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Mponda M, Kudowa E, Craven DM, Eastburg LC, Chikasema M, Kasonkanji E, Tomoka T, Roush SM, Simwinga L, Mumba N, Gopal S, Fedoriw Y, Painschab MS. Safety, efficacy, and affordability of ABVD for Hodgkin lymphoma in Malawi: a prospective cohort study. EClinicalMedicine 2024; 69:102480. [PMID: 38356728 PMCID: PMC10864874 DOI: 10.1016/j.eclinm.2024.102480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/22/2023] [Accepted: 01/25/2024] [Indexed: 02/16/2024] Open
Abstract
Background ABVD (doxorubicin, bleomycin, vinblastine, and dexamethasone) is a proven, curative regimen for Hodgkin lymphoma (HL). Prospective data describing HL treatment in sub-Saharan Africa are limited. We aimed to fill this knowledge gap, using data from Malawi. Methods We report a prospective observational cohort of HL (aged ≥ 15) from a single, tertiary referral centre in Malawi. We enrolled patients with pathologicially confirmed Hodgkin lymphoma between June 1, 2013, and Dec 31, 2021 with follow-up censored on May 31, 2022. Patients were treated with ABVD and concurrent antiretroviral therapy if HIV-positive and were followed up for 5 years. The primary outcome was overall survival; secondary outcomes included progression-free survival, response assessment, and adverse events. Microcosting of HL diagnosis, treatment, and follow-up was embedded. Findings We enrolled 38 patients with a median age of 27 years (interquartile range 19-46); eleven (28%) were HIV-positive. Of 35 patients treated with ABVD, 24 (71%) had stage III/IV, nine (26%) unfavourable limited stage, and two (6%) favourable limited stage. Among HIV-infected individuals, mean CD4 count at HL diagnosis was 179 cells/uL and ten (91%) had HIV RNA < 400 copies/mL. Grade 3/4 neutropenia occurred in 24 (68%) patients and caused treatment delay in 16 (46%). Of ten deaths, seven were due to HL, two possible treatment-related toxicity, and one uncertain. 2-year overall survival was 82% (95% CI 70-96%) and 2-year progression-free survival was 64% (95% CI 50-83%). PFS appeared better for HIV-positive patients (HR 0.23 (95% CI 0.05-1.02)) after controlling for stage and performance status (p = 0.05). We estimated $2708 (2022 USD) for HL diagnosis, treatment, and follow-up in our cohort. Interpretation Our findings suggest that treatment with ABVD is safe, efficacious, and affordable for HL in Malawi. Outcomes are worse than in high-income countries due to HL progression. Future studies are needed to understand outcome inequities and to assess efficacy of therapies for patients with relapsed or refractory HL in Malawi. Funding National Institutes of Health, Lineberger Comprehensive Cancer Center.
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Affiliation(s)
- Marriam Mponda
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi
| | - Evaristar Kudowa
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi
| | - Dalton M. Craven
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi
| | - Luke C. Eastburg
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maria Chikasema
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi
| | | | - Tamiwe Tomoka
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi
| | - Sophie Maharry Roush
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lusayo Simwinga
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi
| | - Noel Mumba
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Rockville, MD, USA
| | - Yuri Fedoriw
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matthew S. Painschab
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Xiao P, Chen X, Chen Y, Fan W, Dong Z, Huang J, Zhang Y. CD4 + T cell count in HIV/TB co-infection and co-occurrence with HL: Case report and literature review. Open Life Sci 2023; 18:20220744. [PMID: 37744454 PMCID: PMC10512445 DOI: 10.1515/biol-2022-0744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 09/26/2023] Open
Abstract
In the human immunodeficiency virus (HIV)-infected population, especially HIV with concomitant tuberculosis (TB) or Hodgkin's lymphoma (HL), numerous risk factors have been reported in recent years. Among them, the decreased CD4+ T cell count was recognized as the common risk factor. We report a case of a patient with HIV and TB and HL co-occurrence, in which patient's CD4+ T cell count was inconsistent with disease. A 58-year-old male presented with fever and shortness of breath that persisted for 2 months. The patient had a 4-year history of HIV infection and underwent antiretroviral therapy (ART) effectively. After blood test, computed tomography, bone biopsy, and lymphoma biopsy, the patient was diagnosed with skeletal TB and HL, underwent TB treatment and received ART, and underwent four cycles of chemotherapy. CD4+ T cell count was not decreased before diagnosed with TB/HL and increased in this case after the fourth cycle of chemotherapy. We collected and analyzed CD4+ T cell counts in our case and reviewed relevant literature. It is suggested that CD4+ T cell count may be insufficient to predict the risk of HIV-related disease, especially lymphoproliferative disorders.
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Affiliation(s)
- Pingping Xiao
- Department of Hematology and Rheumatology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P. R. China
| | - Xuyan Chen
- Department of Hematology and Rheumatology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P. R. China
| | - Yongquan Chen
- Department of Hematology and Rheumatology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P. R. China
| | - Wei Fan
- Department of Hematology and Rheumatology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P. R. China
| | - Zhigao Dong
- Department of Hematology and Rheumatology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P. R. China
| | - Jinmei Huang
- Department of Hematology and Rheumatology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P. R. China
| | - Yi Zhang
- Department of Hematology and Rheumatology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P. R. China
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Rubinstein PG, Moore PC, Bimali M, Lee JY, Rudek MA, Chadburn A, Ratner L, Henry DH, Cesarman E, DeMarco CE, Costagliola D, Taoufik Y, Ramos JC, Sharon E, Reid EG, Ambinder RF, Mitsuyasu R, Mounier N, Besson C, Noy A. Brentuximab vedotin with AVD for stage II-IV HIV-related Hodgkin lymphoma (AMC 085): phase 2 results from an open-label, single arm, multicentre phase 1/2 trial. Lancet Haematol 2023; 10:e624-e632. [PMID: 37532416 PMCID: PMC10859222 DOI: 10.1016/s2352-3026(23)00157-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/08/2023] [Accepted: 05/16/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Brentuximab vedotin in combination with doxorubicin, vinblastine, and dacarbazine (AVD) is approved in the upfront setting for advanced stage classical Hodgkin lymphoma (cHL). People living with HIV have been excluded from these studies. We aimed to understand the activity and safety of brentuximab vedotin-AVD in people living with HIV diagnosed with Hodgkin lymphoma, while focusing on HIV disease parameters and antiretroviral therapy (ART) interactions. METHODS We present the phase 2 portion of a multicentre phase 1/2 study. Eligible patients were 18 years or older, had untreated stage II-IV HIV-associated cHL (HIV-cHL), a Karnofsky performance status of more than 30%, a CD4+ T-cell count of 50 cells per μL or more, were required to take ART, and were not on strong CYP3A4 or P-glycoprotein inhibitors. Patients were treated intravenously with 1·2 mg/kg of brentuximab vedotin (recommended phase 2 dose) with standard doses of AVD for six cycles on days 1 and 15 of a 28-day cycle. The primary endpoint of the phase 2 portion was 2-year progression-free survival (PFS), assessed in all eligible participants who began treatment. Accrual has been completed. This trial is registered at ClinicalTrials.gov, NCT01771107. FINDINGS Between March 8, 2013, and March 7, 2019, 41 patients received study therapy with a median follow up of 29 months (IQR 16-38). 34 (83%) of 41 patients presented with stage III-IV and seven (17%) with stage II unfavourable HIV-cHL. 37 (90%) of 41 patients completed therapy, all 37 of whom achieved complete response. The 2-year PFS was 87% (95% CI 71-94) and the overall survival was 92% (78-97). The most common grade 3 or worse adverse events were peripheral sensory neuropathy (four [10%] of 41 patients), neutropenia (18 [44%]), and febrile neutropenia (five [12%]). One treatment-related death was reported, due to infection. INTERPRETATION Brentuximab vedotin-AVD was highly active and had a tolerable adverse event rate in HIV-cHL and is an important therapeutic option for people with HIV-cHL. The complete reponse rate is encouraging and is possibly related to a unique aspect of HIV-cHL biology. Upcoming 5-year data will evaluate the sustainability of the outcomes obtained. FUNDING National Institutes of Health and National Cancer Institute.
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Affiliation(s)
- Paul G Rubinstein
- John H Stroger Jr Hospital of Cook County (Cook County Hospital), Section of Hematology/Oncology, Department of Medicine, Chicago, IL, USA; Ruth M Rothstein CORE Center, Chicago, IL, USA; University of Illinois, Chicago, Section of Hematology/Oncology, Department of Medicine, Chicago, IL, USA.
| | - Page C Moore
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Milan Bimali
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeanette Y Lee
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Amy Chadburn
- Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Lee Ratner
- Washington University School of Medicine, St Louis, MO, USA
| | - David H Henry
- Abramson Cancer Center, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Ethel Cesarman
- Weill Cornell Medical College, Cornell University, New York, NY, USA
| | | | - Dominique Costagliola
- INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, UPMC Univ Paris 06, Sorbonne Universités, Paris, France
| | - Yassine Taoufik
- Faculté de médecine Paris Sud, Université Paris Sud, Le Kremlin-Bicétre, France; Service d'imunologie biologique, Hôpitaux Paris Sud, AP-HP, Le Kremlin-Bicétrse, France
| | - Juan Carlos Ramos
- University of Miami School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Elad Sharon
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Erin G Reid
- Moores Cancer Center, Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | | | - Ronald Mitsuyasu
- University of California Los Angeles, Center for Clinical AIDS Research and Education, Los Angeles, CA, USA
| | | | - Caroline Besson
- CH Versailles, Le Chesnay, France; Inserm U1018, CESP, UVSQ, University Paris-Saclay, Villejuif, France
| | - Ariela Noy
- Weill Cornell Medical College, Cornell University, New York, NY, USA; Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
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Simba K, Mohamed Z, Opie JJ, Andera LF, Brown K, Oosthuizen J, Antel K, Dawood T, der Vyfer LV, Toit CD, Louw VJ, Verburgh E. The International Prognostic Score and HIV status predict red cell concentrate transfusion needs in Hodgkin lymphoma. Leuk Lymphoma 2023; 64:613-620. [PMID: 36562564 PMCID: PMC10200008 DOI: 10.1080/10428194.2022.2157214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
Despite the burden of anemia among Hodgkin lymphoma (HL) patients, data evaluating red cell concentrate transfusion are limited. We retrospectively studied 285 newly diagnosed HL patients who received first-line adriamycin, bleomycin sulfate, vinblastine sulfate, and dacarbazine (ABVD) treatment at Groote Schuur Hospital, Cape Town. HIV prevalence in the cohort was 39.5% and 74.2% of patients had advanced stage HL. Patient prognosis was scored using the HL International Prognostic Score (IPS-7) and HL IPS-3. Seventy (24.6%) patients were transfused with a median of 2 (IQR 1-5) units per patient. Compared to HIV-negative patients, more HIV-positive patients were transfused (14.1% vs. 40.4%, p < .001) and received more units, median 2 (IQR 1-3) vs. 3 (IQR 2-5), p = .035. HL IPS-7 (OR 2.1, p < .001) and HL IPS-3 (OR 2.6, p < .001) were independently associated with transfusion. HL IPS-7, HL IPS-3, and HIV positivity remained associated with transfusion after adjusting for covariates. For patients with newly diagnosed HL, HL IPS-7, HL IPS-3, and HIV status predicted transfusion.
