Characteristics of indolent non‐hodgkin lymphoma in patients with type 1 human immunodeficiency virus infection

Abstract

BACKGROUND There is recent evidence that the incidence of indolent non‐Hodgkin lymphoma (NHL) appears to be increased in persons with the acquired immunodeficiency syndrome (AIDS). The current study was conducted to describe the clinical, immunologic, and pathologic characteristics of indolent B‐cell lymphoma in patients infected with the human immunodeficiency virus (HIV). METHODS The current report was a retrospective study of 10 cases of indolent NHL identified from the AIDS‐Lymphoma Registry at the University of Southern California School of Medicine. These patients were compared with 336 consecutive patients with systemic intermediate/high‐grade AIDS‐related NHL who were diagnosed and treated at a single institution. RESULTS The pathology of the indolent cases included follicular lymphoma (five patients), small lymphocytic lymphoma (two patients), and one case each of mucosa‐associated lymphoid tissue (MALT), monocytoid B‐cell, and marginal zone lymphoma. When comparing the indolent lymphomas with the intermediate/high‐grade AIDS‐NHL cases, no differences were observed with regard to demographic characteristics or history of prior opportunistic infection. HIV patients with indolent lymphomas were found to have a significantly higher median CD4+ lymphocyte count compared with patients with intermediate/high‐grade NHL (531 /mm3 vs. 90 /mm3) (P < 0.0001). Bone marrow involvement was significantly more common in indolent NHL cases (50%) versus intermediate/high‐grade NHL cases (17%) (P = 0.02). The median survival for patients with indolent NHL was significantly longer compared with patients with intermediate/high‐grade NHL (66.8 months vs. 7.1 months) (P = 0.007). CONCLUSIONS Indolent lymphomas occurring in patients infected with HIV appear to differ from intermediate/high‐grade lymphomas with regard to immune status and propensity for bone marrow involvement and prolonged survival. The median survival in the group of HIV‐seropositive patients with indolent NHL examined in the current study was found to be comparable to that reported in HIV‐negative individuals. Cancer 2002;94:1500–6. © 2002 American Cancer Society. DOI 10.1002/cncr.10368

Splenic marginal zone B-cell lymphoma in a HIV-positive patient: a case report

“…Our case of splenic marginal zone B cell lymphoma confirms the typical features reported for indolent lymphomas in HIV-positive patients in comparison to HIV-positive aggressive lymphomas (bone marrow involvement and higher CD4 cell counts) and to HIV-negative indolent lymphomas (male prevalence, younger age at onset, B symptoms) [3]. In the largest series of splenic marginal zone lymphoma reported so far [5], median age at onset was 64 years with a slight prevalence of females; B symptoms were present in only 20% of patients.…”

“…Lymphoma is one of the most frequent HIV-related neoplasia; in HIV patients, various types of lymphoma can occur, frequently including aggressive B cell lymphoma (i.e., diffuse large B cell lymphoma, Burkitt's lymphoma, plasmablastic lymphoma, and Hodgkin's disease) often with primary extranodal clinical presentation (primary effusion lymphoma and primary central nervous system lymphoma) [1,2]. In contrast, indolent lymphomas are much rarer and only a few cases of mucosa-associated lymphoid tissue lymphoma have been described in both pediatric and adult patients with HIV infection [3][4][5]. Levine et al [3] reported from the AIDS Lymphoma Registry at the University of Southern California ten cases of indolent non-Hodgkin lymphoma with only one case of marginal zone lymphoma (MZL).…”

“…In contrast, indolent lymphomas are much rarer and only a few cases of mucosa-associated lymphoid tissue lymphoma have been described in both pediatric and adult patients with HIV infection [3][4][5]. Levine et al [3] reported from the AIDS Lymphoma Registry at the University of Southern California ten cases of indolent non-Hodgkin lymphoma with only one case of marginal zone lymphoma (MZL).…”

“…In our case, the efficacious anti-HIV therapy induced immunological reconstitution [13], delaying the diagnosis of lymphoma. As suggested by Levine et al [3], different pathophysiologic mechanisms may be involved in the development of indolent and aggressive lymphomas among HIV-positive patients and it is arguable that indolent lymphomas may arise in HIV-positive patients regardless of HIV infection.…”

Extranodal Lymphoma Originating from Mucosa-associated Lymphoid Tissue of the Nasopharynx

“…Epstein-Barr virus has been identified as a potential factor in the development of gastric lymphomas (11,12). HIV type 1 patients with indolent lymphoma (including MALT) were found to have more CD4+ lymphocyte (13). All antibodies to viruses were found to be negative in our patient.…”