A Prognostic Index for Systemic AIDS-Related Non-Hodgkin Lymphoma Treated in the Era of Highly Active Antiretroviral Therapy

Bower, Mark; Gazzard, Brian; Mandalia, Sundhiya; Newsom-Davis, Tom; Thirlwell, Christina; Dhillon, Tony; Young, Anne Marie; Powles, Tom; Gaya, Andrew; Nelson, Mark; Stebbing, Justin

doi:10.7326/0003-4819-143-4-200508160-00007

Cited by 116 publications

(81 citation statements)

References 30 publications

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“…This includes patients diagnosed with lymphoma in the era of combination antiretroviral therapy (cART). [3][4][5][6] Nevertheless, several factors require refinement of the IPI in patients with AIDS-related lymphomas (ARL). First, ARL commonly include more aggressive lymphomas than DLBCL, including Burkitt lymphoma (BL).…”

Section: Introductionmentioning

confidence: 99%

A new prognostic score for AIDS-related lymphomas in the rituximab-era

et al. 2014

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Methods Patients and data collectionWe performed a systematic review of the literature to identify prospectively conducted clinical trials that assessed therapeutic interventions for HIV-associated NHL. A detailed description of the search strategy has been previously reported 12 and is available in the Online Supplementary Appendix. We limited our dataset to only patients treated with rituximab-containing chemoimmunotherapy.

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Section: Introductionmentioning

confidence: 99%

A new prognostic score for AIDS-related lymphomas in the rituximab-era

et al. 2014

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“…Not only is this unusual in patients with NK/T cell lymphoma, particularly one with HIV/AIDS, but is also surprising as our patient presented with other poor prognostic indicators including intestinal involvement, disseminated disease, high level of EBV DNA in the CSF, and a low CD4 count [3,13,14]. Although therapy for NK/T cell lymphoma has focused on anthracycline-based chemotherapy with or without radiation [13], because of the need to treat her CNS disease, a regimen utilizing methotrexate every 14 days was used [15].…”

Section: Discussionmentioning

confidence: 99%

NK/T cell non-Hodgkin lymphoma in a HIV-positive patient

et al. 2010

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NK/T lymphomas have rarely been reported in HIV/AIDS patients. Here we report a case of a 37-year-old woman, with AIDS and a recent diagnosis of Kaposi sarcoma in a mesenteric lymph node, who presented with extra-ocular nerve palsies and gastrointestinal bleeding. A small intestine resection specimen revealed an extra-nodal NK/T cell lymphoma, nasal type. The unique presentation of this rare and aggressive lymphoma in the setting of AIDS and Kaposi sarcoma underscores the importance of maintaining a broad differential diagnosis when evaluating a malignant neoplasm from a HIV-positive patient.

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confidence: 99%

“…[11][12][13] Arterial complications can occur as a result of damage to the entire vascular system and include coronary artery disease, cerebrovascular disease, and peripheral artery disease. 14,15 While the latency period for many of these diseases can be short, survivors often do not have clinical evidence of disease until several years following HCT.…”

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confidence: 99%

“…11,12 The main prognostic factors for these patients were the IPI score and the CD4 lymphocyte count at the time of diagnosis. 13 In addition, it is of note that chemotherapy and concomitant HAART do not cause prolonged suppression of lymphocyte subsets 14 and, most importantly, that the immmunological response to HAART has a positive effect on the survival of these patients. 15 Treatment of patients with HIV-related BL has evolved from reduced-dose or CHOP-like chemotherapy regimens with resultant poor clinical outcomes to more Burkitt-oriented short, intensive multiagent chemotherapy including fractionated cyclophosphamide, high-dose methotrexate and cytarabine.…”

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Human immunodeficiency virus-related non-Hodgkin's lymphoma

Ribera¹,

Navarro²

2008

Haematologica

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F e r r a t a S t o r t i F o u n d a t i o n © F e r r a t a S t o r t i F o u n d a t i o nEditorialsaccount. The results of the combination of full dose chemotherapeutic regimens and HAART have improved the response rate and the survival of patients with HIV-related lymphomas ( Figure 1). In two comparative studies, the prognosis of patients with HIVrelated lymphomas was similar to that observed in non-immunosuppressed patients with non-Hodgkin's lymphoma of the same histological type. 11,12 The main prognostic factors for these patients were the IPI score and the CD4 lymphocyte count at the time of diagnosis. 13 In addition, it is of note that chemotherapy and concomitant HAART do not cause prolonged suppression of lymphocyte subsets 14 and, most importantly, that the immmunological response to HAART has a positive effect on the survival of these patients. 15 Treatment of patients with HIV-related BL has evolved from reduced-dose or CHOP-like chemotherapy regimens with resultant poor clinical outcomes to more Burkitt-oriented short, intensive multiagent chemotherapy including fractionated cyclophosphamide, high-dose methotrexate and cytarabine. The widespread use of HAART has overcome much of the reluctance to pursue intensive regimens in AIDS-related BL. Specific therapies for these patients have includ- Although these regimens have been associated with significant toxicity in HIV-related BL, they have resulted in an improvement in the response rate and in the survival probability of up to 50%. In the ALL3/97 study, no significant differences were observed in the survival of patients with HIV-related or unrelated BL. 18Again, patients with an immunological response to HAART had a better prognosis than those who did not take or did not respond to HAART.Mimicking non-Hodgkin's lymphoma in nonimmunosuppressed patients, the next step was to use immunochemotherapy for both AIDS-related DLBCL and BL. Three phase II trials with chemotherapy (CHOP in two trials 19,20 and CDE in one 21) and rituximab have shown that immunochemotherapy with concomitant administration of HAART is feasible, safe and effective, with complete responses in more than 70% of patients and survival probabilities ranging from 65% to 75%. However, from the data of these phase II trials it is difficult to determine the contribution of rituximab to the overall efficacy. The only comparative trial published to date, the AMC-10 trial, 22 which compared the CHOP regimen with or without rituximab, showed a not statistically significant trend for a better response rate (57.6% vs. 47%) in the rituximab-CHOP (R-CHOP) arm, which did not translate into better survival, at least in part because of the excess number of infectious deaths in that arm (14% vs. 2%). Nevertheless, even in moderately immunosuppressed patients (i.e., those with a CD4 lymphocyte count over 100/µL) no significant benefits in terms of survival were observed in the R-CHOP arm. The inclusion of a high number of severely immunosuppressed patients in that trial could explain the inferio...

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A Prognostic Index for Systemic AIDS-Related Non-Hodgkin Lymphoma Treated in the Era of Highly Active Antiretroviral Therapy

Cited by 116 publications

References 30 publications

A new prognostic score for AIDS-related lymphomas in the rituximab-era

A new prognostic score for AIDS-related lymphomas in the rituximab-era

NK/T cell non-Hodgkin lymphoma in a HIV-positive patient

Human immunodeficiency virus-related non-Hodgkin's lymphoma

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