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Affiliation(s)
- Kudakwashe Simba
- Department of Medicine, Division of Clinical Haematology, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Zainab Mohamed
- Department of Radiation Oncology, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Jessica J. Opie
- Department of Pathology, Division of Haematology, National Health Laboratory Service, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Lillian F. Andera
- Department of Medicine, Division of Clinical Haematology, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Karryn Brown
- Department of Medicine, Division of Clinical Haematology, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Jenna Oosthuizen
- Department of Medicine, Division of Clinical Haematology, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Katherine Antel
- Department of Medicine, Division of Clinical Haematology, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Tareen Dawood
- Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, Cape Town South Africa
| | - Lydia Van der Vyfer
- Department of Medicine, Division of Clinical Haematology, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Cecile Du Toit
- Department of Medicine, Division of Clinical Haematology, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Vernon J. Louw
- Department of Medicine, Division of Clinical Haematology, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Estelle Verburgh
- Department of Medicine, Division of Clinical Haematology, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
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5
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Wang C, Liu J, Liu Y. Progress in the Treatment of HIV-Associated Lymphoma When Combined With the Antiretroviral Therapies. Front Oncol 2022; 11:798008. [PMID: 35096597 PMCID: PMC8792758 DOI: 10.3389/fonc.2021.798008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/23/2021] [Indexed: 01/11/2023] Open
Abstract
With the wide use of combination antiretroviral therapy (cART), the life expectancy of HIV-infected individuals drastically improved. However, HIV infection and HIV-associated cancers were the most common causes of death in the HIV-infected populations. The HIV-associated cancers are divided into acquired immune deficiency syndrome (AIDS)-defining and non-AIDS-defining cancers based on the incidence among the HIV-infected patients. Among HIV-associated cancers, acquired immune deficiency syndrome-related lymphoma (ARL) is still the most common condition and the leading cause of HIV/AIDS-related deaths. Diffuse large B-cell lymphoma (DLBCL) and Burkitt’s lymphoma (BL) are the most common subtypes of the ARL. Although Hodgkin’s lymphoma (HL) is not considered as an AIDS-defining cancer, incidence of HL in HIV-infected individuals is higher than the general population. The review summarizes the new progress in the treatment of HIV-associated lymphoma.
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Affiliation(s)
- Chaoyu Wang
- Department of Hematology-Oncology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Jun Liu
- Department of Hematology-Oncology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Yao Liu
- Department of Hematology-Oncology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
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6
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Louarn N, Galicier L, Bertinchamp R, Lussato D, Montravers F, Oksenhendler É, Merlet P, Gérard L, Vercellino L. First Extensive Analysis of 18F-Labeled Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in a Large Cohort of Patients With HIV-Associated Hodgkin Lymphoma: Baseline Total Metabolic Tumor Volume Affects Prognosis. J Clin Oncol 2022; 40:1346-1355. [PMID: 35073166 DOI: 10.1200/jco.21.01228] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE 18F-labeled fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG PET-CT) data in HIV-associated Hodgkin lymphoma (HIV-HL) are scarcely reported. In addition to the description of the characteristics of both baseline and interim 18F-FDG PET-CT examinations (PET1 and iPET, respectively), the aim of this study was to assess the prognostic value of PET1 and previously identified clinical parameters in this population. PATIENTS AND METHODS PET1 of 109 patients with HIV-HL, treated with doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy regimen since 2007, and 104 iPET were centrally reviewed. All the patients were enrolled in an ongoing prospective single-center cohort of HIV-associated lymphoma. RESULTS Most patients had a disseminated disease according to the Ann Arbor classification (30% stage III and 43% stage IV), with especially bone marrow and liver as extranodal localizations. After a median follow-up of 6.7 years, 12 patients relapsed (11%) and 13 died (12%). Five-year progression-free survival (PFS) was 75.1%, and 5-year overall survival was 86.1%. Median total metabolic tumor volume (TMTV) was 121.4 cm3. The optimal TMTV cutoff identified for prognostic analysis was 527 cm3, with a 2-year PFS of 71% in the 20 patients with TMTV > 527 cm3, compared with 91% in the 89 patients with TMTV ≤ 527 cm3 (P = .004). On multivariate analysis, a high TMTV was the only parameter independently associated with PFS. CONCLUSION In this large series of HIV-HL patients with a homogeneous management, high TMTV on PET1 examination was associated with a poor prognosis.
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Affiliation(s)
- Nicolas Louarn
- Service de Médecine Nucléaire, Hôpital Saint-Louis, APHP, Paris, France.,Service de Médecine Nucléaire, Hôpital Henri Mondor, APHP, Créteil, France.,Université Paris-Est Créteil, Créteil, France
| | - Lionel Galicier
- Service d'Immunopathologie Clinique, Hôpital Saint-Louis, APHP, Paris, France.,Service de Médecine Interne, Hôpital Saint-Joseph, Marseille, France
| | - Rémi Bertinchamp
- Service d'Immunopathologie Clinique, Hôpital Saint-Louis, APHP, Paris, France
| | - David Lussato
- Service de Médecine Nucléaire, Centre Cardiologique du Nord, Saint-Denis, France
| | - Françoise Montravers
- Service de Médecine Nucléaire, Hôpital Tenon, APHP, Paris, France.,Sorbonne Université, Paris, France
| | - Éric Oksenhendler
- Service d'Immunopathologie Clinique, Hôpital Saint-Louis, APHP, Paris, France.,Université de Paris, Paris, France
| | - Pascal Merlet
- Service de Médecine Nucléaire, Hôpital Saint-Louis, APHP, Paris, France.,Université de Paris, Paris, France
| | - Laurence Gérard
- Service d'Immunopathologie Clinique, Hôpital Saint-Louis, APHP, Paris, France
| | - Laetitia Vercellino
- Service de Médecine Nucléaire, Hôpital Saint-Louis, APHP, Paris, France.,Université de Paris, INSERM, UMR_S942 MASCOT, F-75006, Paris, France
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7
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Wong Y, Meehan MT, Burrows SR, Doolan DL, Miles JJ. Estimating the global burden of Epstein-Barr virus-related cancers. J Cancer Res Clin Oncol 2022; 148:31-46. [PMID: 34705104 PMCID: PMC8752571 DOI: 10.1007/s00432-021-03824-y] [Citation(s) in RCA: 81] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/28/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND More than 90% of the adult population globally is chronically infected by the Epstein-Barr virus (EBV). It is well established that EBV is associated with a number of malignancies, and advances in knowledge of EBV-related malignancies are being made every year. Several studies have analysed the global epidemiology and geographic distribution of EBV-related cancers. However, most have only described a single cancer type or subtype in isolation or limited their study to the three or four most common EBV-related cancers. This review will present an overview on the spectrum of cancers linked to EBV based on observations of associations and proportions in the published literature while also using these observations to estimate the incidence and mortality burden of some of these cancers. METHOD We have reviewed the literature on defining features, distribution and outcomes across six cancers with a relatively large EBV-related case burden: Nasopharyngeal carcinoma (NPC), Gastric carcinoma (GC), Hodgkin lymphoma (HL), Burkitt lymphoma (BL), Diffuse large B-cell lymphoma (DLBCL) and Extranodal NK/T-cell lymphoma, Nasal type (ENKTL-NT). We retrieved published region-specific EBV-related case proportions for NPC, GC, HL and BL and performed meta-analyses on pooled region-specific studies of EBV-related case proportions for DLBCL and ENKTL-NT. We match these pooled proportions with their respective regional incidence and mortality numbers retrieved from a publicly available cancer database. Additionally, we also reviewed the literature on several other less common EBV-related cancers to summarize their key characteristics herein. CONCLUSION We estimated that EBV-related cases from these six cancers accounted for 239,700-357,900 new cases and 137,900-208,700 deaths in 2020. This review highlights the significant global impact of EBV-related cancers and extends the spectrum of disease that could benefit from an EBV-specific therapeutic.
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Affiliation(s)
- Yide Wong
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, 4878, Australia.
- Centre for Molecular Therapeutics, James Cook University, Cairns, QLD, 4870, Australia.
