Acquired immunodeficiency syndrome‐related lymphoma

Abstract

BACKGROUNDHighly active antiretroviral therapy (HAART) has improved the survival of patients with acquired immunodeficiency syndrome‐related lymphoma (ARL). The German ARL Study Group investigated whether HAART administered concomitantly with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy compromised the course of immune parameters during and after chemotherapy and exerted a positive effect on remission and survival.METHODSFrom 1997 to 2001, 72 patients with ARL were stratified prospectively into a standard‐risk group (n = 48 patients) and a high‐risk group (n = 24 patients) with either 0‐1 or 2‐3 of the following risk factors: CD4 < 50/μL, prior opportunistic infection, and/or a World Health Organization performance status ≥ 3. Patients in the high‐risk group received ≥75% of the CHOP regimen.RESULTSIn the standard‐risk group (CD4 = 223/μL; age‐adjusted International Prognostic Index [aaIPI], 38% ≥ 2), the complete remission (CR) rate was 79%, and median survival was not reached after a median 47 months of follow‐up. CD4 counts did not change from baseline to 4 weeks after the end of chemotherapy (206/μL). In the high‐risk group (CD4 = 34/μL; aaIPI, 88% ≥ 2), the CR rate was 29%, and the median survival was 7.2 months (3 patients survived for > 3 yrs). Toxicity was moderate: Leukopenia Grade 3 or 4 occurred in 100 of 249 chemotherapy cycles (40%) in the standard‐risk group and in 70 of 102 cycles (69%) in the high‐risk group.CONCLUSIONSBased on the aaIPI, the survival of patients in the standard‐risk group was very similar to that achieved by nonhuman immunodeficiency virus‐infected patients who had aggressive lymphomas. Concurrent CHOP plus HAART can be administered in an outpatient setting. Thus, the authors recommend using this modality as first‐line therapy for patients with ARL. Cancer 2006. © 2006 American Cancer Society.

Clinical and prognostic analysis of 78 patients with human immuno-deficiency virus associated non-Hodgkin’s lymphoma in Chinese population

“…As an important trigger of HIV to activate c-myc , BL was the second common pathologic subtype of the lymphoma (29/78, 37.2%) among this population. Compared to NHL in general population, AIDS patients with NHL presents with a more aggressive features including advanced Ann Arbor stage, significantly elevated LDH, and poor ECOG performance status, and a high IPI score eventually [2]. Of note, BL patients presented with even higher risk features while compared with those with DLBCL [22].…”

“…Generally, HIV associated NHLs present with more aggressive clinical behaviors as compared with general population, exemplified with a huge tumor burden, more extranodal diseases, and a tendency of involving genital system [2, 3]. Fortunately, although the prognosis of HIV associated NHLs remains very poor, with the introduction of combined antiretroviral therapy (cART) and high dose chemotherapy, a considerable portion of the patients could be cured [4, 5].…”

Zidovudine-based lytic-inducing chemotherapy for Epstein–Barr virus-related lymphomas

“…Our results using high-dose AZT–MTX-based chemotherapy for EBV+ NHLs are comparable to those reported in prospective chemotherapy trials for ARLs. A CR can be achieved in up to 70 – 80% of patients with ARL treated with CHOP or DAEPOCH plus HAART [24,29,32]. By comparison with these studies, our patient cohort included a higher proportion of more aggressive lymphomas (four PBL, three BL, one PEL and two advanced stage DLBCL).…”

Evaluating Antiretroviral Therapy Initiation in HIV-Associated Malignancy: Is There Enough Evidence to Inform Clinical Guidelines?

“…25–28 Whether increased reliance on granulocyte colony-stimulating factor or blood products would diminish the survival benefit or make concurrent ART initiation less feasible in resource-limited settings is not clear. To date, most studies have been performed in higher-resource settings and have little applicability to sub-Saharan Africa other than to offer caution in prescribing certain regimens concurrently.…”