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Vargas JC, Marques MDO, Pereira J, Braga WMT, Hamerschlak N, Tabacof J, Ferreira PRA, Colleoni GWB, Baiocchi OCG. Factors associated with survival in patients with lymphoma and HIV. AIDS 2023; 37:1217-1226. [PMID: 36939075 DOI: 10.1097/qad.0000000000003549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
OBJECTIVE To analyze the factors associated with survival in the largest cohort of individuals with HIV and lymphoma so far described in Brazil. DESIGN A retrospective, observational, multicenter study involving five institutions in São Paulo, Brazil. METHODS The medical records of consecutive patients with HIV diagnosed with lymphoma between January 2000 and December 2019 were screened. Inclusion criteria consisted of age over 17 years and a biopsy-confirmed diagnosis of lymphoma. The data collected included age, sex, staging (Ann Arbor system), duration of HIV infection, CD4 + lymphocyte count, HIV viral load, lactate dehydrogenase, erythrocyte sedimentation rate and serum beta-2-microglobulin levels, treatment and outcome. RESULTS Overall, 276 patients were included. Median age was 42 years. Most patients were male (74.3%) and with an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 (28.6% and 46.4%, respectively). Most had non-Hodgkin lymphomas (89.2%, n = 246), particularly diffuse large B-cell lymphoma (40.9%) and Burkitt lymphoma (26.4%). Hodgkin lymphoma accounted for 9.4%. Advanced stages III/IV were predominant (86.8%). HIV viral load at the moment of lymphoma diagnosis was detectable in 52.9% of patients. A CD4 + cell count of <200 cells/μl was recorded for 53% of the patients. Most patients (62.4%) were on combination antiretroviral therapy. The factors that significantly affected survival were: the ECOG performance status, lymphoma subtype, staging, beta-2-microglobulin level, central nervous system (CNS) infiltration, site of CNS infiltration, relapsed/refractory lymphoma and International Prognostic Index score. CONCLUSIONS HIV status, CD4 + -lymphocyte count and relapsed/refractory disease affected survival. Rituximab did not appear to improve outcome in HIV-related lymphomas.
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Affiliation(s)
- Juliano Cordova Vargas
- Department of Clinical and Experimental Oncology, Federal University of São Paulo
- Department of Hematology, Americas Oncologia e Hematologia
| | - Mariana de Oliveira Marques
- Department of Clinical and Experimental Oncology, Federal University of São Paulo
- Department of Hematology, Hospital Alemão Oswaldo Cruz
| | - Juliana Pereira
- Department of Clinical Medicine and Hematology, São Paulo State Cancer Institute. University of São Paulo
| | | | - Nelson Hamerschlak
- Department of Hematology, Americas Oncologia e Hematologia
- Department of Hematology, Hospital Israelita Albert Einstein
| | | | | | | | - Otavio C G Baiocchi
- Department of Clinical and Experimental Oncology, Federal University of São Paulo
- Department of Hematology, Hospital Alemão Oswaldo Cruz
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Lipscomb J, Switchenko JM, Flowers CR, Gillespie TW, Wortley PM, Bayakly AR, Almon L, Ward KC. Impact of multi-agent systemic therapy on all-cause and disease-specific survival for people living with HIV who are diagnosed with non-Hodgkin lymphoma: population-based analyses from the state of Georgia. Leuk Lymphoma 2023; 64:151-160. [PMID: 36308021 PMCID: PMC9905298 DOI: 10.1080/10428194.2022.2133539] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 01/12/2023]
Abstract
For people living with HIV (PLWH) who are subsequently diagnosed with non-Hodgkin lymphoma (NHL), we investigate the impact of standard-of-care (SoC) cancer treatment on all-cause, NHL-specific, and HIV-specific survival outcomes. The focus is on a registry-derived, population-based sample of HIV + adults diagnosed with NHL within 2004-2012 in the state of Georgia. SoC treatment is defined as receipt of multi-agent systemic therapy (MAST). In multivariable survival analyses, SoC cancer treatment is significantly associated with better all-cause and NHL-specific survival, but not better HIV-specific survival across 2004-2017. Having a CD4 count <200 near the time of cancer diagnosis and Ann Arbor stage III/IV disease are associated with worse all-cause and HIV-specific survival; the effects on NHL survival trend negative but are not significant. Future work should expand the geographic base and cancers examined, deepen the level of clinical detail brought to bear, and incorporate the perspectives and recommendations of patients and providers.