- Centre for Tropical Bioinformatics and Molecular Biology, James Cook University, Cairns, QLD, 4878, Australia.
| | - Michael T Meehan
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, 4811, Australia
| | - Scott R Burrows
- QIMR Berghofer Medical Research Institute, Herston, QLD, 4006, Australia
- Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia
| | - Denise L Doolan
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, 4878, Australia
- Centre for Molecular Therapeutics, James Cook University, Cairns, QLD, 4870, Australia
- Centre for Tropical Bioinformatics and Molecular Biology, James Cook University, Cairns, QLD, 4878, Australia
| | - John J Miles
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, 4878, Australia
- Centre for Molecular Therapeutics, James Cook University, Cairns, QLD, 4870, Australia
- Centre for Tropical Bioinformatics and Molecular Biology, James Cook University, Cairns, QLD, 4878, Australia
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8
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Lievin R, Hendel-Chavez H, Baldé A, Lancar R, Algarte-Génin M, Krzysiek R, Costagliola D, Assoumou L, Taoufik Y, Besson C. Increased Production of B-Cell Activating Cytokines and Altered Peripheral B-Cell Subset Distribution during HIV-Related Classical Hodgkin Lymphoma. Cancers (Basel) 2021; 14:cancers14010128. [PMID: 35008292 PMCID: PMC8750095 DOI: 10.3390/cancers14010128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Patients with HIV are at high risk of developing Hodgkin’s lymphoma. This is potentially due to alterations in blood circulating B-lymphocytes and their activating cytokines. We analyzed the distribution of circulating B-lymphocytes and the level of the activating cytokines IL6, IL10 and BAFF in 38 patients with HIV-related Hodgkin’s lymphoma during a 2-year follow-up. We also compared their characteristics at diagnosis with (1) pre-diagnosis serum samples and (2) samples from control HIV-infected subjects without lymphoma. We found an increase in activating cytokines in cases compared to controls. The level of activating cytokines increased in advanced lymphoma. It decreased over time during follow-up. B-lymphocytic count was similar between patients and controls, but their subset distribution differed. There was an overrepresentation of naive B-lymphocytes over memory B-lymphocytes in HIV-associated Hodgkin lymphoma patients, more pronounced in those with advanced lymphoma. Follow-up showed an increase in B-lymphocytic count with an even greater proportion of naive B-cells. Together this suggests that in HIV-infected patients, Hodgkin lymphoma is associated with an altered blood distribution of B-lymphocytic subsets and an increased production of activating cytokines. This environment may contribute to the process of tumorigenesis. Abstract Classical Hodgkin Lymphoma incidence increases in HIV-1-infected patients (HIV-cHL). HIV infection is associated with higher B-cell activation. Here, in 38 HIV-cHL patients from the French cohort ANRS-CO16 Lymphovir, we examined longitudinally over 24 months the serum levels of the B-cell activating cytokines IL10, IL6, and BAFF, and blood distribution of B-cell subsets. Fourteen HIV-cHL patients were also compared to matched HIV-infected controls without cHL. IL10, IL6, and BAFF levels were higher in HIV-cHL patients than in controls (p < 0.0001, p = 0.002, and p < 0.0001, respectively). Cytokine levels increased in patients with advanced-stage lymphoma compared to those with limited-stage (p = 0.002, p = 0.03, and p = 0.01, respectively). Cytokine levels significantly decreased following HIV-cHL diagnosis and treatment. Blood counts of whole B-cells were similar in HIV-cHL patients and controls, but the distribution of B-cell subsets was different with higher ratios of naive B-cells over memory B-cells in HIV-cHL patients. Blood accumulation of naive B-cells was more marked in patients with advanced cHL stages (p = 0.06). During the follow-up, total B-cell counts increased (p < 0.0001), and the proportion of naive B-cells increased further (p = 0.04). Together the results suggest that in HIV-infected patients, cHL is associated with a particular B-cell-related environment that includes increased production of B-cell-activating cytokines and altered peripheral distribution of B-cell subsets. This B-cell-related environment may fuel the process of tumorigenesis.
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Affiliation(s)
- Raphael Lievin
- Department of Hematology and Oncology, Hospital of Versailles, 78150 Le Chesnay, France;
| | - Houria Hendel-Chavez
- Service d’Hématologie et Immunologie Biologique, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, 94270 Le Kremlin-Bicêtre, France; (H.H.-C.); (R.K.); (Y.T.)
- INSERM 1186, Institut Gustave Roussy, 94805 Villejuif, France
| | - Aliou Baldé
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP, Sorbonne Université, INSERM UMR-S 1136, 75646 Paris, France; (A.B.); (R.L.); (M.A.-G.); (D.C.); (L.A.)
| | - Rémi Lancar
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP, Sorbonne Université, INSERM UMR-S 1136, 75646 Paris, France; (A.B.); (R.L.); (M.A.-G.); (D.C.); (L.A.)
| | - Michèle Algarte-Génin
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP, Sorbonne Université, INSERM UMR-S 1136, 75646 Paris, France; (A.B.); (R.L.); (M.A.-G.); (D.C.); (L.A.)
| | - Roman Krzysiek
- Service d’Hématologie et Immunologie Biologique, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, 94270 Le Kremlin-Bicêtre, France; (H.H.-C.); (R.K.); (Y.T.)
- INSERM 1186, Institut Gustave Roussy, 94805 Villejuif, France
| | - Dominique Costagliola
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP, Sorbonne Université, INSERM UMR-S 1136, 75646 Paris, France; (A.B.); (R.L.); (M.A.-G.); (D.C.); (L.A.)
| | - Lambert Assoumou
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP, Sorbonne Université, INSERM UMR-S 1136, 75646 Paris, France; (A.B.); (R.L.); (M.A.-G.); (D.C.); (L.A.)
| | - Yassine Taoufik
- Service d’Hématologie et Immunologie Biologique, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, 94270 Le Kremlin-Bicêtre, France; (H.H.-C.); (R.K.); (Y.T.)
- INSERM 1186, Institut Gustave Roussy, 94805 Villejuif, France
| | - Caroline Besson
- Department of Hematology and Oncology, Hospital of Versailles, 78150 Le Chesnay, France;
- Université Versailles Saint Quentin en Yvelines, Université Paris-Saclay, 78180 Montigny le Bretonneux, France
- Centre for Research in Epidemiology and Population Health, INSERM Unit 1018, 94800 Villejuif, France
- Correspondence:
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9
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Hematological cancers in individuals infected by HIV. Blood 2021; 139:995-1012. [PMID: 34469512 DOI: 10.1182/blood.2020005469] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/22/2020] [Indexed: 11/20/2022] Open
Abstract
HIV infection increases cancer risk and is linked to cancers associated to infectious agents classified as carcinogenic to humans by the International Agency for Research on Cancer. Lymphomas represent one of the most frequent malignancies among individuals infected by HIV. Diffuse large B-cell lymphoma remains a leading cancer after the introduction of combined antiretroviral therapy (cART). The incidence of other lymphomas including Burkitt lymphoma, primary effusion lymphomas, and plasmablastic lymphoma of the oral cavity remain stable, while the incidence of Hodgkin lymphoma and Kaposi sarcoma-associated herpesvirus (KSHV)-associated Multicentric Castleman Disease has increased. The heterogeneity of lymphomas in individuals infected by HIV likely depends on the complexity of involved pathogenetic mechanisms, i.e. HIV-induced immunosuppression, genetic abnormalities, cytokine dysregulation, co-infection with the gamma-herpesviruses, Epstein Barr virus and KSHV, and the dysregulation of the immune responses controlling these viruses. In the modern cART era, standard treatments for HIV-associated lymphoma including stem cell transplantation in relapsed/refractory disease, mirrors that of the general population. The combination of cART and anti neoplastic treatments has resulted in remarkable prolongation of long-term survival. However, oncolytic and immunotherapic strategies, and therapies targeting specific viral oncogenes will need to be developed primarily.
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10
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Hodgkin Lymphoma in People Living with HIV. Cancers (Basel) 2021; 13:cancers13174366. [PMID: 34503176 PMCID: PMC8430611 DOI: 10.3390/cancers13174366] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 01/24/2023] Open
Abstract
Simple Summary Hodgkin lymphoma (HL) is a non-AIDS defining neoplasm, but people living with HIV (PLWH) have between a 5- and 26-fold higher risk of developing it than the general population. Epstein-Barr virus is present in almost all HIV-related HL cases, and plays an important role in its etiopathogenesis. Despite the aggressive characteristics, the prognosis of HL affecting PLWH is similar to that of the general population if patients are treated following the same recommendations. Administration of cART concomitantly with chemotherapy is highly recommended. However, this combination may be challenging due to drug–drug interactions and overlapping toxicity. Thus, interdisciplinary collaboration between hemato-oncologists and HIV specialists is crucial for the optimal treatment of both lymphoma and HIV infection. Abstract Despite widespread use of combined antiretroviral therapy (cART) and increased life expectancy in people living with HIV (PLWH), HIV-related lymphomas (HRL) remain a leading cause of cancer morbidity and mortality for PLWH, even in patients optimally treated with cART. While the incidence of aggressive forms of non-Hodgkin lymphoma decreased after the advent of cART, incidence of Hodgkin lymphoma (HL) has increased among PLWH in recent decades. The coinfection of Epstein–Barr virus plays a crucial role in the pathogenesis of HL in the HIV setting. Currently, PLWH with HRL, including HL, are treated similarly to HIV-negative patients and, importantly, the prognosis of HL in PLWH is approaching that of the general population. In this regard, effective cART during chemotherapy is strongly recommended since it has been shown to improve survival rates in all lymphoma subtypes, including HL. As a consequence, interdisciplinary collaboration between HIV specialists and hemato-oncologists for the management of potential drug–drug interactions and overlapping toxicities between antiretroviral and antineoplastic drugs is crucial for the optimal treatment of PLWH with HL. In this article the authors review and update the epidemiological, clinical and biological aspects of HL presenting in PLWH with special emphasis on advances in prognosis and the factors that have contributed to it.
