bb3-9187-1442754a51c6","order_by":7,"name":"Yulin Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIiWNgGAWjYFAC5oYDDAwHQIwDUJEEQloYYVrYYEqJ0MIA0cJjQJwWgxuJjYcL/tyRN+df8/HDz5zDDPzsOQYMP3fg1dJweAbPM8OdM95uluzddphBsueNAWPvGQJaeCQOM264cXYbMyNQi8GNHANmxjZCWgwO22+4ceYZWIs9cVoSDiduON/DBrFFgoAWyTMPgVoOHE7ecIPNGOiXdB6JM88KDvbi0cJ3PPnwZ54/h203nD/88MPPbdZy/O3JGx/8xKNF4QCMJZEApnhAxAFsSmFAvgHG4serbhSMglEwCkYyAAArnV50cmA/ogAAAABJRU5ErkJggg==","orcid":"","institution":"Department of Respiratory and Critical Care Medicine, Beijing Youan Hospital, Capital Medical University, Beijing 100069","correspondingAuthor":true,"prefix":"","firstName":"Yulin","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2025-02-10 10:23:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5998165/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5998165/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00277-025-06424-9","type":"published","date":"2025-05-30T15:57:26+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":81004158,"identity":"86a5af39-1dda-41a3-b00a-4d5d1ce30843","added_by":"auto","created_at":"2025-04-21 06:45:05","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":148435,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlowchart depicting patient selection and exclusion criteria. \u003c/strong\u003eHL, Hodgkin lymphoma; NHL, non-Hodgkin lymphoma; DLBCL, diffuse large B-cell lymphoma; BL, burkitt lymphoma; PBL, plasmablastic lymphoma\u003c/p\u003e","description":"","filename":"OnlineFig.1tif.png","url":"https://assets-eu.researchsquare.com/files/rs-5998165/v1/d2781004a4832ff1b36392e0.png"},{"id":81004155,"identity":"b841b6d0-6f13-4273-915d-2c0b38a23d17","added_by":"auto","created_at":"2025-04-21 06:45:05","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":256898,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eKaplan-Meier survival curves based on OS.\u003c/strong\u003e (a) Kaplan-Meier estimate of OS for ARL (n=130). (b) Kaplan-Meier estimate of OS for People Living with HIV with BL (n=56), DLBCL (n=51), PBL (n=8), T/NK CL (n=6), and HL (n=9). ARL, AIDS-related lymphoma; OS, overall survival; DLBCL, diffuse large B-cell lymphoma; BL, Burkitt lymphoma; PBL, plasmablastic lymphoma; T/NK CL, T/NK Cell lymphoma; HL, Hodgkin lymphoma\u003c/p\u003e","description":"","filename":"OnlineFig.2.png","url":"https://assets-eu.researchsquare.com/files/rs-5998165/v1/4f83fcc1ee9888cbdaccc65b.png"},{"id":83783015,"identity":"392e0b01-4435-45b9-ac4d-9306df1b7e97","added_by":"auto","created_at":"2025-06-02 16:09:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1878319,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5998165/v1/a5d8443f-5d41-4733-af69-51faa4abd3b9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinicopathological Features and Prognostic Factors of AIDS-Related Lymphoma: A Retrospective Single- Center Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn 2023, approximately 40\u0026nbsp;million people living with human immunodeficiency virus (PLWH), and this number is expected to continue rising\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Prior to the advent of antiretroviral therapy (ART), PLWH faced a risk of developing non-Hodgkin lymphoma (NHL) more than 100 times higher than that of the general population, while the risk of classical Hodgkin lymphoma (HL) was approximately 7 times greater\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Since the introduction of ART in 1996, its widespread use has significantly extended the lifespan of PLWH; however, acquired immunodeficiency syndrome (AIDS)-related malignancies, particularly lymphoma, remain a substantial health threat \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Although the incidence of AIDS-related lymphoma (ARL) has declined with the widespread use of ART, ARL still accounts for more than 50% of all AIDS-related malignancies and remains a leading cause of death among PLWH\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAmong PLWH, the most prevalent lymphoma subtypes are diffuse large B-cell lymphoma (DLBCL) and Burkitt lymphoma (BL), with other forms such as primary effusion lymphoma (PEL) and plasmablastic lymphoma (PBL) also being relatively common\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. The complex interplay between human immunodeficiency virus (HIV) infection, immune suppression, and co-infection with Epstein-Barr virus (EBV) is thought to contribute to significant variations in the incidence and prognosis of NHL and HL, as well as differences between various NHL subtypes \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Research has identified several key risk factors for NHL, including low CD4\u0026thinsp;+\u0026thinsp;T cell count and high HIV viral load \u003csup\u003e[\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Moreover, PLWH generally exhibit poorer outcomes for malignancies compared to their HIV-negative counterparts \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Current treatment guidelines advocate for the provision of the same therapeutic interventions for PLWH diagnosed with malignancies as those offered to HIV-negative patients\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. In the United States, PLWH are more likely to be diagnosed at advanced stages of malignancy than non-PLWH \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Despite significant strides in understanding the relationship between HIV and lymphoma, most research has focused on specific subtypes or regions, with a lack of large-scale, population-based studies. As one of the countries with the highest number of PLWH globally, China faces a critical need for systematic research to better understand the epidemiology and clinical outcomes of ARL.\u003c/p\u003e \u003cp\u003eOur study retrospectively examines the clinical data of ARL patients at our institution, focusing on their initial clinical presentations, immunohistochemical profiles, treatment regimens, and clinical outcomes. The aim is to elucidate the prognostic differences between lymphoma subtypes in PLWH and to identify the key factors influencing lymphoma survival outcomes. This research provides critical insights that may inform the early diagnosis, individualized treatment strategies, and prognostic management of ARL, while advancing the scientific understanding and clinical management of this devastating disease.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Participants\u003c/h2\u003e \u003cp\u003eThis retrospective study analyzed patients diagnosed with ARL at Beijing Youan Hospital, affiliated with Capital Medical University, from January 2017 to November 2024. To ensure diagnostic consistency and accuracy, all cases underwent a comprehensive retrospective pathological review and were independently re-evaluated by two experienced pathologists in accordance with the 2022 WHO classification criteria \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. Patients were excluded based on the following criteria: (a) presence of concurrent malignancies; (b) missing treatment data; and (c) incomplete diagnoses or cases that did not meet the established diagnostic criteria. The patient selection process is illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e1\u003c/span\u003e. A total of 130 lymphoma patients were included, consisting of 51 cases of DLBCL, 56 cases of BL, 8 cases of PBL, 6 cases of T/NK cell lymphoma, and 9 cases of HL. This study was conducted in accordance with the Declaration of Helsinki and approved by our Institutional Review Board (reference number: Jing You Ke Lun Zi\u0026thinsp;\u0026lt;\u0026thinsp;2020\u0026thinsp;\u0026gt;\u0026thinsp;107). Informed consent was waived due to the retrospective nature of the study. All patient data were handled with strict confidentiality and anonymization.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eBlood samples and tumor tissue specimens were collected from all patients prior to treatment. Demographic characteristics (gender and age), HIV-related factors (duration from HIV infection to lymphoma diagnosis, date of initiation of ART, CD4\u0026thinsp;+\u0026thinsp;T cell count, and HIV viral load at lymphoma diagnosis), lymphoma-related factors (cell of origin subtype, Eastern Cooperative Oncology Group (ECOG) performance status, serum lactate dehydrogenase (LDH), B symptoms, extranodal involvement, Ann Arbor staging, bone marrow and central nervous system involvement, immunohistochemical markers (Ki-67, MYC, BCL2, MUM1, CD38 expression, and Epstein-Barr virus-encoded RNA (EBER)), and other characteristics (EBV viral load)) were collected. For patients who died during hospitalization, the date of death was retrieved from medical records. For those who survived or died after discharge, the last follow-up date was used as the endpoint for survival data. The primary endpoint of this study was overall survival (OS). OS was defined as the time from diagnosis to death from any cause or to the last follow-up for surviving patients.