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Carbone A, Chadburn A, Gloghini A, Vaccher E, Bower M. Immune deficiency/dysregulation -associated lymphoproliferative disorders. Revised classification and management. Blood Rev 2024; 64:101167. [PMID: 38195294 DOI: 10.1016/j.blre.2023.101167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/13/2023] [Accepted: 12/30/2023] [Indexed: 01/11/2024]
Abstract
Significant advances in the field of lymphoma have resulted in two recent classification proposals, the International Consensus Classification (ICC) and the 5th edition WHO. A few entities are categorized differently in the ICC compared to the WHO. Nowhere is this more apparent than the immunodeficiency lymphoproliferative disorders. The three previous versions of the WHO classification (3rd, 4th and revised 4th editions) and the ICC focused on four clinical settings in which these lesions arise for primary categorization. In contrast the 2023 WHO 5th edition includes pathologic characteristics including morphology and viral status, in addition to clinical setting, as important information for lesion classification. In addition, the 2023 WHO recognizes a broader number of clinical scenarios in which these lesions arise, including not only traditional types of immune deficiency but also immune dysregulation. With this classification it is hoped that new treatment strategies will be developed leading to better patient outcomes.
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Affiliation(s)
- Antonino Carbone
- Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico, National Cancer Institute, Aviano, Italy.
| | - Amy Chadburn
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, United States of America.
| | - Annunziata Gloghini
- Department of Advanced Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Emanuela Vaccher
- Infectious Diseases and Tumors Unit, Department of Medical Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, National Cancer Institute, Aviano, Italy.
| | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London SW109NH, UK.
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Huguet M, Navarro JT, Moltó J, Ribera JM, Tapia G. Diffuse Large B-Cell Lymphoma in the HIV Setting. Cancers (Basel) 2023; 15:3191. [PMID: 37370801 DOI: 10.3390/cancers15123191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Despite the widespread use of combined antiretroviral therapy (cART) and the subsequent decrease in AIDS-defining cancers, HIV-related lymphomas remain a leading cause of morbidity and mortality in people with HIV (PWH). Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma (NHL) subtype in PWH. This lymphoma is a heterogeneous disease including morphological variants and molecular subtypes according to the cell of origin or the mutation profile. In the pre-cART era, treatment with standard-dose chemotherapy induced high rates of toxicity and outcomes were very poor. The introduction of cART and the incorporation of infection prophylaxis allowed the use of conventional intensive chemotherapy regimens used in the general population, such as R-CHOP or R-EPOCH. The use of cART during chemotherapy treatment was initially controversial due to the potential risk of adverse drug-drug interactions. However, the availability of current cART regimens with less potential to cause drug interactions and evidence that cART improves survival rates in NHL strongly support the use of cART in PWH with DLBCL. Consequently, interdisciplinary collaboration between HIV specialists and hemato-oncologists for the management of potential interactions and overlapping toxicities between antiretroviral and antineoplastic drugs is crucial for the optimal treatment of PWH with NHL.