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11
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Benavente R, Peña C, Soto A, Valladares X, Puga B, Cabrera ME. Overall survival in Chilean patients with lymphoma and human immunodeficiency virus: A retrospective cohort study. Hematol Transfus Cell Ther 2021; 44:497-503. [PMID: 34489215 PMCID: PMC9605900 DOI: 10.1016/j.htct.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 05/04/2021] [Accepted: 06/13/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction People living with human immunodeficiency virus (PLWH) still face high morbidity and mortality resulting from lymphoma. Aim To describe a population of PLWH and lymphoma in a Chilean public hospital and compare the overall survival (OS) with a previously reported cohort from the same institution. Methods Retrospective single-center cohort study. All the patients diagnosed between 2010 and 2017 were included. Demographic and clinical variables were obtained from medical records. The overall survival (OS) was estimated in treated patients from diagnosis until death or October 2020. The OS was then compared with a cohort of patients diagnosed between 1992 and 2008. Main Results Eighty-four patients were included. The most common histological types were Burkitt´s lymphoma (BL), diffuse large B-cell lymphoma (DLBCL), Hodgkin´s lymphoma (HL) and plasmablastic lymphoma (PBL) at 31%, 27%, 21% and 14%, respectively. The three-year OS for the whole cohort of BL, DLBCL, HL and PBL was 58.9%, 65.2%, 47.4%, 76.4% and 50%, respectively. Compared to the cohort of 1992 to 2008, a global increase in the OS was found after excluding HL and adjusting for age and clinical stage (HR 0.38, p = 0.002). However, when the main types were analyzed individually, the increase in the OS was statistically significant only in DLBCL (HR 0.29, p = 0.007). Most patients with DLBCL received CHOP chemotherapy, as in the previous cohort. Conclusion The OS has improved in this population, despite no major changes in chemotherapy regimens, mainly due to the universal access to antiretroviral therapy.
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Affiliation(s)
- Rafael Benavente
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Hospital del Salvador, Santiago, Chile.
| | | | - Andrés Soto
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Hospital del Salvador, Santiago, Chile
| | | | - Bárbara Puga
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Hospital del Salvador, Santiago, Chile
| | - María Elena Cabrera
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Hospital del Salvador, Santiago, Chile
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12
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Dzobo K. What to Do for Increasing Cancer Burden on the African Continent? Accelerating Public Health Diagnostics Innovation for Prevention and Early Intervention on Cancers. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2021; 25:567-579. [PMID: 34399067 DOI: 10.1089/omi.2021.0098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
No other place illustrates the increasing burden of cancer than in Africa and in particular, sub-Saharan Africa. Many of the individuals to be diagnosed with cancer will be in low-resource settings in the future due to, for example, an increase in populations and aging, and high co-morbidity with infections with viruses such as human immunodeficiency virus (HIV) and human papillomavirus (HPV), as well as the presence of infectious agents linked to cancer development. Due to lack of prevention and diagnostic innovation, patients present with advanced cancers, leading to poor survival and increased mortality. HIV infection-associated cancers such as B cell lymphomas, Kaposi's sarcoma, and HPV-associated cancers such as cervical cancer are particularly noteworthy in this context. Recent reports show that a host of other cancers are also associated with viral infection and these include lung, oral cavity, esophageal, and pharyngeal, hepatocellular carcinoma, and anal and vulvar cancers. This article examines the ways in which diagnostic innovation empowered by integrative biology and informed by public health priorities can improve cancer prevention or early intervention in Africa and beyond. In addition, I argue that because diagnostic biomarkers can often overlap with novel therapeutic targets, diagnostics research and development can have broader value for and impact on medical innovation.
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Affiliation(s)
- Kevin Dzobo
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town Component, Cape Town, South Africa.,Institute of Infectious Disease and Molecular Medicine, Division of Medical Biochemistry, Department of Integrative Biomedical Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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13
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Tazi I, Lahlimi FZ. [Human immunodeficiency virus and lymphoma]. Bull Cancer 2021; 108:953-962. [PMID: 34246454 DOI: 10.1016/j.bulcan.2021.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/13/2021] [Accepted: 03/20/2021] [Indexed: 12/14/2022]
Abstract
Lymphomas remain a leading cause of morbidity and mortality for HIV-positive patients. The most common lymphomas include diffuse large B-cell lymphoma, Burkitt lymphoma, primary effusion lymphoma, plasmablastic lymphoma and Hodgkin lymphoma. Appropriate approach is determined by lymphoma stage, performans status, comorbidities, histological subtype, status of the HIV disease and immunosuppression. Treatment outcomes have improved due to chemotherapy modalities and effective antiretroviral therapy. This review summarizes epidemiology, pathogenesis, pathology, and current treatment landscape in HIV associated lymphoma.
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Affiliation(s)
- Illias Tazi
- CHU Mohamed VI, Université Cadi Ayyad, Faculté de Médecine, Service d'Hématologie Clinique, Marrakech, Maroc.
| | - Fatima Zahra Lahlimi
- CHU Mohamed VI, Université Cadi Ayyad, Faculté de Médecine, Service d'Hématologie Clinique, Marrakech, Maroc
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14
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Abstract
Despite widely available antiretroviral therapy, lymphoma remains the leading cause of death for human immunodeficiency virus (HIV)-infected persons in economically developed countries. Even a few months of drug interruptions can lead to drops in the CD4 cell count, HIV viremia, and an increased risk of lymphoma. Currently, good HIV control facilitates intensive therapies appropriate to the lymphoma, including autologous and even allogeneic hematopoietic stem cell transplantation. Nonetheless, HIV-related lymphomas have unique aspects, including pathogenetic differences driven by the presence of HIV and often coinfection with oncogenic viruses. Future therapies might exploit these differences. Lymphoma subtypes also differ in the HIV-infected population, and the disease has a higher propensity for advanced-stage, aggressive presentation and extranodal disease. Other unique aspects include the need to avoid potential interactions between antiretroviral therapy and chemotherapeutic agents and the need for HIV-specific supportive care such as infection prophylaxis. Overall, the care of these patients has progressed sufficiently that recent guidelines from the American Society of Clinical Oncology advocate the inclusion of HIV-infected patients alongside HIV-negative patients in cancer clinical trials when appropriate. This article examines HIV lymphoma and includes Burkitt lymphoma in the general population.
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15
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Prospective evaluation of blood Epstein-Barr virus DNA load and antibody profile in HIV-related non-Hodgkin lymphomas. AIDS 2021; 35:861-868. [PMID: 33749224 DOI: 10.1097/qad.0000000000002839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The value of Epstein-Barr virus (EBV) biomarkers on the prognosis of HIV-related non-Hodgkin's lymphoma (NHL) has been poorly explored in the combined antiretroviral therapy (cART) era. DESIGN We evaluated EBV DNA load and EBV antibodies in HIV-NHL patients enrolled in the French ANRS-CO16 Lymphovir Cohort between 2008 and 2015. METHODS Whole blood and plasma EBV DNA load and serological profiles were analyzed in 76 HIV-infected patients at diagnosis of NHL and 6 months after the initiation of chemotherapy. RESULTS Prechemotherapy whole blood (WB) and plasma EBV DNA loads were positive for 80 and 45% of HIV-NHL patients, respectively. Pretreatment WB EBV DNA positivity was associated with a positive plasma HIV-1 RNA load (relative risk (RR), 4.42 [1.33; 14.72]) and plasma EBV DNA positivity with EBV in situ detection (RR 10.62 [2.38; 47.49]). Following chemotherapy, the proportions of patients with positive WB or plasma EBV DNA declined from 81 to 23% (P < 0.0001) and from 43 to 8% (P < 0.0001), respectively. Estimated 2-year progression-free survival did not differ according to prechemotherapy WB positivity (82% versus 67%, P = 0.15) or plasma EBV DNA positivity (76% versus 81%, P = 0.52). CONCLUSIONS The plasma EBV DNA load correlates with in situ EBV detection. The WB EBV DNA load correlates with HIV load. WB and plasma EBV DNA loads at NHL diagnosis do not constitute prognostic markers for HIV-NHL patients in the modern cART era.
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16
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Vasseur L, Prevot S, Mounier N, Costagliola D, Besson C. Favorable outcome of HIV-associated Burkitt lymphoma in the modern combined antiretroviral therapy era. Eur J Cancer 2020; 138:189-192. [PMID: 32896718 DOI: 10.1016/j.ejca.2020.07.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/24/2020] [Accepted: 07/30/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Loïc Vasseur
- Unit of Hematology-Oncology, Versailles Hospital, Le Chesnay, France
| | - Sophie Prevot
- Université Paris Sud, Faculté de Médecine Paris Sud, Le Kremlin-Bicêtre, France; Pathology Unit, AP-HP, Hopitaux Paris Sud Site Béclère, Clamart, France
| | - Nicolas Mounier
- Department of Onco-Hematology, Archet Hospital, Nice, France
| | - Dominique Costagliola
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Caroline Besson
- Unit of Hematology-Oncology, Versailles Hospital, Le Chesnay, France; Université Versailles Saint Quentin en Yvelines, Université Paris-Saclay, Communauté Paris-Saclay, Paris, France; INSERM U1018, Centre pour La Recherche en Epidémiologie et Sante des Populations (CESP), Equipe Générations et Santé, Gustave Roussy, Villejuif, France.
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17
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Kimani SM, Painschab MS, Horner MJ, Muchengeti M, Fedoriw Y, Shiels MS, Gopal S. Epidemiology of haematological malignancies in people living with HIV. Lancet HIV 2020; 7:e641-e651. [PMID: 32791045 PMCID: PMC10199168 DOI: 10.1016/s2352-3018(20)30118-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 12/19/2022]
Abstract
People living with HIV or AIDS are at increased risk of Hodgkin and non-Hodgkin lymphoma compared with HIV-negative individuals. Data on the risk of multiple myeloma or leukaemia are inconsistent and of low quality but the risk does not seem to be increased. Specific haematological malignancies occur in different contexts of age, CD4 cell count, HIV control, viral co-infections, or chronic inflammation, and the expansion of combination antiretroviral therapy has led to varied demographic and epidemiological shifts among people with HIV. Increased use of combination antiretroviral therapy has substantially reduced the risks of diffuse large B-cell lymphoma, Burkitt lymphoma, and primary CNS lymphoma, and to a lesser extent, Hodgkin lymphoma. There is no effect of combination antiretroviral therapy use on multiple myeloma or leukaemia. Although many cases of HIV are in low-income and middle-income countries, high-quality epidemiological data for haematological malignancies from these regions are scarce. Closing this gap is an essential first step in decreasing mortality from HIV-associated haematological malignancies worldwide. Finally, although multicentric Castleman disease is not a neoplastic condition, it is an emerging precursor to neoplastic high-grade B-cell lymphoproliferation among people with HIV, especially for individuals on long-term combination antiretroviral therapy with well controlled HIV.