\u003c/p\u003e\n\u003ch3\u003eHistopathological, Immunohistochemical, and EBER In Situ Hybridization Analysis\u003c/h3\u003e\n\u003cp\u003eHematoxylin and eosin (HE) staining was performed to evaluate the morphological characteristics of the tumors. Immunohistochemical (IHC) analysis was conducted on formalin-fixed, paraffin-embedded (FFPE) tissue samples, using antibodies targeting Ki-67, CD10, BCL6, BCL2, MYC, MUM1, and CD38. The positivity thresholds for CD10, BCL-6, MUM1, and CD38 were set at 30%, for MYC at 40%, and for BCL2 at 50%. Ki-67 expression was quantified in 10% increments, with \u0026ge;\u0026thinsp;80% staining classified as \"positive/high.\" EBER was detected using the EBV probe in situ hybridization kit (ISH-6021, Zhongshan Golden Bridge Biotechnology Co., Ltd., Beijing, China) according to the manufacturer\u0026rsquo;s instructions, with positive signals appearing brownish yellow in the cell nucleus.\u003c/p\u003e\n\u003ch3\u003eTerminology Definitions\u003c/h3\u003e\n\u003cp\u003eThe Ann Arbor staging was determined based on pre-treatment computed tomography (CT) or positron emission tomography/computed tomography (PET/CT) scans of the chest, abdomen, and pelvis, in conjunction with bone marrow biopsy results\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. Patients were defined as having B symptoms if they met any of the following criteria: (a) unexplained weight loss of more than 10% of the body weight during the 6 months before initial staging investigation; (b) unexplained, persistent, or recurrent fever with temperatures above 38\u0026deg;C during the previous month; and (c) recurrent drenching night sweats during the previous month\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eLymphoma Chemotherapy\u003c/h3\u003e\n\u003cp\u003eTreatment information for patients was collected from hospital records and pharmacy archives. ARL patients received chemotherapy regimens, including CHOP regimen (cyclophosphamide, doxorubicin, vincristine, and prednisone)\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e, EPOCH (etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone)\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e, the Hyper-CVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone)\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e, and the ABVD regimen (Doxorubicin, Bleomycin, Vinblastine, and Dexamethasone)\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e, with some patients also undergoing surgical treatment.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using SPSS version 26.0. For continuous variables, intergroup comparisons were conducted using the Mann-Whitney U test, while categorical variables were analyzed using the chi-square test. Survival curves were constructed using the Kaplan-Meier method, with group differences evaluated by the log-rank test. Patients who remained alive at the last follow-up were censored at that time, whereas those lost to follow-up were censored at the date of last contact, assuming no further events occurred beyond that point. Univariate and multivariate analyses were performed using the Cox proportional hazards model to calculate hazard ratios (HR) and 95% confidence intervals (95% CI). Variables with a \u003cem\u003eP\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in univariate analysis were included in the multivariate model. A two-tailed \u003cem\u003eP\u003c/em\u003e-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant for all tests.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003ePatient Characteristics\u003c/h2\u003e \u003cp\u003eThis study included a total of 130 patients, and the baseline characteristics of HIV-related factors for all patients are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Among the histologically confirmed ARL, BL and DLBCL were the most prevalent subtypes, accounting for 43.1% and 39.2% of cases, respectively. This was followed by HL at 6.9%, PBL at 6.2%, and T/NK cell lymphoma, which was the least common, comprising 4.6% of the cohort. The median age of the patients was 39 years (range: 17\u0026ndash;75), with a male predominance (94.6%). At the time of lymphoma diagnosis, 51.5% of patients had been living with HIV for more than 6 months; however, only 35.4% had received ART for more than 6 months prior to the ARL diagnosis. Upon diagnosis, the median CD4\u0026thinsp;+\u0026thinsp;T cell count was 140 cells/\u0026micro;l (range: 4\u0026ndash;593), with 62.3% of patients presenting with a CD4\u0026thinsp;+\u0026thinsp;T cell count\u0026thinsp;\u0026lt;\u0026thinsp;200 cells/\u0026micro;l. Among the 116 patients who underwent HIV viral load testing, 64.7% had a viral load\u0026thinsp;\u0026ge;\u0026thinsp;40 copies/\u0026micro;l. Of the 120 patients tested for EBV viral load, 42.5% exhibited a viral load\u0026thinsp;\u0026ge;\u0026thinsp;500 copies/\u0026micro;l. Notably, when comparing AR-DLBCL and BL, BL patients were significantly younger (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), had higher CD4\u0026thinsp;+\u0026thinsp;T cell count (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.035), and were more likely to have a positive HIV viral load (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Characteristics of Patients with AIDS-related lymphoma (n\u0026thinsp;=\u0026thinsp;130).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll (n\u0026thinsp;=\u0026thinsp;130)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDLBCL (n\u0026thinsp;=\u0026thinsp;51)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBL (n\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePBL (n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eT/NK CL(n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHL (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian age (range) (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (17\u0026ndash;75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (22\u0026ndash;75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (22\u0026ndash;57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35 (27\u0026ndash;59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36 (17\u0026ndash;54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e36 (25\u0026ndash;47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGender, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e123 (94.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (94.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54 (96.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8 (88.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (11.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTime from HIV diagnosis to lymphoma (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.802\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (0-144)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (0-144)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.5 (0-122)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.5 (1\u0026ndash;72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e90 (2-144)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e36 (6\u0026ndash;96)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63 (48.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (55.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;6, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (51.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (44.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTime from ART initiation to lymphoma diagnosis (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.343\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0-144)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0-144)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0-120)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (0\u0026ndash;36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13 (0\u0026ndash;60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e36 (6\u0026ndash;96)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84 (64.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;6, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (35.