AIDS-related lymphoid neoplasia. The memorial hospital experience

Abstract

The clinical features and laboratory results of 63 patients with or at risk for AIDS with lymphoid neoplasias seen from November 1980 through November 1986 are reviewed. Forty-three had systemic non-Hodgkin's lymphoma (NHL), nine had primary large cell lymphomas of the brain, 11 had Hodgkin's disease (HD), and one had plasmacytoma evolving to myeloma. Those with systemic NHL included 40 (93%) with intermediate or high-grade histologies, 35 (81%) with advanced stage (III, IV), and 28 (65%) with extranodal disease at presentation (predominantly marrow and meninges). Overall survival was short (median, 10.5 months from diagnosis) with the majority of deaths attributable to AIDS-related opportunistic infections (OI). However, 17 patients with diffuse NHL achieved a complete clinical remission, and nine now have been disease-free for more than 1 year (median follow-up, 28 months; range, 12 to 73 months). Early stage and lack of systemic symptoms were features associated with prolonged disease-free survival. Primary brain NHL was a uniformly lethal manifestation of AIDS, being diagnosed at postmortem in seven of nine severely immunosuppressed homosexual men. As with NHL, a propensity towards advanced disease and extranodal involvement was also observed in HD, suggesting that the atypical clinical behavior of HD may be an additional epiphenomenon of AIDS. This experience tends to argue for the use of intensive therapy in at least some patients with AIDS-related systemic NHL since it has resulted in a proportion of long-term disease-free survivors.

Clinical, immunologic, and pathologic correlates of bone marrow involvement in 291 patients with acquired immunodeficiency syndrome–related lymphoma

“…1 Since then, many reports of AIDS-related nonHodgkin lymphoma (NHL) have documented the widespread nature of the disease at the time of diagnosis, the tendency for extranodal involvement, and the short median survival. [2][3][4][5][6][7][8][9][10] Bone marrow involvement has been reported in approximately 20% to 30% of patients with AIDS-related NHL at initial diagnosis 3,10 and in approximately 20% of human immunodeficiency virus (HIV)-negative patients with diffuse large-cell NHL. [11][12][13] Bone marrow involvement has been considered a poor prognostic factor in AIDS-related lymphoma (ARL), associated with shorter survival.…”

“…[6][7][8][9][10] In the current large series, 19% of 291 HIV-positive patients were shown to have such morphologic involvement at diagnosis. Immunostains performed on a random sample of 10% of morphologically negative cases failed to detect occult lymphomatous involvement in any additional cases.…”

The epidemiology of AIDS-associated non-Hodgkin's lymphoma in the World Health Organization European Region

“…The occurrence of NHL is rarely the presenting disease in a patient with AIDS; most often NHL is diagnosed after the development of KS or opportunistic infections or it may even be silent during life (Myskowski et al, 1990). In a series of 43 patients with AIDSassociated NHL from Memorial Hospital (Lowenthal et al, 1988), one third presented initially with KS and one third had an antecedent opportunistic infection. Furthermore, in seven out of nine patients with primary lymphoma of the brain the diagnosis was made at autopsy only (Lowenthal et al, 1988).…”

“…In a series of 43 patients with AIDSassociated NHL from Memorial Hospital (Lowenthal et al, 1988), one third presented initially with KS and one third had an antecedent opportunistic infection. Furthermore, in seven out of nine patients with primary lymphoma of the brain the diagnosis was made at autopsy only (Lowenthal et al, 1988). Clinical evidence suggests that approximately 10% of patients with AIDS develop NHL during the course of their disease (Kaplan et al, 1989;Cremer et al, 1990;Monfardini et al, 1990), but for HIV infected patients treated with long-term antiretroviral therapy such percentage seems to increase even more, being nearly 45% after 3 years of treatment (Pluda et al, 1990).…”

The biology of HIV-associated lymphomas

“…Approximately a third of HIV-associated lymphomas are small non-cleaved cell Burkitt-like lymphomas (Ziegler et al, 1984;Knowles et al, 1988;Lowenthal et al, 1988;Roithmann et al, 1991 (Pellici et al, 1986). In endemic BL which is consistenly associated with Epstein-Barr virus (EBV), breaks occur up to 75 kB 5' (upstream) of the c-myc oncogene; in sporadic BL most of the translocations occur around exon-1 of c-myc (Shiramizu et al, 1991).…”