Clinical characteristics and blood product usage in AIDS‐associated lymphoma in haemophiliacs: a case‐control study

Abstract

In order to determine risk factors associated with the development of AIDS-associated lymphoma (AIDS-NHL) in individuals with haemophilia, we undertook a case-control study of 25 patients with AIDS-NHL identified prospectively in the multicentre Hemophilia Malignancy Study (HMS) and 100 haemophilia controls with AIDS matched 1:4 by age and date of AIDS diagnosis. Clinical, laboratory and lifestyle characteristics and blood product usage during the 2 years before seroconversion and AIDS or AIDS-NHL diagnosis were compared between cases and controls. AIDS-NHL cases had higher haemoglobin, platelets, %CD4 and white blood count, with the latter approaching significance, 5700 microL-1 vs. 4000 microL-1, P = 0.063. The proportion of cases receiving anti-retroviral treatment prior to diagnosis was similar to that of AIDS-controls, 72% vs. 86%, but a significantly lower proportion of cases had been treated with intravenous pentamidine, 4% vs. 26%, P = 0.048. There were no differences between cases and controls in prevalence of antibody to hepatitis B or hepatitis C, HIV-related symptoms, lifestyle characteristics, or in the type or amount of blood product usage. Thus, clinical, lifestyle characteristics, antiviral drug treatment and blood product usage appear to have little, if any, effect on the development of AIDS lymphoma in HIV(+) patients with haemophilia.

Co‐morbidities and quality of life in elderly persons with haemophilia

“…The incidence of HIV‐associated non‐Hodgkin lymphomas and HCV‐associated HCC is an important cause of death among the virus‐infected ageing haemophilia population (Darby et al , 1997; Ragni et al , 1998). Indeed, in the study conducted in the Netherlands between 1992 and 2001, deaths due to neoplasms including HCC were 1·5‐times higher in haemophilia patients than in the general population (Plug et al , 2006).…”

AIDS‐associated lymphomas and other cancers in individuals with haemophilia

“…Latent EBV small RNAs (EBERs) immunostaining is positive in 44% of HIV( + ) haemophilia AIDS-lymphomas [24], and EBV serological assays reveal high levels of antibody to viral capsid (EBV VCA-IgC), persistence of antibody to early antigen (anti-EA), and absent antibody to nuclear antigen (anti-EBNA) [20], similar to the findings in homosexual men. These data strongly support the role of EBV in lymphomagenesis in HIV-induced immunosuppression, although EBV does not appear to be essential for lymphoma to occur as EBV is not always detectable in lymphoma tissue.…”

“…Both IL-6 and IL-10 are effectors of Th2 cells, which upregulate EBV-immortal i d B cells [19]. Clinical studies have established that IL-6 levels are etevated at the time of diagnosis of AIDSlymphomas in homosexual men, and the IL-6 receptor is expressed by malignant cells [20]. Thus, HIV is thought to play an indirect role in the development of AIDSassociated lymphomas through HIV-induced cytokine dysregulation [ 191.…”

Does haemophilia influence cancer‐related mortality in HIV‐negative patients?

“…Only few studies have analyzed the causes of deaths after excluding those related to HIV or HCV infections {i.e. HIV‐related non‐Hodgkin‐lymphoma (NHL) and HCV‐related HCC [8,9]}. Only the exclusion of virus‐related deaths can show a potential effect of haemophilia on the cancer mortality.…”