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCD4\u0026thinsp;+\u0026thinsp;T cell count (cells/ul)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003e0.035\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140 (4-593)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e106 (5-535)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e144 (9-576)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e106 (14\u0026ndash;570)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e139 (135\u0026ndash;593)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e353 (4-547)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;200, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (62.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (76.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32 (57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2 (22.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;200, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (37.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (23.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7 (77.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHIV viral load (copies/ul), n/N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1566 (0-1170821)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e306 (0-1170821)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18790 (0-996948)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0-1170820)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4773 (0-516305)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0 (0-2831)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41/116 (35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23/50 (46.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9/51 (17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4/7 (57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1/3 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4/5 (80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75/116 (64.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27/50 (54.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42/51 (82.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3/7 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2/3 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1/5 (20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eEBV viral load copies/ul, n/N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.567\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0-1.8\u0026times;10\u003csup\u003e8\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0-1.87\u0026times;10\u003csup\u003e7\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0-1.8\u0026times;10\u003csup\u003e8\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.145\u0026times;10\u003csup\u003e4\u003c/sup\u003e (0-1.18\u0026times;10\u003csup\u003e6\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0-4.22\u0026times;10\u003csup\u003e3\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.49\u0026times;10\u003csup\u003e3\u003c/sup\u003e (0-1.03\u0026times;10\u003csup\u003e5\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69/120 (57.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29/48 (60.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33/50 (66.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1/8 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4/5 (80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2/9 (22.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51/120 (42.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19/48 (39.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17/50 (34.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7/8 (87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1/5 (20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7/9 (77.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAbbreviation\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e NHL, non-Hodgkin lymphoma; DLBCL, diffuse large B-cell lymphoma; BL, Burkitt lymphoma; PBL, plasmablastic lymphoma; T/NK CL, T/NK cell lymphoma; HL, Hodgkin lymphoma; HIV, human immunodeficiency virus; ART, antiretroviral therapy; EBV, Epstein‐Barr virus.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-values were calculated comparing DLBCL and BL groups and statistically significant \u003cem\u003eP\u003c/em\u003e-values are highlighted.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eImmunohistochemistry\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarizes the immunohistochemical characteristics of the various ARL subtypes. In patients with DLBCL, approximately half (46.9%) were of germinal center B-cell-like (\u003cb\u003eGCB\u003c/b\u003e) origin. Ki-67 expression was notably high, with 76.5% of patients showing\u0026thinsp;\u0026ge;\u0026thinsp;80% staining. A majority of DLBCL cases were positive for BCL2 (67.3%), MUM1 (73.5%), and CD38 (61.4%), while 43.1% exhibited positivity for EBER via in situ hybridization. For BL, all cases demonstrated\u0026thinsp;\u0026ge;\u0026thinsp;80% Ki-67 staining, with high positivity for MYC (85.7%) and CD38 (71.7%), but relatively low expression of BCL2 (16.4%) and MUM1 (37.5%). The EBER positivity rate in BL was 30.4%. Given the limited number of PBL, T/NK cell lymphoma, and HL cases, the statistical significance of their immunohistochemical results was less robust. Nonetheless, it is noteworthy that nearly all HIV-infected PBL and HL cases were EBER positive. When comparing DLBCL with BL, BL patients had significantly higher rates of Ki-67\u0026thinsp;\u0026ge;\u0026thinsp;80% (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and MYC positivity (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while BCL2 and MUM1 expression were lower (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eImmunohistochemistry of AIDS-related lymphoma (n\u0026thinsp;=\u0026thinsp;130).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDLBCL (n\u0026thinsp;=\u0026thinsp;51)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBL (n\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePBL (n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eT/NK CL(n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHL (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eCOO\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGCB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23/49 (46.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e-\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-GCB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26/49 (53.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e-\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eKi 67%, n/N\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12/51 (23.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/56 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/8 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1/6 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0/9 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39/51 (76.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56/56 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8/8 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5/6 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9/9 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eMYC, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28/51 (54.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8/56 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/6 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0/2 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23/51 (45.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48/56 (85.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6/6 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2/2 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eBCL2, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16/49 (32.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46/55 (83.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3/5 (60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1/5(20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4/4 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33/49 (67.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9/55 (16.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2/5 (40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4/5 (80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0/4 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eMUM1, n/N (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13/49 (26.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35/56 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2/8 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0/4 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0/7 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36/49 (73.