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Affiliation(s)
- Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jeffrey M Switchenko
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Christopher R Flowers
- Division of Cancer Medicine, Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - Theresa W Gillespie
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Surgical Oncology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Lyn Almon
- Georgia Center for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kevin C Ward
- Georgia Center for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Rapiti N, Abdelatif N, Moosa MYS. Prognostic variables and 4-year survival outcomes in CD20 Positive AIDS-Related Lymphoma in the Anti-retroviral treatment era: A Retrospective Review from a Single Centre in KwaZulu-Natal, South Africa. PLoS One 2022; 17:e0272282. [PMID: 36048870 PMCID: PMC9436083 DOI: 10.1371/journal.pone.0272282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/16/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To describe 4-year survival outcomes and assess the value of established and additional relevant variables to predict complete response (CR), four-year progression-free survival (PFS) and overall survival (OS) of CD20 positive AIDS-Related Lymphoma (ARL) treated with standard combination chemotherapy. Method We performed a retrospective review of patients diagnosed with CD20 positive ARL between 2006 and 2016. All patients over 12 years of age who received at least one cycle of combination chemotherapy with curative intent were included in the analysis. Variables assessed included the International Prognostic Index (IPI), age-adjusted-IPI, age, gender, B symptoms, extent of disease, functional performance status, CD4 cell count, viral load, concurrent ART with chemotherapy, rituximab inclusion, and number of chemotherapy cycles used. Kaplan-Meier survival curves for OS and PFS at 4 years were compared for IPI and aaIPI using the log-rank test. A Cox proportional hazards model was used to investigate the effects of prognostic variables for patients achieving OS and PFS at 4 years and logistic regression for patients achieving CR. Results A total of 102 patients were included in the analysis. At year four of follow-up, the OS was 50% (n = 51) and PFS was 43% (n = 44). Attaining a CR and male gender were significantly associated with improved 4-year OS (p<0.001 and p = 0.028 respectively) and PFS (p<0.001 and 0.048 respectively). A viral load of < 50 copies/ml was associated with a higher complete response rate (aOR 6.10 [95% CI 1.15, 24.04], p = 0.01). Six or more cycles of chemotherapy was superior to fewer cycles for both PFS (aHR 0.17 [95% CI 0.10, 0.29]) and OS (aHR 0.12 [95% CI 0.07, 0.22]) with p-value < 0.001 for both PFS and OS. The Kaplan-Meier survival estimates demonstrated the prognostic utility of the IPI and aaIP for OS (p = 0.002 and 0.030 respectively) and the IPI for PFS (p = 0.002). Conclusion This study is a first from a high prevalence HIV area in KwaZulu-Natal, South Africa, and confirms the utility of the internationally accepted prognostic scoring systems in predicting survival in CD20 positive ARL in the local population.
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Affiliation(s)
- Nadine Rapiti
- Department of Haematology, NHLS/University of KwaZulu Natal/King Edward VIII Hospital, Durban, South Africa
- * E-mail:
| | - Nada Abdelatif
- Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa
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Ronchetti AM, Matheron S, Galicier L, Damond F, Mahjoub N, Chaghil N, Meignin V, Mechaï F, Simon F, Oksenhendler E, Gérard L. Lymphoma in HIV-2-infected patients in combination antiretroviral therapy era. AIDS 2021; 35:2299-2309. [PMID: 34231524 DOI: 10.1097/qad.0000000000003015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe lymphoma in HIV-2-infected patients and compare their characteristics with lymphoma in HIV-1-infected patients. DESIGN Ancillary analysis from a single center prospective cohort of HIV-lymphoma. METHODS We report on 16 patients with HIV-2-lymphoma diagnosed after 1996 and included in a prospective cohort of HIV lymphoma. Five additional HIV-2-infected patients coinfected with HIV-1 or/and HTLV-I (6 lymphomas) are separately reported. The incidence of lymphoma in HIV-2-infected patients was evaluated in the French multicentric HIV-2 cohort. RESULTS Incidence of lymphoma in the French HIV-2 cohort was estimated as 0.6/1000 patient-years. In our series, the median CD4+ cell count was 166 × 106/l at the time of lymphoma diagnosis and 50% of patients had undetectable plasma HIV-2-RNA. Lymphomas were non-Hodgkin lymphoma (n = 12) and classical Hodgkin lymphoma (n = 4). Similarly to HIV-1-lymphoma, clinical presentation was aggressive in most cases. All but one patient received intensive chemotherapy. Complete remission was achieved in 13 cases and 1 patient relapsed. The overall survival was not statistically different from that observed in patients with HIV-1 lymphoma. The six additional lymphomas observed in five HIV-2-infected patients coinfected with HIV-1 or/and HTLV-I presented with similar clinical presentation but worse prognosis. CONCLUSION Despite the lower pathogenicity of HIV-2, the risk of developing lymphoma seems to be close to that observed in HIV-1 population with similar lymphoma characteristics. Compared with HIV-1, HIV-2-infected patients developed lymphoma later in their life but at a similar CD4+ cell count level.
