Optimizing treatment of HIV-associated lymphoma

Noy, Ariela

doi:10.1182/blood-2018-01-791400

Cited by 75 publications

(90 citation statements)

References 115 publications

(100 reference statements)

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“…Early initiation of ART results in better quality of life and better performance status, thus enabling use of more intensive chemotherapy regimens. [11] None of the patients in this study had significant drug interactions involving ART and chemotherapy.…”

Section: Discussionmentioning

confidence: 88%

Clinical Spectrum and Treatment Outcomes of HIV Associated Cancers in a Tertiary Care Centre

Elumalai¹,

Kannan²,

Sundarrajan³

et al. 2019

jemds

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BACKGROUND India has a high adult HIV prevalence rate (0.26%). In the Highly Active Anti Retro Viral Therapy (HAART) era, there is increased lifespan of HIV patients which confers a higher lifetime risk of developing cancer. The estimated prevalence of HIV infection in the age group 15-49 years in India is 0.26% according to the 2015 NACO (National AIDS Control Organisation) report. Patients with HIV infection are prone to develop malignancies, especially viral mediated cancers like Kaposi sarcoma (related to HHV-8), invasive cervical cancers (HPV related) and aggressive B cell lymphomas (often EBV related) due to the loss of immune surveillance. Cancers are an important cause of morbidity and mortality in patients with HIV infection accounting for nearly 36% of the deaths in PLWHA (People Living with HIV-AIDS). METHODS A retrospective analysis of the patients with HIV and cancer registered in the Department of Medical Oncology, during January 2014 to June 2018 was done using baseline patient factors, pathology reports and treatment details. The survival analysis was done using IBM SPSS software (v-21). RESULTS The study included 44 patients with HIV and cancer, all of whom were on antiretroviral therapy. The mean time to presentation of cancer after diagnosis of AIDS was 5.4 years. Non-AIDS Defining Cancers (NADC) were present in 72.7% of patients. The most common malignancy was Non-Hodgkin`s lymphoma (31.8%), plasmablastic lymphoma being the most common subtype. Extranodal presentations (78%) were more common. B symptoms were present in 57% of cases. Head & neck, penile, anal, cervical and colorectal cancers were the common solid tumours. Majority of the NHL patients presented with stage 1 disease, while most solid tumours were in advanced stages. Among the 14 NHL patients, 7 received chemotherapy and had a median survival of 6 months. Chemotherapy regimens included CHOP, CVP, R-CHOP and R-CHOP-E. Treatment schedule was completed in 4 patients with 2 achieving partial response. 46.6% of HIV patients with solid tumours received chemotherapy with 5 achieving partial response (PR) and 1 achieving complete response (CR). They had a median survival of 7 months as compared to 2 months in those who received only supportive care. CONCLUSIONS In the HAART era, NADCs are more common than ADCs. The most common malignancy in HIV patients in this study is NHL, with plasmablastic subtype being the commonest. In the HIV associated lymphoma patients, chemotherapy provides a response rate of 50 % and achieves a median survival of 6 months as compared to only 1.5 months in those treated with supportive care. Standard chemotherapy in HIV patients with solid cancers achieve a response rate of 46%.

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Section: Discussionmentioning

confidence: 88%

Clinical Spectrum and Treatment Outcomes of HIV Associated Cancers in a Tertiary Care Centre

Elumalai¹,

Kannan²,

Sundarrajan³

et al. 2019

jemds

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“…Therefore, both HIV infection and AML may be considered as relatively uncommon disorders in the general population, but the precise frequency of AML occurrence in the setting of HIV infection is uncertain, because epidemiological studies are very limited and show some controversial results [22]. Of note, the median life expectancy of PLWH treated with modern ART is actually 72 to 75 years, compared with less than 65 and 55 years observed in 2010 and 2000, respectively [14,23,24]. As mentioned above, these gradual improvements in life expectancy and clinical conditions parallel with a significant increase in absolute incidence of non-AIDS-defining cancers, including non-AIDS-defining hematological malignancies [6,22,[25][26][27].…”

Section: Which Is the Actual Epidemiology Of Aml In Plwh?mentioning

confidence: 99%

“…Only for cases with scheduled prolonged consolidation and maintenance phases, ART was indicated, with selection of antiretroviral agents guided by the knowledge of pharmacokinetics of various drugs [57]. Conversely, although careful monitoring is needed and modifications to ART may be necessary, continuation of therapy for HIV infection is actually recommended during anti-leukemic treatments, at least to facilitate immune reconstitution, therefore reducing infection mortality [7,14,22]. ART regimens containing integrase inhibitors, such as raltegravir or dolutegravir, without pharmacologic boosters are currently favored in the setting of malignancy, because of their low potential for drug-drug interactions [7,11].…”