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21/56 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6/8 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4/4 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7/7 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCD38, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.281\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17/44 (38.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15/53 (28.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1/8 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2/3 (76.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2/2 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27/51 (61.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38/53 (71.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7/8 (87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1/3 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0/2 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eEBER, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.170\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22/51 (43.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17/56 (30.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8/8 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3/8 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9/9 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29/51 (56.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39/56 (69.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3/8 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0/0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cp\u003e\u003cstrong\u003eAbbreviation\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eDLBCL, diffuse large B-cell lymphoma; BL, Burkitt lymphoma; PBL, plasmablastic lymphoma; T/NK CL, T/NK cell lymphoma; HL, Hodgkin lymphoma; EBER, Epstein-Barr virus-encoded RNA.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-values were calculated comparing DLBCL and BL groups and statistically significant P-values are highlighted.\u003c/p\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eClinical Analysis, Treatment, and Survival Outcomes\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e provides a comprehensive summary of the clinical staging, prognosis, treatment, and outcomes of ARL. The majority of patients in this study were young, with only six DLBCL patients exceeding 60 years of age. At the time of diagnosis, most patients exhibited poor performance status, particularly those with DLBCL, who had elevated ECOG scores. Most patients were diagnosed at advanced stages (III-IV), with widespread extranodal involvement. Bone marrow infiltration was observed across all ARL subtypes, with the highest frequencies in BL and T/NK cell lymphomas (46.4% and 50%, respectively), whereas the incidence in DLBCL was comparatively lower (21.7%). Central nervous system (CNS) involvement was also documented in patients with DLBCL, BL, and PBL. Additionally, over half of the patients had elevated LDH levels and presented with B symptoms. Compared with DLBCL, BL was characterized by a younger age at diagnosis (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.026), lower ECOG performance status scores (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009), and a significantly higher frequency of bone marrow involvement (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007). Additionally, risk stratification was conducted for each lymphoma subtype, classifying patients into low-, intermediate-, and high-risk categories. The International Prognostic Index (IPI) was used for DLBCL and PBL, while the BL-IPI score was applied to BL. T/NK-cell lymphomas were assessed using the Prognostic Index for T-cell lymphoma (PIT), and the International Prognostic Score (IPS) was employed for HL.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical staging, prognosis, treatment, and outcomes of AIDS-related lymphoma (n\u0026thinsp;=\u0026thinsp;130).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDLBCL (n\u0026thinsp;=\u0026thinsp;51)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBL (n\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePBL (n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eT/NK CL(n\u0026thinsp;=\u0026thinsp;6)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHL (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eAge (years), n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.026\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (88.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eECOG score, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (37.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (62.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (33.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eAnn Arbor stage, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.478\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅠ/Ⅱ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (9.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅢ/Ⅳ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (90.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (85.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (44.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eExtranodal involved sites, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.562\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (35.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (77.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (58.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (64.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (22.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eLDH, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.343\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;1\u0026times;ULN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (77.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1\u0026times;ULN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (22.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB symptoms, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.311\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (44.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (55.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBone marrow involvement, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (21.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (46.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCNS involvement, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.699\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eRisk stratification, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (26.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eintermediate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (92.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (33.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (22.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (39.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eInitial chemotherapy regimen for lymphoma, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHOP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (45.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (32.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"6\" rowspan=\"7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEPOCH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyper-CVAD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eABVD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (77.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther regimens\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo regimen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (22.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegimen with R\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (82.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (60.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.401\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian survival (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2-year OS, (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e85.