Risk of non-Hodgkin lymphoma subtypes in HIV-infected people during the HAART era

Gibson, Todd M.; Morton, Lindsay M.; Shiels, Meredith S.; Clarke, Christina A.; Engels, Eric A.

doi:10.1097/qad.0000000000000428

Cited by 165 publications

(159 citation statements)

References 19 publications

(23 reference statements)

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“…We observed no HIV in BL, which is somewhat inconsistent with associations seen in other sub‐Saharan African populations,3, 4, 18, 19 and the fact that BL is a recognized AIDS‐defining subtype of NHL in adults 17. Of note, the endemic variant of BL in sub‐Saharan Africa mainly affects children and all cases occurred in persons <18 years old in Rwanda.…”

Section: Discussioncontrasting

confidence: 91%

See 1 more Smart Citation

A case–control study of HIV infection and cancer in the era of antiretroviral therapy in Rwanda

Mpunga

Znaor

Uwizeye³

et al. 2018

Intl Journal of Cancer

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The aim of this study was to assess the association between HIV infection and cancer risk in Rwanda approximately a decade after the introduction of antiretroviral therapy (cART). All persons seeking cancer care at Butaro Cancer Center of Excellence (BCCOE) in Rwanda from 2012 to 2016 were routinely screened for HIV, prior to being confirmed with or without cancer (cases and controls, respectively). Cases were coded according to ICD‐O‐3 and converted to ICD10. Associations between individual cancer types and HIV were estimated using adjusted unconditional logistic regression. 2,656 cases and 1,196 controls differed by gender (80.3% vs. 70.8% female), age (mean 45.5 vs. 37.7 years), place of residence and proportion of diagnoses made by histopathology (87.5% vs. 67.4%). After adjustment for these variables, HIV was significantly associated with Kaposi Sarcoma (n = 60; OR = 110.3, 95%CI 46.8–259.6), non‐Hodgkin lymphoma (NHL) (n = 265; OR = 2.5, 1.4–4.6), Hodgkin lymphoma (HL) (n = 76; OR = 5.2, 2.3–11.6) and cancers of the cervix (n = 560; OR = 5.9, 3.8–9.2), vulva (n = 23; OR = 17.8, 6.3–50.1), penis (n = 29; OR = 8.3, 2.5–27.4) and eye (n = 17; OR = 4.7, 1.0–25.0). Associations varied by NHL/HL subtype, with that for NHL being limited to DLBCL (n = 56; OR = 6.6, 3.1–14.1), particularly plasmablastic lymphoma (n = 6, OR = 106, 12.1–921). No significant associations were seen with other commonly diagnosed cancers, including female breast cancer (n = 559), head and neck (n = 116) and colorectal cancer (n = 106). In conclusion, in the era of cART in Rwanda, HIV is associated with increased risk of a range of infection‐related cancers, and accounts for an important fraction of cancers presenting to a referral hospital.

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Section: Discussioncontrasting

confidence: 91%

“…We saw no cases of primary effusion lymphoma, also considered to be strongly associated with HIV 15. Nor did we find any associations with T‐cell NHL subtypes, consistent with large studies in high‐income settings 16, 17…”

Section: Discussionsupporting

confidence: 80%

A case–control study of HIV infection and cancer in the era of antiretroviral therapy in Rwanda

Mpunga

Znaor

Uwizeye³

et al. 2018

Intl Journal of Cancer

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“…From 2007 to 2010, 13 AMCs enrolled 34 patients (Table 2), all but 2 of whom were high risk. Four had evidence of leptomeningeal disease, none had parenchymal CNS disease, 88% were male, 65% were white, 15% were African American, and 24% were Hispanic.…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…[10][11][12] BL was more recently estimated at 10%, although this study included 31% NHL unspecified. 13 Patients with HIV-BL closely resemble the general BL population in terms of stage, marrow involvement (33% to 35%), CNS involvement (17% to 19%), 14 and histology. 15 Prior to HAART, combination chemotherapy was less successful for patients with HIV-associated NHL than for HIV-negative patients with similar NHL histopathology.…”

Section: Introductionmentioning

confidence: 99%

AMC 048: modified CODOX-M/IVAC-rituximab is safe and effective for HIV-associated Burkitt lymphoma

Noy

Lee

Cesarman

et al. 2015

Blood

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• We report the first dedicated prospective study in HIV-Burkitt lymphoma demonstrating safety and efficacy in a multiinstitutional setting.• We offer a new therapeutic option by modifying an existing regimen and making it much less toxic.The toxicity of dose-intensive regimens used for Burkitt lymphoma prompted modification of cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate/ifosfamide, etoposide, and high-dose cytarabine (CODOX-M/IVAC) for HIV-positive patients. We added rituximab, reduced and/or rescheduled cyclophosphamide and methotrexate, capped vincristine, and used combination intrathecal chemotherapy. Antibiotic prophylaxis and growth factor support were required; highly active antiretroviral therapy (HAART) was discretionary. Thirteen AIDS Malignancy Consortium centers enrolled 34 patients from 2007 to 2010. Median age was 42 years (range, 19-55 years), 32 of 34 patients were high risk, 74% had stage III to IV BL and CD4 count of 195 cells per mL (range, 0-721 cells per mL), and 5 patients (15%) had CD4 <100 cells per mL. Twenty-six patients were receiving HAART; viral load was <100 copies per mL in 12 patients. Twenty-seven patients had at least one grade 3 to 5 toxicity, including 20 hematologic, 14 infectious, and 6 metabolic. None had grade 3 to 4 mucositis. Five patients did not complete treatments because of adverse events. Eleven patients died, including 1 treatment-related and 8 disease-related deaths. The 1-year progressionfree survival was 69% (95% confidence interval [CI], 51%-82%) and overall survival was 72% (95% CI, 53%-84%); 2-year overall survival was 69% (95% CI, 50%-82%). Modifications of the CODOX-M/IVAC regimen resulted in a grade 3 to 4 toxicity rate of 79%, which was lower than that in the parent regimen (100%), without grade 3 to 4 mucositis. Despite a 68% protocol completion rate, the 1-year survival rate compares favorably with 2 studies that excluded HIV-positive patients. This trial was registered at http:// clinicaltrials.gov as #NCT00392834. (Blood. 2015;126(2):160-166)