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Affiliation(s)
- Stephen M Kimani
- Division of Hematology and Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Matthew S Painschab
- Division of Hematology and Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Marie-Josèphe Horner
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | | | - Yuri Fedoriw
- Division of Hematology and Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Satish Gopal
- Division of Hematology and Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; University of North Carolina Project-Malawi, Lilongwe, Malawi.
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18
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Abstract
OBJECTIVE Chronic hepatitis C virus (HCV) and hepatitis B virus (HBV) infections are associated with increased risks of lymphomas in the non-HIV setting. Their impacts on HIV-associated lymphomas deserved further studies in the modern combined antiretroviral therapy (cART) era. DESIGN We evaluated the associations between HCV, HBV and HIV-related lymphomas in the Lymphovir-ANRS-CO16 cohort. METHODS Prevalence of HCV seropositivity and chronic HBV infections were compared with those observed in the French Hospital Database on HIV (FHDH-ANRS-CO4). RESULTS Between 2008 and 2015, 179 patients with HIV-related lymphomas from 32 French hospitals were enrolled, 69 had Hodgkin's lymphoma (39%), and 110 non-Hodgkin's lymphoma (NHL) (61%). The prevalence of HCV infection was higher in patients with NHL than in the FHDH-ANRS-CO4 [26 versus 14%, odd ratio (OR): 2.15; 95% confidence interval (1.35-3.32)] whereas there was no association between Hodgkin's lymphoma and chronic HCV infection. Chronic HBV infection was not associated with NHL in our cohort with a prevalence of 5 versus 7% in FHDH-ANRS-CO4 but tended to be associated with Hodgkin's lymphoma [prevalence of 14%, OR: 2.16 (0.98-4.27)]. Chronic HCV infection tended to pejoratively impact 2-year overall survival in patients with NHL: 72% [57%, 91%] versus 82% [74%, 91%], hazard ratio: 2.14 [0.95-4.84]. In contrast, chronic HBV infection did not correlate with outcome. CONCLUSION In the modern cART era, chronic HCV infection is associated with an increased risk of NHL in PLWHIV and tends to pejoratively impact overall survival. HBV infection is not associated with the risk of NHL but with a borderline increase of Hodgkin's lymphoma risk.
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19
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Hernández-Walias FJ, Vázquez E, Pacheco Y, Rodríguez-Fernández JM, Pérez-Elías MJ, Dronda F, Casado JL, Moreno A, Hermida JM, Quereda C, Hernando A, Tejerina-Picado F, Asensi V, Galindo MJ, Leal M, Moreno S, Vallejo A. Risk, Diagnostic and Predictor Factors for Classical Hodgkin Lymphoma in HIV-1-Infected Individuals: Role of Plasma Exosome-Derived miR-20a and miR-21. J Clin Med 2020; 9:jcm9030760. [PMID: 32168859 PMCID: PMC7141191 DOI: 10.3390/jcm9030760] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/27/2020] [Accepted: 03/08/2020] [Indexed: 02/07/2023] Open
Abstract
The incidence of classical Hodgkin lymphoma (cHL) in the HIV-1 setting has increased 5–25-fold compared to that observed in the general population. This study aimed to determine whether selected micro RNAs (miRs) and other soluble biomarkers and cellular subsets are dysregulated in cHL and could be used as biomarkers. This was a retrospective and longitudinal matched case-control study of 111 Caucasian, HIV-1-infected adult individuals, including 37 individuals with cHL and 74 with no type of cancer. Immunovirological data, plasma exosome-derived miR-16, miR-20a, miR-21, miR-221, miR-223, miR-106a, miR-185, miR-23, miR-30d, miR-222, miR-146a and miR-324, plasma IL-6, sCD14, sCD27, sCD30, sIL-2R, TNFR1, and cell phenotyping of T and B lymphocytes and natural killer (NK) cells were analyzed. Before cHL diagnosis, miR-20a, miR-21, and sCD30 were higher in cHL (p = 0.008, p = 0.009 and p = 0.042, respectively), while miR-16 was down-regulated (p = 0.040). miR-20a and miR-21 were independently associated with cHL (p = 0.049 and p = 0.035, respectively). The combination of miR-20a and miR-21 showed a good AUC value of 0.832 with a moderate likelihood ratio positive (LR+) value of 5.6 and a slight likelihood ratio negative (LR−) value of 0.23. At cHL diagnosis, miR-20a, miR-21 and miR-324 were overexpressed in cHL (p = 0.005, p = 0.024, and p = 0.001, respectively), while miR-223, miR-16, miR-185 and miR-106a were down regulated (p = 0.042, p = 0.007, p = 0.006, and p = 0.002, respectively). In addition, sCD14, sCD27, sCD30 and IL2R levels were higher in these individuals (p = 0.038, p = 0.010, p = 0.030, p = 0.006, respectively). miR-20a was independently associated with cHL (p = 0.011). The diagnostic value of miR-20a showed good AUC value of 0.754 (p = 0.074) with a slight LR+ value of 2 and a slight LR− of 0.25. After chemotherapy, miR-20a was higher in those individuals who had an adverse outcome (p < 0.001), while sCD14 and sCD30 were higher (p < 0.001). A specific signature of miRs and cytokines associated with a subsequent cHL diagnosis was found in this study, especially miR-20a and miR-21. Also, another biomarker signature was found at cHL diagnosis, with a relevant discriminant disease value for miR-20a. Of note, miR-20a expression was higher in those individuals who had an adverse clinical outcome after chemotherapy.
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Affiliation(s)
- Francisco J. Hernández-Walias
- Laboratory of Immunovirology, Infectious Diseases Department, Health Research Institute Ramon y Cajal (IRyCIS), Ramon y Cajal University Hospital, 28034 Madrid, Spain; (F.J.H.-W.); (E.V.); (M.J.P.-E.); (F.D.); (J.L.C.); (A.M.); (J.M.H.); (C.Q.); (S.M.)
| | - Esther Vázquez
- Laboratory of Immunovirology, Infectious Diseases Department, Health Research Institute Ramon y Cajal (IRyCIS), Ramon y Cajal University Hospital, 28034 Madrid, Spain; (F.J.H.-W.); (E.V.); (M.J.P.-E.); (F.D.); (J.L.C.); (A.M.); (J.M.H.); (C.Q.); (S.M.)
| | - Yolanda Pacheco
- Biomedicine Institute of Seville (IBiS), University Hospital Virgen del Rocío, 41013 Seville, Spain; (Y.P.); (M.L.)
| | | | - María J. Pérez-Elías
- Laboratory of Immunovirology, Infectious Diseases Department, Health Research Institute Ramon y Cajal (IRyCIS), Ramon y Cajal University Hospital, 28034 Madrid, Spain; (F.J.H.-W.); (E.V.); (M.J.P.-E.); (F.D.); (J.L.C.); (A.M.); (J.M.H.); (C.Q.); (S.M.)
| | - Fernando Dronda
- Laboratory of Immunovirology, Infectious Diseases Department, Health Research Institute Ramon y Cajal (IRyCIS), Ramon y Cajal University Hospital, 28034 Madrid, Spain; (F.J.H.-W.); (E.V.); (M.J.P.-E.); (F.D.); (J.L.C.); (A.M.); (J.M.H.); (C.Q.); (S.M.)
| | - José L. Casado
- Laboratory of Immunovirology, Infectious Diseases Department, Health Research Institute Ramon y Cajal (IRyCIS), Ramon y Cajal University Hospital, 28034 Madrid, Spain; (F.J.H.-W.); (E.V.); (M.J.P.-E.); (F.D.); (J.L.C.); (A.M.); (J.M.H.); (C.Q.); (S.M.)
| | - Ana Moreno
- Laboratory of Immunovirology, Infectious Diseases Department, Health Research Institute Ramon y Cajal (IRyCIS), Ramon y Cajal University Hospital, 28034 Madrid, Spain; (F.J.H.-W.); (E.V.); (M.J.P.-E.); (F.D.); (J.L.C.); (A.M.); (J.M.H.); (C.Q.); (S.M.)
| | - José M. Hermida
- Laboratory of Immunovirology, Infectious Diseases Department, Health Research Institute Ramon y Cajal (IRyCIS), Ramon y Cajal University Hospital, 28034 Madrid, Spain; (F.J.H.-W.); (E.V.); (M.J.P.-E.); (F.D.); (J.L.C.); (A.M.); (J.M.H.); (C.Q.); (S.M.)
| | - Carmen Quereda
- Laboratory of Immunovirology, Infectious Diseases Department, Health Research Institute Ramon y Cajal (IRyCIS), Ramon y Cajal University Hospital, 28034 Madrid, Spain; (F.J.H.-W.); (E.V.); (M.J.P.-E.); (F.D.); (J.L.C.); (A.M.); (J.M.H.); (C.Q.); (S.M.)
| | - Asunción Hernando
- Department of Medicine, 12 de Octubre University Hospital, Universidad European University of Madrid, Instituto de Investigación Hospital 12 de Octubre (imas12), 28041 Madrid, Spain;
| | | | - Víctor Asensi
- Infectious Diseases Department, Central University Hospital of Asturias, University Medical School, 33011 Oviedo, Spain;
- Group of Translational Research in Infectious Diseases, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | | | - Manuel Leal
- Biomedicine Institute of Seville (IBiS), University Hospital Virgen del Rocío, 41013 Seville, Spain; (Y.P.); (M.L.)