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Affiliation(s)
- Maria Huguet
- Department of Hematology, Institut Català d'Oncologia, Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Ctra. de Canyet, S/N, 08916 Badalona, Spain
- Josep Carreras Leukaemia Research Institute, 08916 Badalona, Spain
| | - José-Tomás Navarro
- Department of Hematology, Institut Català d'Oncologia, Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Ctra. de Canyet, S/N, 08916 Badalona, Spain
- Josep Carreras Leukaemia Research Institute, 08916 Badalona, Spain
| | - José Moltó
- Fundació Lluita Contra les Infeccions, Infectious Diseases Department, Germans Trias i Pujol University Hospital, Ctra. de Canyet, S/N, 08916 Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
| | - Josep-Maria Ribera
- Department of Hematology, Institut Català d'Oncologia, Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Ctra. de Canyet, S/N, 08916 Badalona, Spain
- Josep Carreras Leukaemia Research Institute, 08916 Badalona, Spain
| | - Gustavo Tapia
- Department of Pathology, Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Ctra. de Canyet, S/N, 08916 Badalona, Spain
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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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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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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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Rezahosseini O, Hanaei S, Hamadani M, Keshavarz-Fathi M, Rezaei N. The promising role of monoclonal antibodies for immunotherapy of the HIV-associated cancer, non-Hodgkin lymphoma. Int Rev Immunol 2017; 37:165-173. [PMID: 29257907 DOI: 10.1080/08830185.2017.1405396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Association between HIV/AIDS and some of the cancers such as lymphomais is well known. Relative risk for developing non-Hodgkin lymphoma (NHL) increases 60-200 folds in HIV-infected individuals. Diffuse large B cell lymphoma (DLBCL), primary effusion lymphoma (PEL), Burkitt's lymphoma (BL) and Plasmablastic Lymphoma (PBL) are among the most frequent subtypes. During the last century, scientists found that the immune system could potentially detect and destroy cancer cells. Therefore, they started a new field of study, which is named immunotherapy. There are different immunotherapeutic methods, among which therapeutic antibodies, such as Brentuximabvedotin (Adcetris), Ibritumomabtiuxetan (Zevalin) and rituximab (Rituxan), used for treatment of NHLs showed promising results. In this article, we will review the immunotherapeutic option, monoclonal antibodies, for treatment of HIV-associated NHLs as well as their recent clinical status. We will also discuss the selective monoclonal antibody for each subtype of NHLs.
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Affiliation(s)
- Omid Rezahosseini
- a Cancer Immunology Project (CIP) , Universal Scientific Education and Research Network (USERN) , Tehran , Iran.,b Department of Infectious and Tropical diseases , Imam Khomeini Hospital Complex, Tehran University of Medical Sciences , Tehran , Iran
| | - Sara Hanaei
- a Cancer Immunology Project (CIP) , Universal Scientific Education and Research Network (USERN) , Tehran , Iran.,c Research Center for Immunodeficiencies , Children's Medical Center, Tehran University of Medical Sciences , Tehran , Iran.,d School of Medicine , Tehran University of Medical Sciences , Tehran , Iran
| | - Mehdi Hamadani
- e Division of Hematology & Oncology , Medical College of Wisconsin , Milwaukee , WI , USA.,f Cancer Immunology Project (CIP) , Universal Scientific Education and Research Network (USERN) , Milwaukee , WI , USA
| | - Mahsa Keshavarz-Fathi
- a Cancer Immunology Project (CIP) , Universal Scientific Education and Research Network (USERN) , Tehran , Iran.,c Research Center for Immunodeficiencies , Children's Medical Center, Tehran University of Medical Sciences , Tehran , Iran.,d School of Medicine , Tehran University of Medical Sciences , Tehran , Iran.,g Students' Scientific Research Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Nima Rezaei
- c Research Center for Immunodeficiencies , Children's Medical Center, Tehran University of Medical Sciences , Tehran , Iran.,h Department of Immunology, School of Medicine , Tehran University of Medical Sciences , Tehran , Iran.,i Cancer Immunology Project (CIP) , Universal Scientific Education and Research Network (USERN) , Sheffield , UK