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u003cstrong\u003eAbbreviation\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eDLBCL, diffuse large B-cell lymphoma; BL, Burkitt lymphoma; PBL, plasmablastic lymphoma; T/NK CL, T/NK cell lymphoma; HL, Hodgkin lymphoma; ECOG, Eastern Cooperative Oncology Group; LDH, lactate dehydrogenase; ULN, upper limit of normal; CNS, central nervous system; CHOP, cyclophosphamide, doxorubicin, vincristine, and prednisone; EPOCH, etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone; Hyper-CVAD, hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone; ABVD, Doxorubicin, Bleomycin, Vinblastine, and Dexamethasone; R, Rituximab; OS, overall survival.\u003c/p\u003e\n\u003cp\u003eThe risk stratification systems for different lymphoma subtypes are as follows:\u003c/p\u003e\n\u003cp\u003eDLBCL and PBL, the International Prognostic Index (IPI) was applied, categorizing patients as low risk (0\u0026ndash;1 points), intermediate risk (2\u0026ndash;3 points), or high risk (4\u0026ndash;5 points);\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBL, assessed using the BL-IPI, with risk groups defined as low (0 points), intermediate (1 point), and high (\u0026ge;2 points);\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eT/NK-cell lymphomas, stratified according to the Prognostic Index for T-cell lymphoma (PIT) into low (0 points), intermediate (1\u0026ndash;2 points), and high-risk (\u0026ge;3 points) groups;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHL, the International Prognostic Score (IPS) was used to define low (0\u0026ndash;2 points), intermediate (3\u0026ndash;4 points), and high-risk (5\u0026ndash;7 points) categories.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-values were calculated comparing DLBCL and BL groups and statistically significant \u003cem\u003eP\u003c/em\u003e-values are highlighted.\u0026nbsp;\u003c/p\u003e\u003cp\u003eIn terms of treatment, 45.1% of DLBCL patients received the CHOP regimen, 41.2% received the EPOCH regimen, and 82.4% were treated with rituximab. Some patients were unable to initiate timely treatment due to rapid disease progression or financial constraints. Among BL patients, 32.1% were treated with CHOP, 28.6% with EPOCH, and 17.9% with Hyper-CVAD, with 60.7% receiving rituximab. In the PBL cohort, 50% received either CHOP or EPOCH, and 37.5% were treated with rituximab. Among NK/T-cell lymphoma patients, 50% received EPOCH and the other 50% underwent surgery. The majority of HL patients (77.8%) received the ABVD regimen, with the remaining patients undergoing surgery.\u003c/p\u003e \u003cp\u003eAs of the last follow-up on November 31, 2024, 60 patients (46.2%) had died, 69 (53.1%) were alive, and 2 were lost to follow-up. The median follow-up duration was 15 months (range: 1\u0026ndash;94 months), with a 2-year OS rate of 50.6% (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ea). The 2-year OS rates for DLBCL, BL, PBL, T/NK cell lymphoma, and HL were 51.7%, 43.8%, 58.3%, 50%, and 85.7%, respectively. Notably, HL patients had the best prognosis, while BL patients had the worst (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eb).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eUnivariate and Multivariate Analysis of NHL\u003c/h2\u003e \u003cp\u003eUnivariate analysis identified several factors significantly associated with poor OS, including a CD4\u0026thinsp;+\u0026thinsp;T cell count\u0026thinsp;\u0026lt;\u0026thinsp;200 cells/\u0026micro;l (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), presence of B symptoms (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.037), ECOG score\u0026thinsp;\u0026gt;\u0026thinsp;1 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), Ann Arbor stage\u0026thinsp;\u0026gt;\u0026thinsp;2 (P\u0026thinsp;=\u0026thinsp;0.014), extranodal involvement in more than one site (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and elevated LDH levels (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and bone marrow involvement (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.033). Multivariate analysis revealed that a CD4\u0026thinsp;+\u0026thinsp;T cell count\u0026thinsp;\u0026lt;\u0026thinsp;200 cells/\u0026micro;l (HR: 2.085, 95% CI: 1.094\u0026ndash;3.974, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.026) and elevated LDH levels (HR: 0.378, 95% CI: 0.192\u0026ndash;0.746, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005) were independent prognostic factors for poor survival. Although EPOCH treatment was associated with improved prognosis compared to CHOP (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.057), this finding did not reach statistical significance. Moreover, high-risk IPI stage (III/IV) (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) was also correlated with worse survival outcomes (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate and multivariate analysis of OS in patients with AR-NHL (n\u0026thinsp;=\u0026thinsp;121)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eMultivariate analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eTime from HIV diagnosis to lymphoma (months)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6 mon vs. \u0026ge; 6 mon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.962 (0.582\u0026ndash;1.590)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.880\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eTime from ART initiation to lymphoma diagnosis (months)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6 mon vs. \u0026ge; 6 mon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.039 (0.609\u0026ndash;1.774)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.888\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eCD4\u0026thinsp;+\u0026thinsp;T cell count (cells/\u0026micro;l)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;200 vs. \u0026ge; 200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.734 (1.480\u0026ndash;5.049)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.085 (1.094\u0026ndash;3.974)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.026\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eHIV viral load (copies/ul)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;40 vs. \u0026ge; 40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.853 (0.487\u0026ndash;1.495)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.579\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eEBV viral load (copies/ul)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;500 vs. \u0026ge; 500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.761 (0.450\u0026ndash;1.288)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.309\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eB symptoms\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes vs. No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.557 (0.321\u0026ndash;0.966)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.037\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.056 (0.569\u0026ndash;1.960)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.864\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;60 vs. \u0026ge; 60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.845 (0.265\u0026ndash;2.699)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.776\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eECOG score\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt; 2 vs. \u0026ge; 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.427 (0.254\u0026ndash;0.718)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.671 (0.378\u0026ndash;1.192)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.174\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eAnn Arbor stage\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI/II vs. III/IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.280 (0.102\u0026ndash;0.773)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.014\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.002 (0.293\u0026ndash;3.426)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eExtranodal involved sites\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2 vs. \u0026ge; 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.373 (0.208\u0026ndash;0.668)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.609 (0.300-1.236)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.170\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eElevated LDH\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes vs. No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.295 (0.154\u0026ndash;0.568)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.378 (0.192\u0026ndash;0.746)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBone marrow involvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes vs. No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.735 (1.046\u0026ndash;2.877)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.033\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.194 (0.687\u0026ndash;2.073)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.530\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCNS involvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes vs. No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.530 (0.276\u0026ndash;1.018)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eIPI score\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0-2 vs. 3‐5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.425 (2.242\u0026ndash;8.731)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eRegimen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHOP vs. EPOCH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.536 (0.285\u0026ndash;1.011)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKI67%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;80% vs. \u0026ge; 80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.244 (0.613\u0026ndash;2.525)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.546\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMYC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;40% vs. \u0026ge; 40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.719 (0.399\u0026ndash;1.295)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.272\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBCL2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt; 50% vs. \u0026ge; 50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.849 (0.502\u0026ndash;1.437)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.542\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMUM1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt; 30% vs. \u0026ge; 30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.986 (0.586\u0026ndash;1.658)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.957\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCD38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt; 30% vs. \u0026ge; 30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.140 (0.645\u0026ndash;2.014)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.653\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEBER\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive vs. Negative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.007 (0.601\u0026ndash;1.687)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.979\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAbbreviation\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eHR, hazard ratio; CI, confidence interval; HIV, human immunodeficiency virus; ART, antiretroviral therapy; EBV, Epstein‐Barr virus; ECOG, Eastern Cooperative Oncology Group; LDH, lactate dehydrogenase; IPI, International Prognostic Index; CHOP, cyclophosphamide, doxorubicin, vincristine, and prednisone; EPOCH, etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone; EBER, Epstein-Barr virus-encoded RNA.\u003c/p\u003e\n\u003cp\u003eStatistically significant\u0026nbsp;\u003cem\u003eP\u003c/em\u003e-values are highlighted.\u0026nbsp;\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eHIV infection increases the risk of malignant tumors through various mechanisms, including systemic immune impairment, genetic alterations, susceptibility to oncogenic viral infections, and chronic B-cell activation \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. Since the introduction of ART in 1996, the immune function of PLWH has significantly improved, and their survival has been prolonged \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. However, despite the substantial reduction in HIV-induced immune deficiency by ART, its impact on the incidence of ARL has not been as pronounced.\u003c/p\u003e \u003cp\u003eIn PLWH, the distribution of lymphoma subtypes differs significantly from that in the general population. A study by Surabhi et al. involving 4115 non-ARL patients reported that HL accounted for 30.35%, while NHL constituted 69.65%. Among NHL cases, B-cell lymphomas made up 84.08%, while T-cell and NK-cell lymphomas represented 15.38%\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. In contrast, in the present study, BL accounted for 43%, DLBCL for 39%, PBL for 6%, peripheral T/NK-cell lymphoma for 5%, and HL for 7%. Overall, ARL is predominantly composed of NHL, with higher incidences of BL and DLBCL, and lower incidences of other subtypes. This difference highlights the significant impact of HIV infection on lymphoma subtype distribution. Furthermore, the median age of ARL patients in our study was relatively young, with only a few patients older than 60, all of whom had DLBCL\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHIV-related factors play a crucial role in the development and progression of lymphoma, and their impact varies across different lymphoma subtypes. In this study, approximately 51.5% of patients had been diagnosed with HIV for more than six months at the time of lymphoma diagnosis, yet only 35.5% had received ART for more than six months. This proportion is significantly lower than previously reported in the literature. For example, one study found that the median time since HIV diagnosis prior to DLBCL diagnosis was 15 years, with nearly 80% of patients already receiving ART\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. In contrast, our patient population exhibited delayed HIV diagnosis and limited exposure to ART. This discrepancy may reflect inadequate awareness of HIV testing and associated health risks, as well as barriers to healthcare access and intervention programs among high-risk populations. Notably, many patients were diagnosed with HIV only after presenting with lymphoma-related symptoms, missing the critical window for early diagnosis and appropriate treatment. NHL patients demonstrated similar patterns of delayed HIV diagnosis and shorter ART exposure compared to the overall cohort. However, HL patients had a longer duration of HIV infection, with all patients being infected for over six months. We observed that, among PLWH, patients with BL were significantly younger (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), had higher CD4\u0026thinsp;+\u0026thinsp;T cell counts (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.035), and exhibited higher HIV viral loads (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002) compared to those with DLBCL. This aligns with previous findings, indicating that, compared to DLBCL, AIDS-related BL is more prevalent in patients with higher CD4\u0026thinsp;+\u0026thinsp;T cell counts and is strongly associated with cumulative HIV viremia\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. Additionally, most PLWH contract EBV during childhood or adolescence\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. Studies suggest that, in the absence of intervention, the risk of lymphoma in PLWH with EBV infection is more than 60 times higher than in the general population \u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e. Despite the widespread use of ART, which has significantly reduced the incidence of AIDS-related malignancies in PLWH, EBV-associated cancers remain prevalent in this group \u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e. In PLWH, the association between different lymphoma types and EBV infection varies: 30%-90% of DLBCL (depending on the subtype), 30%-60% of BL, 70%-80% of PBL, and 100% of HL cases are associated with EBV infection\u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e. In our cohort, we found that PBL and HL had high EBV viral loads, with positivity rates of 87.5% and 77.8%, respectively, while T/NK cell lymphoma had lower EBV viral loads. Immunohistochemistry further confirmed the close relationship between lymphoma in PLWH and EBV infection. Notably, the EBER positivity rate was 100% in HL and 87.5% in PBL, compared to approximately 20% in HL. These differences suggest that EBV plays a more crucial role in the pathogenesis of lymphoma in PLWH, particularly in HL and PBL.