- Department of Internal Medicine and Infectious Diseases, Viamed Hospital, Santa Ángela de la Cruz, 41014 Seville, Spain
| | - Santiago Moreno
- Laboratory of Immunovirology, Infectious Diseases Department, Health Research Institute Ramon y Cajal (IRyCIS), Ramon y Cajal University Hospital, 28034 Madrid, Spain; (F.J.H.-W.); (E.V.); (M.J.P.-E.); (F.D.); (J.L.C.); (A.M.); (J.M.H.); (C.Q.); (S.M.)
| | - Alejandro Vallejo
- Laboratory of Immunovirology, Infectious Diseases Department, Health Research Institute Ramon y Cajal (IRyCIS), Ramon y Cajal University Hospital, 28034 Madrid, Spain; (F.J.H.-W.); (E.V.); (M.J.P.-E.); (F.D.); (J.L.C.); (A.M.); (J.M.H.); (C.Q.); (S.M.)
- Correspondence:
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Abstract
Cancer is the leading cause of death for HIV-infected persons in economically developed countries, even in the era of antiretroviral therapy (ART). Lymphomas remain a leading cause of cancer morbidity and mortality for HIV-infected patients and have increased incidence even in patients optimally treated with ART. Even limited interruptions of ART can lead to CD4 cell nadirs and HIV viremia, and increase the risk of lymphoma. The treatment of lymphoma is now similar for HIV-infected patients and the general population: patients with good HIV control can withstand intensive therapies appropriate to the lymphoma, including autologous and even allogeneic hematopoietic stem cell transplantation. Nonetheless, HIV-related lymphomas have unique aspects, including differences in lymphoma pathogenesis, driven by the presence of HIV, in addition to coinfection with oncogenic viruses. These differences might be exploited in the future to inform therapies. The relative incidences of lymphoma subtypes also differ in the HIV-infected population, and the propensity to advanced stage, aggressive presentation, and extranodal disease is higher. Other unique aspects include the need to avoid potential interactions between ART and chemotherapeutic agents, and the need for HIV-specific supportive care, such as infection prophylaxis. Despite these specific challenges for cancer treatment in the setting of HIV infection, the care of these patients has progressed sufficiently that recent guidelines from the American Society of Clinical Oncology advocate the inclusion of HIV-infected patients alongside HIV- patients in cancer clinical trials when appropriate.
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Epstein-Barr virus biomarkers have no prognostic value in HIV-related Hodgkin lymphoma in the modern combined antiretroviral therapy era. AIDS 2019; 33:993-1000. [PMID: 30946153 DOI: 10.1097/qad.0000000000002129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Epstein-Barr virus (EBV) has been implicated in lymphomagenesis of HIV-related classical Hodgkin lymphoma (HIV-cHL). The utility of EBV molecular and serological biomarkers has scarcely been examined in HIV-cHL in the recent combined antiretroviral therapy (cART) era. DESIGN We evaluated EBV DNA load and a panel of EBV antibodies in HIV-cHL patients prospectively enrolled in the French ANRS-CO16 Lymphovir cohort between 2008 and 2015. METHODS Pretreatment whole blood, plasma EBV DNA load and serological profiles were analysed in 63 HIV-infected patients diagnosed with cHL. For the 42 patients with available material, comparisons were performed between values at diagnosis and 6 months after the initiation of chemotherapy. RESULTS Pretreatment whole blood and plasma EBV DNA loads were positive in 84 and 59% of HIV-cHL patients, respectively. Two-year progression-free survival estimates did not differ between the patients with pretreatment whole blood (n = 53) or plasma (n = 37) EBV DNA(+) and the patients with pretreatment whole blood (n = 10) or plasma (n = 26) EBV DNA(-) (92 vs. 80% or 89 vs. 92%, P = 0.36 and 0.47, respectively). At diagnosis, 47% of patients harboured an EBV reactivation serological profile. Following chemotherapy, whole blood and plasma EBV DNA levels significantly declined from medians of 1570 [interquartile range, 230-3760) and 73 (0-320) copies/ml to 690 (0-1830) and 0 (0-0) copies/ml, respectively (P = 0.02 and P < 0.0001, respectively]. Anti-EBV IgG antibody level significantly dropped at 6-month follow-up (P = 0.004). CONCLUSION Whole blood and plasma EBV DNA loads do not constitute prognostic markers in HIV-cHL patients in the modern cART era.
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Navarro JT, Muncunill J, Garcia O, Hernández-Rodríguez Á, Baptista MJ. Reply to Lupo et al. Clin Infect Dis 2019; 68:892-893. [PMID: 30204856 DOI: 10.1093/cid/ciy788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- José-Tomás Navarro
- Department of Hematology, Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona.,Josep Carreras Leukaemia Research Institute, IJC Can Ruti Campus
| | - Josep Muncunill
- Department of Hematology, Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona.,Josep Carreras Leukaemia Research Institute, IJC Can Ruti Campus
| | - Olga Garcia
- Department of Hematology, Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona.,Josep Carreras Leukaemia Research Institute, IJC Can Ruti Campus
| | - Águeda Hernández-Rodríguez
- Department of Microbiology, Hospital Germans Trias I Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Maria Joao Baptista
- Department of Hematology, Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona.,Josep Carreras Leukaemia Research Institute, IJC Can Ruti Campus
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Romaru J, Lebrun D, Brunet A, Kheirallah S, Cousson J, Delmer A, Bani-Sadr F. [Isolated digestive localization of Hodgkin lymphoma in an HIV-infected patient, detected after hemophagocytic lymphohistiocytosis]. Med Mal Infect 2019; 49:221-224. [PMID: 30691919 DOI: 10.1016/j.medmal.2019.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/05/2018] [Accepted: 01/10/2019] [Indexed: 11/18/2022]
Affiliation(s)
- J Romaru
- Service de médecine interne, maladies infectieuses et immunologie clinique, hôpital Robert-Debré, CHU Reims, avenue Général-Koenig, 51100 Reims, France.
| | - D Lebrun
- Service de médecine interne, maladies infectieuses et immunologie clinique, hôpital Robert-Debré, CHU Reims, avenue Général-Koenig, 51100 Reims, France; Service de médecine interne et maladies infectieuses, centre hospitalier de Charleville-Mézières, 08000 Charleville-Mézières, France
| | - A Brunet
- Service de médecine interne, maladies infectieuses et immunologie clinique, hôpital Robert-Debré, CHU Reims, avenue Général-Koenig, 51100 Reims, France
| | - S Kheirallah
- Laboratoire d'anatomie pathologique, hôpital Robert-Debré, CHU Reims, France
| | - J Cousson
- Unité de réanimation polyvalente, hôpital Robert-Debré, CHU Reims, France
| | - A Delmer
- Service d'hématologie clinique, hôpital Robert-Debré, CHU Reims, France
| | - F Bani-Sadr
- Service de médecine interne, maladies infectieuses et immunologie clinique, hôpital Robert-Debré, CHU Reims, avenue Général-Koenig, 51100 Reims, France
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Hiv and Lymphoma: from Epidemiology to Clinical Management. Mediterr J Hematol Infect Dis 2019; 11:e2019004. [PMID: 30671210 PMCID: PMC6328036 DOI: 10.4084/mjhid.2019.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/23/2018] [Indexed: 01/19/2023] Open
Abstract
Patients infected with human immunodeficiency virus (HIV) are at increased risk for developing both non-Hodgkin’s lymphoma (NHL) and Hodgkin’s lymphoma (HL). Even if this risk has decreased for NHL after the introduction of combination antiretroviral therapy (cART), they remain the most common acquired immune deficiency syndrome (AIDS)-related cancer in the developed world. They are almost always of B-cell origin, and some specific lymphoma types are more common than others. Some of these lymphoma types can occur in both HIV-uninfected and infected patients, while others preferentially develop in the context of AIDS. HIV-associated lymphoma differs from lymphoma in the HIV negative population in that they more often present with advanced disease, systemic symptoms, and extranodal involvement and are frequently associated with oncogenic viruses (Epstein-Barr virus and/or human herpesvirus-8). Before the introduction of cART, most of these patients could not tolerate the treatment strategies routinely employed in the HIV-negative population. The widespread use of cART has allowed for the delivery of full-dose and dose-intensive chemotherapy regimens with improved outcomes that nowadays can be compared to those seen in non-HIV infected patients. However, a great deal of attention should be paid to opportunistic infections and other infectious complications, cART-chemotherapy interactions, and potential cumulative toxicity. In the context of relatively sparse prospective and randomized trials, the optimal treatment of AIDS-related lymphomas remains a challenge, particularly in patients with severe immunosuppression. This paper will address epidemiology, pathogenesis, and therapeutic strategies in HIV-associated NHL and HL.
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Hodgkin lymphoma at Groote Schuur Hospital, South Africa: the effect of HIV and bone marrow infiltration. Ann Hematol 2018; 98:381-389. [PMID: 30397846 DOI: 10.1007/s00277-018-3533-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/19/2018] [Indexed: 12/14/2022]
Abstract
Human immunodeficiency virus (HIV) is associated with an increased risk of developing Hodgkin lymphoma (HL). South Africa (SA) has the highest HIV prevalence rate in the world. There is currently no outcome-based data for HIV-associated HL from SA. A bone marrow database was compiled of all bone marrow biopsies (BMB) reported at National Health Laboratory Service (NHLS) Groote Schuur Hospital (GSH) between January 2005 and December 2012. Patients who had a BMB performed for staging of HL or where HL was diagnosed on the BMB were included for further analysis. Clinical and laboratory data was extracted from medical and laboratory records. Primary outcome measures included histological subtype, bone marrow infiltration (BMI) by HL, CD4 count, HIV-viral load (HIV-VL), tuberculosis (TB) data, treatment with chemotherapy and 5-year overall survival (OS). The database included 6569 BMB and 219 patients of these had HL and were included for analysis. The median age at presentation (32 years) was similar in the HIV+ and HIV- populations. While males predominated in the HIV- group, females predominated in the HIV+ group (male:female ratio of 1.5:1 vs 0.7:1, respectively). The majority of patients (71%) were HIV negative (HIV-) and 29% were HIV positive (HIV+). The diagnosis of HL was made on BMB in 17% of cases. BMI was seen in 37% (82/219) overall, and was found in more HIV+ patients (61%; 39/64) than HIV- patients (28%; 43/155; p = 0.03). The histological subtype varied according to HIV status with nodular sclerosis classical Hodgkin lymphoma (NSCHL) being most frequent in the HIV- group and classical Hodgkin lymphoma (CHL)-unclassifiable the most frequent in the HIV+ group. HIV+ patients had a median CD4 count of 149 × 106/L and 39% were anti-retroviral therapy (cART) naive at HL diagnosis. HIV+ patients had received anti-TB therapy more frequently than HIV- patients (72% vs 17%; p = 0.007). More HIV+ patients did not receive chemotherapy than HIV- patients (31% vs 3%; p = 0.001). The 5-year OS was 56%. HIV+ patients with BMI had a 5-year OS of 18%. BMI, HIV status, low CD4 count, histological subtype and TB therapy had a statistical significant impact on 5-year OS (p < 0.01). The 5-year OS was 56%, with both BMI and HIV+ status being associated with poor survival. BMB provided the diagnosis of HL in 17% of cases, confirming its diagnostic utility in our setting. Our cohort showed similar survival outcomes to other countries in Africa, Asia and Central America with comparable socio-economic constraints to SA.