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Xiao J, Du S, Dai G, Gao G, Yang D, Zhao H. Efficacy and tolerability of chemotherapy in Chinese patients with AIDS-related Burkitt lymphoma and diffuse large B-cell lymphoma: An observational study. Sci Rep 2017; 7:1905. [PMID: 28507339 PMCID: PMC5432515 DOI: 10.1038/s41598-017-02086-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 04/05/2017] [Indexed: 02/08/2023] Open
Abstract
We evaluated the efficacy and tolerability of chemotherapy in HIV-infected patients with diffuse large B-cell lymphoma (DLBCL) receiving CHOP ± R (n = 17) or Burkitt lymphoma (BL) receiving CODOX-M/IVAC ± R (n = 15). The study was conducted in Beijing Ditan Hospital from January 2009 to August 2015. The following grade 4 adverse effects were observed in BL and DLBCL patients, respectively: neutropenia (80% versus 47.1%), anaemia (46.7% versus 5.9%), thrombocytopenia (53.3% versus 11.8%), bacterial pneumonia (33.3% versus 5.9%), and sepsis (20% versus 5.9%) (p < 0.05). In the BL group, 10 (66.7%) patients died from treatment-related or tumour-related causes, 5 (33.3%) achieved complete response, 1 achieved partial response (6.7%), and 7 developed progressive disease. The 1-year overall survival and progression-free survival rates were 33.3%. Of the DLBCL patients, 3 (17.6%) died from treatment-related causes, 14 (82.4%) achieved complete response, and 3 had progressive disease. The 1-year overall survival and progression-free survival rates were 82.4%. The strongest risk factor for death was relapse between chemotherapy cycles (adjusted hazard ratio = 47.3; 95%CI, 4.2-528.6, p = 0.002). Initiating antiretroviral therapy before chemotherapy failed to improve overall survival. DLBCL patients demonstrated good responses and survival outcomes, while BL patients could not tolerate chemotherapy due to more severe toxicity, and showed poor responses and survival outcomes.
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Affiliation(s)
- Jiang Xiao
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Shuxu Du
- Beijing Shijitan Hospital, Capital Medical University, Beijing, 100020, China
| | - Guorui Dai
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Guiju Gao
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Di Yang
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Hongxin Zhao
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China.
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HIV-infection impact on clinical-biological features and outcome of diffuse large B-cell lymphoma treated with R-CHOP in the combination antiretroviral therapy era. AIDS 2015; 29:811-8. [PMID: 25730510 DOI: 10.1097/qad.0000000000000624] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Since the introduction of combination antiretroviral therapy (cART) patients with HIV-related diffuse large B-cell lymphoma (DLBCL) show better control of immunosuppression, which may have an impact on the characteristics and prognosis of the disease. We aimed to compare the clinical presentation and prognosis of patients with HIV-related and HIV-unrelated DLBCL treated with rituximab, cyclophosphamide, adriamycin, vincristine, and prednisone (R-CHOP) in the cART era. METHODS AND DESIGN Eighty-one HIV-infected patients included in a Spanish multicentre trial were compared with 84 HIV-uninfected patients diagnosed in a Spanish institution in the same period all treated with R-CHOP. RESULTS HIV-infected patients had a worse performance status, more frequent B-symptoms, and higher Ann-Arbor stages than HIV-uninfected patients, with similar frequency of extranodal involvement. The complete response (CR) rate of patients with high tumor burden was not different in HIV-infected and HIV-uninfected patients. Patients with HIV-related DLBCL showed a worse overall survival (OS) (5-year OS: 56 vs. 74%) but a similar disease-free survival (DFS) (5-year DFS: 84 vs. 73%). In the subgroup of patients with high tumor, the results regarding survival were similar to the whole series. Previous AIDS-defining illness was the strongest negative prognostic factor for OS in HIV-infected patients. CONCLUSION In the cART era, HIV-related DLBCL still presents more aggressive features than HIV-unrelated DLBCL, and has a worse OS despite having a similar DFS. Prevention of HIV-related complications is essential to achieve outcomes comparable with HIV-uninfected patients with DLBCL.