Section: Should Hiv-positive Patients Receive Art During Treatment Fomentioning

confidence: 99%

“…Of note, anthracyclines and antimetabolite agents, which are frequently used for AML treatment, generally undergo non-CYP450 routes of elimination and their metabolism is unlikely to be significantly altered by ART [11]. Given the current availability of ART and evidence of improved immune recovery, it would be unlikely and possibly considered unethical to perform a randomized clinical trial investigating intensively-treated HIV-positive AML patients with or without ART [14]. Indeed, with the widespread use of ART in the last few years and concurrent improvements in prophylactic strategies with agents against bacterial, fungal (including mold-active triazoles) and opportunistic infections, namely mycobacterial infections, Pneumocystis jirovecii and herpervirus reactivations, intensive induction, and consolidation therapeutic approaches for AML have become more feasible in PLWH, with an acceptable reduction of infectious morbidity and mortality, even during long-lasting neutropenic phases [7,11,22,[58][59][60]].…”

Section: Should Hiv-positive Patients Receive Art During Treatment Fomentioning

confidence: 99%

“…However, the incidence of ADC continues to be higher than in the general population, and aging due to longer life expectancy in the ART era has led to increased incidence of non-AIDS-defining malignancies [3,6,[11][12][13]. In general, the lifetime risk of developing cancer still remains 25% to 40% in PLWH receiving ART, with malignancies accounting for approximately 33% of all HIV-related deaths [11,[14][15][16][17]. The elevation of cancer-related mortality for many malignancy subtypes among HIV-infected patients compared with HIV-uninfected subjects is not only related to advanced tumor stage or differences in treatment approaches, but also potentially reflects a direct correlation between immunosuppression and tumor progression [18].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Acute Myeloid Leukemia in Patients Living with HIV Infection: Several Questions, Fewer Answers

Forghieri

Nasillo

Bettelli

et al. 2020

IJMS

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Both human immunodeficiency virus (HIV) infection and acute myeloid leukemia (AML) may be considered relatively uncommon disorders in the general population, but the precise incidence of AML in people living with HIV infection (PLWH) is uncertain. However, life expectancy of newly infected HIV-positive patients receiving anti-retroviral therapy (ART) is gradually increasing, rivaling that of age-matched HIV-negative individuals, so that the occurrence of AML is also expected to progressively increase. Even if HIV is not reported to be directly mutagenic, several indirect leukemogenic mechanisms, mainly based on bone marrow microenvironment disruption, have been proposed. Despite a well-controlled HIV infection under ART should no longer be considered per se a contraindication to intensive chemotherapeutic approaches, including allogeneic hematopoietic stem cell transplantation, in selected fit patients with AML, survival outcomes are still generally unsatisfactory. We discussed several controversial issues about pathogenesis and clinical management of AML in PLWH, but few evidence-based answers may currently be provided, due to the limited number of cases reported in the literature, mainly as case reports or small retrospective case series. Prospective multicenter clinical trials are warranted to more precisely investigate epidemiology and cytogenetic/molecular features of AML in PLWH, but also to standardize and further improve its therapeutic management.

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How can we establish animal models of HIV‐associated lymphoma?

Xiao,

Zhai,

Zhang

et al. 2024

Anim Models and Exp Med

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Human immunodeficiency virus (HIV) infection is strongly associated with a heightened incidence of lymphomas. To mirror the natural course of human HIV infection, animal models have been developed. These models serve as valuable tools to investigate disease pathobiology, assess antiretroviral and immunomodulatory drugs, explore viral reservoirs, and develop eradication strategies. However, there are currently no validated in vivo models of HIV‐associated lymphoma (HAL), hampering progress in this crucial domain, and scant attention has been given to developing animal models dedicated to studying HAL, despite their pivotal role in advancing knowledge. This review provides a comprehensive overview of the existing animal models of HAL, which may enhance our understanding of the underlying pathogenesis and approaches for malignancies linked to HIV infection.

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Optimizing treatment of HIV-associated lymphoma

Abstract: This review discusses the pathogenesis and current treatment of HIV-related lymphomas.

Cited by 75 publications

References 115 publications

Clinical Spectrum and Treatment Outcomes of HIV Associated Cancers in a Tertiary Care Centre

Clinical Spectrum and Treatment Outcomes of HIV Associated Cancers in a Tertiary Care Centre

Acute Myeloid Leukemia in Patients Living with HIV Infection: Several Questions, Fewer Answers

How can we establish animal models of HIV‐associated lymphoma?

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