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18F-FDG-PET metabolic metrics and International Prognostic Score for risk assessment in HIV-infected patients with Hodgkin lymphoma. Nucl Med Commun 2018; 39:1005-1012. [DOI: 10.1097/mnm.0000000000000905] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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27
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Lupo J, Germi R, Costagliola D, Morand P, Besson C. Utility of Epstein-Barr Virus Biomarkers in Human Immunodeficiency Virus–related Lymphomas in the Modern Combined Antiretroviral Therapy Era. Clin Infect Dis 2018; 68:891-892. [DOI: 10.1093/cid/ciy786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Julien Lupo
- Institut de Biologie Structurale, Commissariat à l’Énergie Atomique, Centre National de la Recherche Scientifique, Université Grenoble-Alpes, and Laboratoire de Virologie, Centre hospitalier Universitaire Grenoble-Alpes
| | - Raphaële Germi
- Institut de Biologie Structurale, Commissariat à l’Énergie Atomique, Centre National de la Recherche Scientifique, Université Grenoble-Alpes, and Laboratoire de Virologie, Centre hospitalier Universitaire Grenoble-Alpes
| | - Dominique Costagliola
- Institut national de la santé et de la recherche médicale (INSERM), Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris
| | - Patrice Morand
- Institut de Biologie Structurale, Commissariat à l’Énergie Atomique, Centre National de la Recherche Scientifique, Université Grenoble-Alpes, and Laboratoire de Virologie, Centre hospitalier Universitaire Grenoble-Alpes
| | - Caroline Besson
- Unité d’Hémato-Oncologie, Centre Hospitalier de Versailles, Le Chesnay
- Université Versailles Saint Quentin en Yvelines, Université Paris-Saclay
- Centre for Research in Epidemiology and Population Health, INSERM Unit 1018, Villejuif, France
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Meister A, Hentrich M, Wyen C, Hübel K. Malignant lymphoma in the HIV-positive patient. Eur J Haematol 2018; 101:119-126. [PMID: 29663523 DOI: 10.1111/ejh.13082] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2018] [Indexed: 12/27/2022]
Abstract
The introduction of combination antiretroviral therapy (cART) drastically improved performance status, immune function, and life expectancy of HIV-infected individuals. In addition, incidence of opportunistic infections and of AIDS-defining malignancies declined. Nevertheless, aggressive non-Hodgkin's lymphoma still remains the leading cause of AIDS-related deaths. The availability of cART, however, significantly improved the therapeutic options for HIV-positive patients with lymphomas. Diffuse large B-cell lymphoma, Burkitt's lymphoma, or Hodgkin lymphoma has increasingly become curable diseases. In light of these favorable developments in the treatment of HIV and HIV-associated lymphomas, reduction in treatment-associated toxicities and further improvement of outcome of patients with advanced immune suppression are major requirements for future clinical trials. This review summarizes the current treatment landscape and gives an overview on future needs in HIV-positive patients with lymphoma.
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Affiliation(s)
- Anne Meister
- Department of Medicine I, University Hospital of Cologne, Cologne, Germany
| | - Marcus Hentrich
- Department of Medicine III, Red Cross Hospital Munich, Munich, Germany
| | - Christoph Wyen
- Department of Medicine I, University Hospital of Cologne, Cologne, Germany.,Praxis am Ebertplatz, Cologne, Germany
| | - Kai Hübel
- Department of Medicine I, University Hospital of Cologne, Cologne, Germany
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Brentuximab vedotin with AVD shows safety, in the absence of strong CYP3A4 inhibitors, in newly diagnosed HIV-associated Hodgkin lymphoma. AIDS 2018; 32:605-611. [PMID: 29280762 DOI: 10.1097/qad.0000000000001729] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Brentuximab vedotin is a Food and Drug Administration approved anti-CD30 antibody drug conjugate potently active in Hodgkin lymphoma. Trials of brentuximab vedotin with doxorubicin, vinblastine, and dacarbazine (AVD-BV) excluded patients with HIV. We studied the safety of AVD-BV in newly diagnosed HIV-associated classical Hodgkin lymphoma . DESIGN AND METHODS Patients diagnosed with stage II-IV HIV-associated classical Hodgkin lymphoma received AVD-BV on days 1 and 15 every 28 days for six cycles. Anti-HIV medications with strong CYP3A4 inhibition were excluded. This phase 1 trial followed a 3+3 dose de-escalation design started with brentuximab vedotin at 1.2 mg/kg with standard dosing of AVD. Dose-limiting toxicities were defined in cycle one. RESULTS Seven patients were enrolled with six being evaluable: five of six stage III/IV, three with an international prognostic score at least 4. With no dose-limiting toxicities identified, all six were treated at the 1.2 mg/kg dose. Only five grade (G) three nonhematological adverse events were noted in three patients: pulmonary infection, diarrhea, and peripheral neuropathy. No G4/5 adverse events occurred. PET/computer tomography was negative in five of six after cycle 2 and six of six post therapy. Progression-free survival was 100% at 25 months with all patients in remission. One patient was deemed ineligible for taking ritonavir, a strong CYP3A4 inhibitor, but developed G3/4 adverse events including febrile neutropenia, and pancreatitis and though consented was excluded from all evaluation. CONCLUSION AVD-BV was well tolerated at recommended phase 2 dose of 1.2 mg/kg. Concurrent strong CYP3A4 inhibitors should be avoided. A phase 2 study of AVD-BV is currently enrolling (NCT01771107).
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Cingolani A, Cozzi Lepri A, Teofili L, Galli L, Mazzotta V, Baldin GM, Hohaus S, Bandera A, Alba L, Galizzi N, Castagna A, D'arminio Monforte A, Antinori A. Survival and predictors of death in people with HIV-associated lymphoma compared to those with a diagnosis of lymphoma in general population. PLoS One 2017; 12:e0186549. [PMID: 29088223 PMCID: PMC5663375 DOI: 10.1371/journal.pone.0186549] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/03/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES to compare overall survival in HIV-associated lymphoma (HIV-L) and lymphoma raising in HIV-negative population (nHIV-L) and to identify predictors of increased risk of death. METHODS All HIV+ patients with HIV-associated lymphoma (Hodgkin lymphoma, HL; non-Hodgkin Lymphoma, NHL) observed between 1.2000 and 12.2013 in the ICONA Foundation Study cohort or in three collaborating centres, and, as control group, nHIV-L individuals followed in one of the four collaborating centres over the same time period, were included. Survival estimates were calculated by use of Kaplan-Meier (KM) and multivariable Cox regression models. RESULTS 1,331 pts were included (465 HIV-L, 866 nHIV-L): 909 (68%) NHL, 422 (32%) HL. 3 years-cumulative probability (95% confidence interval, CI) of death was higher in HIV-L compared to nHIV-L in NHL (38% (33-44) vs. 22% (19-26); p<0.001), and HL (22% [15-29] vs. 10% (6-13), p<0.001). Among HL, HIV was associated with an increased risk of death (hazard ratio [HR] = 2.37 [95% CI: 1.24-4.55], p = 0.009) independently of calendar year, age, gender, type of chemotherapy and stage; in NHL, HIV was no longer an independent predictor of death after controlling for rituximab use and IPI (HR = 1.26 (0.97-1.63), p = 0.08). CONCLUSIONS Our analysis shows a reduced overall survival in HIV+ patients diagnosed with lymphoma compared to HIV-negative controls. Whereas in HIV people with HL, the increased risk of death was confirmed even after adjustment for main confounders, the association between HIV status and survival in NHL appears to be somewhat attenuated after controlling for more aggressive presentation and lower frequency of rituximab use in HIV-+ people.