\u003c/p\u003e \u003cp\u003eKi-67 is a commonly used proliferation marker in oncology, often reflecting tumor cell proliferative activity\u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e. In the general population, Ki-67 expression in DLBCL typically ranges from 40\u0026ndash;90%, while BL generally shows nearly 100% Ki-67 positivity \u003csup\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e. Our findings are consistent with these reports. Notably, there is a significant difference in Ki-67 expression between BL and DLBCL (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), suggesting that Ki-67 could serve as an important marker for distinguishing between BL and DLBCL, with potential diagnostic value. Furthermore, DLBCL in PLWH showed higher rates of MYC and BCL-2 expression (MYC: 45.1%, BCL-2: 67.3%) \u003csup\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/sup\u003e, indicating that HIV-associated lymphoma is more aggressive, particularly with features of double-hit or triple-hit lymphoma. In this study, we found that CD38 was highly expressed in B-cell NHL, with particularly elevated levels observed in patients with PBL and BL. CD38 is a transmembrane glycoprotein that serves as a marker for GCB subtype, in addition to marking mature plasma cells and plasma cell tumors\u003csup\u003e[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/sup\u003e. Within the tumour microenvironment, CD38⁺ cells may contribute to immune evasion through the secretion of immunosuppressive mediators\u003csup\u003e[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/sup\u003e. Interestingly, in PLWH without lymphoma, an increased proportion of circulating CD8+/CD38\u003csup\u003e+\u003c/sup\u003e T cells is predictive of AIDS progression, CD4\u0026thinsp;+\u0026thinsp;T cell decline and elevated viral load \u003csup\u003e[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/sup\u003e. Additionally, co-expression of CD38 and HLA-DR on CD4+/CD45RO\u003csup\u003e+\u003c/sup\u003e T cells correlates with disease activity, while high CD38 expression on CD4\u0026thinsp;+\u0026thinsp;T cells, indicative of chronic immune activation, is associated with poor prognosis in advanced HIV infection. Despite these associations, anti-CD38 therapies have not been systematically evaluated in AIDS-related DLBCL, HL or BL. Nevertheless, some studies have reported CD38 expression in all cases of ARL, with significant variation in expression levels depending on the histological subtype\u003csup\u003e[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/sup\u003e. Daratumumab, a CD38-targeting monoclonal antibody approved for the treatment of multiple myeloma, has shown encouraging safety and efficacy in hematologic malignancies, and may represent a promising therapeutic approach for ARL, particularly in PBL and BL\u003csup\u003e[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]\u003c/sup\u003e. In terms of clinical presentation, our patients were often diagnosed at advanced stages, with significant extranodal involvement and frequent B symptoms \u003csup\u003e[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn terms of treatment, For B-cell-origin NHL, CHOP or EPOCH regimens are commonly used, with most patients also receiving rituximab. previous studies have indicated that EPOCH is one of the first-line treatment options for AR- DLBCL, HHV8-positive DLBCL, and primary effusion lymphoma (PEL), and it is the preferred regimen for AIDS-related BL according to the 2019 NCCN guidelines\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. These recommendations are based on phase II trial results of EPOCH in AR-DLBCL and high-grade lymphomas, as well as a large meta-analysis indicating that EPOCH is more effective than CHOP in ARL\u003csup\u003e[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]\u003c/sup\u003e. Our study found that EPOCH treatment was superior to CHOP for NHL, although this trend did not reach statistical significance. Rituximab is a monoclonal antibody targeting CD20, and it is routinely recommended in combination with standard chemotherapy for the treatment of B cell NHL in PLWH, regardless of HIV status\u003csup\u003e[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]\u003c/sup\u003e. In recent years, the prognosis of ARL patients treated with rituximab-based regimens has significantly improved in economically developed countries \u003csup\u003e[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]\u003c/sup\u003e. However, in China, due to the lack of medical insurance coverage for rituximab, and the higher proportion of low- and middle-income patients in this study, many patients may be unable to afford the cost of the drug due to financial constraints, and some have poor compliance, failing to complete the treatment as recommended. Furthermore, the use of rituximab has been associated with an increased risk of infection-related mortality. Accordingly, careful monitoring for infectious complications is essential throughout the course of treatment, particularly in patients with CD4 counts below 50 cells/\u0026micro;l \u003csup\u003e[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]\u003c/sup\u003e. Current studies have shown that for patients with extranodal T/NK cell lymphoma, those treated with asparaginase (Asp)-containing chemotherapy regimens achieve significantly higher complete remission rates compared to those receiving non-Asp-based regimens\u003csup\u003e[\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]\u003c/sup\u003e. However, in our cohort, T/NK cell lymphoma patients primarily received anthracycline-based chemotherapy or surgical treatment. This treatment pattern may introduce bias related to treatment-associated mortality.\u003c/p\u003e \u003cp\u003eA comprehensive database study highlights that HIV infection remains an independent risk factor for mortality in patients with lymphoma\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. In Western countries, the prognosis of lymphoma among PLWH is similar to that of the general population\u003csup\u003e[\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]\u003c/sup\u003e. However, in developing countries, including China, remain markedly inferior, particularly among patients with BL \u003csup\u003e[\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]\u003c/sup\u003e. Early retrospective analyses indicated that, even in the era of ART, BL outcomes lagged behind those of DLBCL \u003csup\u003e[\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]\u003c/sup\u003e. A subsequent German study reported improved survival for both HIV-associated BL and DLBCL, with no significant difference between the two subtypes \u003csup\u003e[\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]\u003c/sup\u003e. In our cohort, the prognosis of BL was notably poorer, likely due to the higher incidence of bone marrow involvement in BL patients (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007). BL is characterized by an exceptionally high proliferative index and aggressiveness, underscoring the importance of timely intervention. However, many of our BL patients were diagnosed during the COVID-19 pandemic, and delays in treatment often resulted in missed opportunities for early therapeutic intervention. Furthermore, despite the need for intensified chemotherapy in BL, limitations in economic and healthcare resources prevented access to these regimens, thereby compromising treatment outcomes. Despite these challenges, it is encouraging that HL outcomes in our study were comparable to those seen in HIV-negative populations \u003csup\u003e[\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIPI is currently the most widely used risk assessment tool for lymphoma patients. However, the applicability of IPI to ARL remains controversial\u003csup\u003e[\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]\u003c/sup\u003e. Some studies have shown that aaIPI or IPI are strongly correlated with the prognosis of AR-NHL \u003csup\u003e[\u003cspan additionalcitationids=\"CR58\" citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]\u003c/sup\u003e. However, a study by Stefan et al. found that IPI has no prognostic value for ARL \u003csup\u003e[\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]\u003c/sup\u003e. In contrast, our study demonstrates that IPI is effective in predicting the prognosis of AR-NHL patients. Barta SK et al. developed a new prognostic tool, the ARL-IPI, which stratifies patients into low-, intermediate-, and high-risk groups\u003csup\u003e[\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]\u003c/sup\u003e. The ARL-IPI incorporates baseline factors such as ECOG performance status, LDH level, disease stage, number of extranodal sites involved, and an HIV score that includes baseline CD4\u0026thinsp;+\u0026thinsp;T cell count, HIV viral load, and prior AIDS history. Barta SK et al. demonstrated that the ARL-IPI outperformed the aa-IPI in predicting OS\u003csup\u003e[\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]\u003c/sup\u003e. In this study, multivariate Cox analysis revealed that a CD4\u0026thinsp;+\u0026thinsp;T cell count\u0026thinsp;\u0026lt;\u0026thinsp;200 cells/\u0026micro;l (HR: 2.051, 95% CI: 1.078\u0026ndash;3.901, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.029) and elevated LDH levels (HR: 0.383, 95% CI: 0.194\u0026ndash;0.754, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005) were independent adverse prognostic factors for OS in patients with AR-NHL.