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“…The advent of HAART not only effected a decreased incidence of AIDS-related NHLs but also underpinned improved patient survival attributed to decreased co-morbid infections, improved tolerance to chemotherapy and increased remission rates [21]. Notwithstanding the impact of HAART on AIDS outcomes, the risk of NHL remains elevated in the AIDS context [22]. Whilst the most common lymphomas in the HAART era are BL and DLBCL [23], the spectrum of HIV-associated lymphomas has expanded to include those that occur commonly in the general population and those that occur with heightened propensity in HIV-infected patients ( In contrast to that in HIV-infected adults, B-cell NHLs are the most common malignancy in HIV-infected children [27].…”

Section: • Dual Expression But Not Dual Rearrangements Of Myc and Bcl2mentioning

confidence: 99%

AIDS-Associated Pediatric High Grade B-cell Lymphoma with MYC and BCL2 Translocations

Mz¹,

Ramdial²,

Jb³

et al. 2017

J AIDS Clin Res

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Abstract"Double hit" lymphomas (DHLs) are now included as a distinct entity in the 2016 revised World Health Classification of lymphoid neoplasms under the rubric "High-grade B-cell lymphoma (HGBCL), with MYC and BCL2 and/or BCL6 translocations". While DHL/HGBCL with MYC and BCL2 translocations accounts for approximately 10% of all lymphomas with the phenotypic and immunophenotypic features of diffuse large B-cell lymphoma (DLBCL), to date, the entity is unreported in children <12 years and in patients with AIDS. In reporting a DHL/HGBCL with MYC and BCL2 translocations in a 10 year old boy, we contextualize, for the first time, its occurrence and clinicopathological profile in the context of pediatric HIV infection and AIDS. In so doing, the defining features of DHL/ HGBCL with MYC and BCL2 translocations in the updated 2016 WHO classification are discussed. In addition, the clinicopathological features and therapeutic approaches in children and adults and related challenges thereof, are highlighted. Finally, the spectrum of AIDS-associated lymphomas in children and adults are tabulated and the associated diagnostic and therapeutic challenges are addressed briefly.Citation: Msimang MZ, Ramdial PK, Kuppusamy JB, Nargan K, Sheik-Gafoor MH (2017) anterior colonic resection with colo-anal anastomosis and covering ileostomy was successfully undertaken, but the patient developed sepsis and required a relaparotomy for resection of necrotic colonic tissue. On recovery he received radiotherapy and further chemotherapy, but responded poorly and demised from multi-organ failure. Pathological featuresGross features: The lower anterior resection specimen measured 38 × 8 cm ( Figure 1A) and contained a 14 × 9 × 7 cm exophytic, creamwhite, fleshy tumor ( Figure 1B) with hemorrhagic foci, 12 cm and 3 cm from the proximal and distal excision margins, respectively. The proximal and circumferential resection margins were tumor-free. The microscopic findings confirmed an ulcerative, invasive malignancy with transmural involvement and a diffusely infiltrative pattern ( Figure 1C). The pleomorphic tumor cells were large with scant eosinophilic cytoplasm, indistinct cell borders and large, vesicular nuclei with distinctive nuclear membranes and prominent nucleoli ( Figure 1D). Brisk mitotic activity was evident. Immunohistochemically, there was bright and diffuse CD45 (Figure 2A), CD20 ( Figure 2B), BCL2 ( Figure 2C), BCL6 ( Figure 2D) and CD10 ( Figure 2E) immunopositivity. In addition, there was patchy MUM-1 ( Figure 3A) and approximately 60%, variable nuclear and cytoplasmic C-MYC immunopositivity ( Figure 3B) and a Ki-67 proliferation index of >90% ( Figure 3C). T-lymphocyte and terminal deoxynucleotidyl transferase immunomarkers were negative. Epstein Barr virus (EBV)-encoded small RNA (EBER) positivity ( Figure 3D) was confirmed on chromogen in-situ hybridization investigation.

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Risk of non-Hodgkin lymphoma subtypes in HIV-infected people during the HAART era

Cited by 165 publications

References 19 publications

A case–control study of HIV infection and cancer in the era of antiretroviral therapy in Rwanda

A case–control study of HIV infection and cancer in the era of antiretroviral therapy in Rwanda

AMC 048: modified CODOX-M/IVAC-rituximab is safe and effective for HIV-associated Burkitt lymphoma

AIDS-Associated Pediatric High Grade B-cell Lymphoma with MYC and BCL2 Translocations

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