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HIV status does not impair the outcome of patients diagnosed with diffuse large B-cell lymphoma treated with R-CHOP in the cART era. AIDS 2014; 28:689-97. [PMID: 24418826 DOI: 10.1097/qad.0000000000000133] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the outcome of patients diagnosed with HIV infection and diffuse large B-cell lymphoma (DLBCL) treated with R-CHOP in the cART era with that of a HIV-negative control group. METHODS From 2003 to 2011, 305 patients (97 HIV-positive) were diagnosed with DLBCL and treated with R-CHOP. Clinical features were compared using chi-square or Fisher's exact test. Survival analysis was performed using the Kaplan-Meier method and log-rank test. Multivariate analysis was performed using the Cox regression proportional hazards model. RESULTS HIV-positive patients had more B symptoms and extranodal sites of disease at diagnosis, but the proportion of patients with high-intermediate/high-risk disease according to the international prognostic index (IPI) was similar between groups. Response rate was 73%, both for patients with and without HIV infection. After a median follow-up of 48 months, 30 patients relapsed after achieving a complete remission, including four HIV-positive patients. Ninety-six patients have died (19 HIV-positive), 73 of them due to DLBCL. Three patients (one HIV-positive) died due to treatment toxicity. Patients with HIV infection had a significantly longer disease-free survival (DFS) (5-year: 94 vs. 77%; P = 0.03) and overall survival (OS) (78 and 64% for HIV-positive and HIV-negative patients, respectively; P = 0.03). These results were confirmed on multivariate analysis when controlled for other potential prognostic confounders. CONCLUSION HIV-positive patients diagnosed with DLBCL in the cART era have an excellent outcome when treated with standard immunochemotherapy. Therefore, the choice of chemotherapy in patients with lymphoma should not be influenced by HIV status.
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Xicoy B, Miralles P, Morgades M, Rubio R, Valencia ME, Ribera JM. Long-term follow up of patients with human immunodeficiency virus infection and advanced stage Hodgkin's lymphoma treated with doxorubicin, bleomycin, vinblastine and dacarbazine. Haematologica 2013; 98:e85-6. [PMID: 23716563 DOI: 10.3324/haematol.2012.079921] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Navarro JT, Baptista MJ, Morgades M, Tural C, Millá F, Feliu E, Ribera JM. Neoplasms and infections as the main causes of death in patients in complete response to HIV-related non-Hodgkin lymphoma in the combination antiretroviral therapy era: a study out of a series of 146 patients. Br J Haematol 2013; 162:289-91. [DOI: 10.1111/bjh.12355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- José-Tomás Navarro
- Department of Haematology; Catalan Institute of Oncology-Germans Trias i Pujol Hospital; Badalona Spain
- Department of Clinical Haematology; Josep Carreras Leukaemia Research Institute; Universitat Autònoma de Barcelona; Badalona Spain
| | - Maria-Joao Baptista
- Department of Haematology; Catalan Institute of Oncology-Germans Trias i Pujol Hospital; Badalona Spain
- Department of Clinical Haematology; Josep Carreras Leukaemia Research Institute; Universitat Autònoma de Barcelona; Badalona Spain
| | - Mireia Morgades
- Department of Haematology; Catalan Institute of Oncology-Germans Trias i Pujol Hospital; Badalona Spain
- Department of Clinical Haematology; Josep Carreras Leukaemia Research Institute; Universitat Autònoma de Barcelona; Badalona Spain
| | - Cristina Tural
- HIV-Unit; Department of Internal Medicine; Germans Trias i Pujol Hospital; Universitat Autònoma de Barcelona; Badalona Spain
| | - Fuensanta Millá
- Department of Haematology; Catalan Institute of Oncology-Germans Trias i Pujol Hospital; Badalona Spain
- Department of Clinical Haematology; Josep Carreras Leukaemia Research Institute; Universitat Autònoma de Barcelona; Badalona Spain
| | - Evarist Feliu
- Department of Haematology; Catalan Institute of Oncology-Germans Trias i Pujol Hospital; Badalona Spain
- Department of Clinical Haematology; Josep Carreras Leukaemia Research Institute; Universitat Autònoma de Barcelona; Badalona Spain
| | - Josep-Maria Ribera
- Department of Haematology; Catalan Institute of Oncology-Germans Trias i Pujol Hospital; Badalona Spain
- Department of Clinical Haematology; Josep Carreras Leukaemia Research Institute; Universitat Autònoma de Barcelona; Badalona Spain
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