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, the retrospective design may introduce selection and data collection biases, which limit the generalizability of the findings. Second, the small sample size, particularly for certain lymphoma subtypes, may result in insufficient statistical power, affecting the stability and accuracy of the results. Third, treatment heterogeneity introduced additional confounding factors that may have influenced the study's outcomes. For instance, while the majority of T/NK cell lymphoma patients in our cohort were treated with anthracycline-based regimens or surgery, prevailing treatment practices increasingly favor asparaginase- or gemcitabine-based protocols. Moreover, the relatively low proportion of BL patients who received intensive chemotherapy in our study could have impacted treatment efficacy. Similarly, despite widespread recommendations for rituximab use in all B cell NHL patients, limited access due to financial constraints in certain cases may have further compromised the reliability of survival analyses. Finally, the lack of molecular mechanisms and genomic data limits a comprehensive understanding of the complex relationship between HIV infection and lymphoma development. Future studies integrating molecular biology data will help clarify the underlying mechanisms and provide a basis for precision medicine.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides a comprehensive analysis of the clinicopathological features, prognostic factors, and treatment outcomes of NHL and HL in PLWH. Our findings emphasize that low CD4\u0026thinsp;+\u0026thinsp;T cell counts and elevated LDH levels are independent risk factors for AR-NHL. Additionally, IPI is effective for prognostic evaluation of AR-NHL. Notably, the EPOCH chemotherapy regimen shows a trend toward improved outcomes compared to CHOP, although statistical significance was not reached. This study underscores the critical role of EBV infection and high-proliferative tumor characteristics in the pathogenesis of ARL. Future research should focus on expanding sample sizes, integrating molecular mechanisms, optimizing prognostic scoring systems, and exploring more targeted therapeutic strategies to improve survival and quality of life for patients with ARL.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eCompeting Interests: The authors declare no competing interests.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all the patients and their families. A special thanks to the staff of the Department of Infectious Diseases and Immunology, as well as the Pathology Department.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eY.L. and J.C. co-wrote the initial draft of the manuscript and prepared the accompanying figures and tables. Y.G., L.S., Z.Y., and L.M. contributed to the study\u0026apos;s concept and design. J.C. secured the funding. C.G. and Y.Z. provided critical intellectual contributions and supervised the overall process. All authors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work is supported by the Beijing Research Ward Excellence Program, BRWEP (BRWEP2024W042180111).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Beijing Youan Hospital and performed in accordance with the 1975 Declaration of Helsinki. Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data set used and/or analyzed during the current study is available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo conflicts of interest to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOpen Access\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article\u0026apos;s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article\u0026apos;s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUNAIDS. 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Haematologica 99(11):1731\u0026ndash;1737\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"annals-of-hematology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aohe","sideBox":"Learn more about [Annals of Hematology](http://link.springer.com/journal/277)","snPcode":"277","submissionUrl":"https://submission.nature.com/new-submission/277/3","title":"Annals of Hematology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"AIDS, lymphoma, ARL, NHL, HL, prognostic","lastPublishedDoi":"10.21203/rs.3.rs-5998165/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5998165/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAIDS-related lymphoma (ARL) is a leading cause of mortality among people living with HIV (PLWH), characterized by distinct clinicopathological features and a generally poor prognosis. However, comprehensive studies on ARL remain limited. This study aimed to evaluate the clinicopathological characteristics, immune status, and EBV/HIV viral loads in PLWH diagnosed with lymphoma, and to assess their prognostic significance. A retrospective analysis was conducted on 130 ARL cases diagnosed between 2017 and 2024. The cohort included 56 Burkitt lymphoma (BL), 51 diffuse large B-cell lymphoma (DLBCL), 9 Hodgkin lymphoma (HL), 8 plasmablastic lymphoma (PBL), and 6 T/NK cell lymphoma patients. The median age was 39 years, with 94.6% of patients being male. The 2-year overall survival (OS) rate was 50.6%, with HL showing the highest survival rate (85.7%) and BL the lowest (43.8%). Univariate analysis identified several factors significantly associated with poorer OS in non-Hodgkin lymphoma (NHL), including CD4\u0026thinsp;+\u0026thinsp;T cell count\u0026thinsp;\u0026lt;\u0026thinsp;200 cells/\u0026micro;L, presence of B symptoms, Eastern Cooperative Oncology Group (ECOG) performance status\u0026thinsp;\u0026gt;\u0026thinsp;1, elevated lactate dehydrogenase (LDH), advanced stage, and multiple extranodal involvements (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Multivariate analysis revealed CD4\u0026thinsp;+\u0026thinsp;T cell count\u0026thinsp;\u0026lt;\u0026thinsp;200 cells/\u0026micro;L (HR: 2.051, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.029) and elevated LDH (HR: 0.383, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005) as independent prognostic factors. In conclusion, NHL, particularly BL and DLBCL, are prevalent in PLWH. Severe immunodeficiency and elevated LDH levels are key factors contributing to mortality in AIDS-related NHL.\u003c/p\u003e","manuscriptTitle":"Clinicopathological Features and Prognostic Factors of AIDS-Related Lymphoma: A Retrospective Single- Center Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-21 06:37:00","doi":"10.21203/rs.3.rs-5998165/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-22T02:26:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-20T16:49:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"65700664267645098620746623102169554817","date":"2025-04-20T10:47:32+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-17T18:37:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"86808227840576465263638949550294192475","date":"2025-04-17T17:11:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-17T08:05:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-17T06:57:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"Annals of Hematology","date":"2025-04-10T14:29:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"annals-of-hematology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aohe","sideBox":"Learn more about [Annals of Hematology](http://link.springer.com/journal/277)","snPcode":"277","submissionUrl":"https://submission.nature.com/new-submission/277/3","title":"Annals of Hematology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"2faa8771-3afa-4c0d-b386-80043b000da6","owner":[],"postedDate":"April 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-06-02T16:05:05+00:00","versionOfRecord":{"articleIdentity":"rs-5998165","link":"https://doi.org/10.1007/s00277-025-06424-9","journal":{"identity":"annals-of-hematology","isVorOnly":false,"title":"Annals of Hematology"},"publishedOn":"2025-05-30 15:57:26","publishedOnDateReadable":"May 30th, 2025"},"versionCreatedAt":"2025-04-21 06:37:00","video":"","vorDoi":"10.1007/s00277-025-06424-9","vorDoiUrl":"https://doi.org/10.1007/s00277-025-06424-9","workflowStages":[]},"version":"v1","identity":"rs-5998165","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5998165","identity":"rs-5998165","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}