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Affiliation(s)
- Antonella Cingolani
- Infectious Diseases Fondazione Policlinico Universitario A. Gemelli-Università Cattolica S. Cuore, Roma, Italy
- * E-mail:
| | - Alessandro Cozzi Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, United Kingdom
| | - Luciana Teofili
- Hematology, Fondazione Policlinico Universitario A. Gemelli-Università Cattolica S. Cuore, Roma, Italy
| | - Laura Galli
- Infectious Diseases, San Raffaele Scientific Institute, Milano, Italy
| | | | - Gian Maria Baldin
- Infectious Diseases Fondazione Policlinico Universitario A. Gemelli-Università Cattolica S. Cuore, Roma, Italy
| | - Stefan Hohaus
- Hematology, Fondazione Policlinico Universitario A. Gemelli-Università Cattolica S. Cuore, Roma, Italy
| | | | - Lucia Alba
- National Institute for Infectious Diseases L. Spallanzani, Roma, Italy
| | - Nadia Galizzi
- Infectious Diseases, San Raffaele Scientific Institute, Milano, Italy
| | | | | | - Andrea Antinori
- National Institute for Infectious Diseases L. Spallanzani, Roma, Italy
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The role of F-18 FDG PET/CT in evaluating the impact of HIV infection on tumor burden and therapy outcome in patients with Hodgkin lymphoma. Eur J Nucl Med Mol Imaging 2017; 44:2025-2033. [PMID: 28660348 DOI: 10.1007/s00259-017-3766-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/21/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND To evaluate the impact of HIV infection on tumor burden and therapy outcome following treatment with chemotherapy in patients with Hodgkin lymphoma. METHODS A total of 136 patients with classical Hodgkin lymphoma were studied (mean age ± SD = 32.31 ± 1.39 years, male = 86, female = 50). Advanced disease (stage III and IV) was present in 64% of patients. HIV infection was present in 57 patients while 79 patients were HIV-negative. Baseline F-18 FDG PET/CT was obtained in all patients. SUVmax, MTV and TLG were determined on the baseline scan to evaluate for tumor burden. All patients completed a standard regimen of adriamycin, bleomycin, vinblastine and dacarbazine (ABVD). After a median period of 8 weeks (range = 6 to 17 weeks), a repeat F-18 FDG PET/CT scan was obtained to evaluate response to therapy using Deauville 5-point scoring system. RESULTS The HIV-positive and HIV-negative groups were similar with regards to age and disease stage. The groups were heterogeneous with respect to gender (p = 0.029). The SUVmax, MTV and TLG of lesions were not significant different between the two groups. Complete response was seen in 72.8% of the study population. Presence of HIV infection was associated with higher rate of treatment failure with 40.4% of the HIV-positive patients having treatment failure while only 17.7% of the HIV-negative patients had treatment failure (p = 0.0034). HIV infection was a significant predictor of response to chemotherapy. Effects of SUVmax, MTV, TLG and Ann Arbor stage of the disease were not statistically significant as predictors of therapy outcome. In a multiple logistic regression, presence of HIV infection still remained an independent predictor of therapy outcome in the presence of other factors such as SUVmax, MTV, TLG and the Ann Arbor stage of the disease. CONCLUSIONS HIV infection is not associated with a higher tumor burden in patients with Hodgkin lymphoma. HIV infection is, however, a strong predictor of poor therapy outcome in patients treated with standard regimen of ABVD.
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Abstract
OBJECTIVE Classical Hodgkin lymphoma (cHL) is a non-AIDS-defining cancer with a good response to chemotherapy in the combined antiretroviral therapy (cART) era. The aim of the present study was to compare the characteristics, the response to treatment and the survival of advanced-stage cHL treated with adriamycin, bleomycin, vinblastine and dacarbazine (ABVD) between cART-treated HIV-positive and HIV-negative patients. DESIGN AND METHODS We retrospectively analyzed advanced-stage cHL patients from a single institution, uniformly treated with ABVD. All HIV-positive patients received cART concomitantly with ABVD. RESULTS A total of 69 patients were included in the study: 21 were HIV-positive and 48 were HIV-negative. HIV-positive patients had more aggressive features at cHL diagnosis, such as worse performance status, more frequent bone marrow involvement and mixed cellularity histologic subtype. There were no differences in complete response rate (89% in HIV-positive vs. 91% in HIV-negative), P = 1; disease-free survival (DFS) [10-year DFS probability (95% CI) 70% (41-99%) vs. 74% (57-91%)], P = 0.907 and overall survival (OS) [10-year OS probability (95% CI) 73% (52-94%) vs. 68% (51-85%)], P = 0.904. On multivariate analysis, HIV infection did not correlate with worse OS. CONCLUSION Although HIV-positive patients with cHL had more aggressive baseline features in this series, there were no differences in response rate or survival between HIV-positive and HIV-negative patients.
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Danilov AV, Li H, Press OW, Shapira I, Swinnen LJ, Noy A, Reid E, Smith SM, Friedberg JW. Feasibility of interim positron emission tomography (PET)-adapted therapy in HIV-positive patients with advanced Hodgkin lymphoma (HL): a sub-analysis of SWOG S0816 Phase 2 trial. Leuk Lymphoma 2017; 58:461-465. [PMID: 27386786 PMCID: PMC5130311 DOI: 10.1080/10428194.2016.1201573] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 05/31/2016] [Accepted: 06/05/2016] [Indexed: 01/20/2023]
Affiliation(s)
| | - Hongli Li
- SWOG Statistical Center, Seattle, WA
| | | | - Ilan Shapira
- Mount Sinai Beth Israel Medical Center, New York, NY
| | | | - Ariela Noy
- Memorial Sloan Kettering Cancer Center and Weill-Cornell Medical College, New York, NY
| | - Erin Reid
- University of California at San Diego Moores Cancer Center, La Jolla, CA
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Abstract
OBJECTIVES Clinical series suggest favorable outcomes of HIV-associated Hodgkin lymphoma, in conflict with population-based statistics. Our objective was to investigate the proportion of Americans who received curative chemotherapy for this disease, and compare their survival with HIV-negative cases using population data. METHODS We selected cases of HIV-associated Hodgkin lymphoma diagnosed in 2004-2012 from the National Cancer Data Base. Factors associated with receipt of chemotherapy were analyzed by logistic regression. Overall survival was compared in proportional hazard models adjusting for available confounding factors. RESULTS Among 2090 HIV-positive patients, 81% received chemotherapy, but 16% received no treatment. Advanced age, male sex, nonwhite race, poor socioeconomic status, and undetermined histologic subtype were associated with higher risk of nontreatment. In 2012, 49% of HIV-positive patients were black, and 15% were Hispanic. Unadjusted 5-year overall survival was significantly lower for HIV-positive (66%) than for HIV-negative (80%) populations. However, among patients who received chemotherapy, HIV-positive status was not significantly associated with higher mortality in classical histologic subtypes, including nodular sclerosis (hazard ratio, HR, 1.08; 95% confidence interval, CI, 0.88-1.33) and mixed cellularity (HR, 1.06; 95% CI, 0.80-1.40). In contrast, prognosis remained significantly worse for cases with undetermined histology (HR, 1.56; 95% CI, 1.31-1.85), suggesting a more aggressive biology or other high-risk characteristics in this subgroup. CONCLUSION Worse survival statistics for HIV-associated Hodgkin lymphoma are driven by lower rates of chemotherapy administration. The disparity in treatment delivery needs attention because a majority of HIV-positive Americans with Hodgkin lymphoma are now black or Hispanic, and this proportion is increasing.
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Spano JP, Poizot-Martin I, Costagliola D, Boué F, Rosmorduc O, Lavolé A, Choquet S, Heudel PE, Leblond V, Gabarre J, Valantin MA, Solas C, Guihot A, Carcelain G, Autran B, Katlama C, Quéro L. Non-AIDS-related malignancies: expert consensus review and practical applications from the multidisciplinary CANCERVIH Working Group. Ann Oncol 2015; 27:397-408. [PMID: 26681686 DOI: 10.1093/annonc/mdv606] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 12/01/2015] [Indexed: 01/01/2023] Open
Abstract
Malignancies represent a major cause of morbidity and mortality in human immunodeficiency virus (HIV)-infected patients. The introduction of combined antiretroviral therapy has modified the spectrum of malignancies in HIV infection with a decreased incidence of acquired immunodeficiency syndrome (AIDS) malignancies such as Kaposi's sarcoma and non-Hodgkin's lymphoma due to partial immune recovery and an increase in non-AIDS-defining malignancies due to prolonged survival. Management of HIV-infected patients with cancer requires a multidisciplinary approach, involving both oncologists and HIV physicians to optimally manage both diseases and drug interactions between anticancer and anti-HIV drugs. The French CANCERVIH group presents here a review and an experience of managing non-AIDS malignancies in HIV-infected individuals.
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Affiliation(s)
- J-P Spano
- Department of Medical Oncology, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, AP-HP, Paris INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé publique, Paris Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC Université Paris 06, Paris
| | - I Poizot-Martin
- Clinical Immunohaematology Service, Université Aix-Marseille, AP-HM Sainte-Marguerite, Marseille INSERM, U912 (SESSTIM), Marseille
| | - D Costagliola
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé publique, Paris Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC Université Paris 06, Paris
| | - F Boué
- Department of Internal Medicine and Immunology, Hôpital Antoine Béclère, Clamart Faculty of Medicine, Université Paris-Sud, Le Kremlin-Bicêtre
| | - O Rosmorduc
- Faculty of Medicine, Sorbonne Universités, UMPC Université Paris 06, Paris Hepatology Service, Hôpital Saint-Antoine, Paris
| | - A Lavolé
- Pneumology Service, Hôpital Tenon, Paris
| | - S Choquet
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé publique, Paris Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC Université Paris 06, Paris Department of Hematology, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Paris
| | - P-E Heudel
- Medical Oncology Service, Centre Léon Bérard, Lyon
| | - V Leblond
- Faculty of Medicine, Sorbonne Universités, UMPC Université Paris 06, Paris Department of Hematology, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Paris Centre for Research in Immunology and Infectious Diseases, Sorbonne Universités, UPMC Université Paris 06, Paris
| | - J Gabarre
- Department of Hematology, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Paris
| | - M-A Valantin
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé publique, Paris Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC Université Paris 06, Paris Department of Infectious Diseases, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Paris
| | - C Solas
- Laboratory of Pharmacokinetics and Toxicology, Hôpital de La Timone, Marseille
| | - A Guihot
- Faculty of Medicine, Sorbonne Universités, UMPC Université Paris 06, Paris Department of Immunology, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Paris
| | - G Carcelain
- Faculty of Medicine, Sorbonne Universités, UMPC Université Paris 06, Paris Centre for Research in Immunology and Infectious Diseases, Sorbonne Universités, UPMC Université Paris 06, Paris
| | - B Autran
- Faculty of Medicine, Sorbonne Universités, UMPC Université Paris 06, Paris Centre for Research in Immunology and Infectious Diseases, Sorbonne Universités, UPMC Université Paris 06, Paris
| | - C Katlama
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé publique, Paris Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC Université Paris 06, Paris Department of Infectious Diseases, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Paris
| | - L Quéro
- Department of Oncology and Radiotherapy, Hôpital Saint Louis, Paris INSERM UMR_S 965, Université Paris Denis Diderot, Paris, France
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