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Affiliation(s)
- Anne-Marie Ronchetti
- Département d'Immunologie Clinique, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris
| | | | - Lionel Galicier
- Département d'Immunologie Clinique, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris
| | - Florence Damond
- Laboratoire de Virologie, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris
| | - Nadia Mahjoub
- Laboratoire de Virologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris
| | - Nathalie Chaghil
- INSERM, Université de Bordeaux, CIC 1401, UMR 1219, Bordeaux Population Health Research Center, CHU de Bordeaux
| | - Véronique Meignin
- Laboratoire de Pathologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris
| | - Frédéric Mechaï
- Service des Maladies Infectieuses et Tropicales, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny
| | - François Simon
- Laboratoire de Virologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris
| | - Eric Oksenhendler
- Département d'Immunologie Clinique, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris
- Université Paris-Diderot, Université de Paris, Paris, France
| | - Laurence Gérard
- Département d'Immunologie Clinique, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris
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Gijs PJ, Clerc O. Long-term remission of AIDS-related primary central nervous system lymphoma in a patient under antiretroviral therapy: a case report and review of the literature. AIDS Res Ther 2021; 18:76. [PMID: 34666791 PMCID: PMC8527804 DOI: 10.1186/s12981-021-00403-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 10/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AIDS-related primary central nervous system lymphoma (AR-PCNSL) is an AIDS-defining disease that usually occurs when the CD4 count is less than 50 cells/μl. The frequency of the disease has substantially decreased in the era of highly active antiretroviral therapy (HAART). Prognosis is poor with rapid progression leading to death within 2-3 months if left untreated. CASE DESCRIPTION A 65 years old male presented to medical attention with gait disturbance, weight loss and slight left-sided hemiparesis. Human immunodeficiency virus infection was diagnosed with an initial CD4 count of 116 cells/µl and a viral load of 260,000 copies/ml. Magnetic resonance imaging of the brain revealed three brain lesions involving the right frontal lobe and the left parietal lobe, which on biopsy led to a diagnosis of AR-PCNSL. HAART was initiated with whole-brain radiotherapy (WBRT), and the patient declined systemic chemotherapy. Due to poor performance status, he was transferred to palliative care. Under HAART, he slowly recovered with normalization of CD4 count and undetectable viral load. Medical imaging showed complete remission (CR) of the brain lesions. At 3-year follow-up, the patient remains in CR, but presented mild neurocognitive dysfunction possibly secondary to WBRT. CONCLUSION Nowadays, treatment paradigm parallels that of primary central nervous system lymphoma in the immunocompetent population based on systemic chemotherapy (primarily high-dose intravenous methotrexate and steroids) in association with HAART. The role of WBRT is questionable because of late neurotoxic effects.
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Affiliation(s)
- Pieter-Jan Gijs
- Service de Médecine Interne, Université de Lausanne et Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Olivier Clerc
- Service des Maladies Infectieuses, Réseau Hospitalier Neuchâtelois, Neuchâtel, Switzerland.
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6
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Martínez LE, Lensing S, Chang D, Magpantay LI, Mitsuyasu R, Ambinder RF, Sparano JA, Martínez-Maza O, Epeldegui M. Immune Activation and Microbial Translocation as Prognostic Biomarkers for AIDS-Related Non-Hodgkin Lymphoma in the AMC-034 Study. Clin Cancer Res 2021; 27:4642-4651. [PMID: 34131000 PMCID: PMC8364886 DOI: 10.1158/1078-0432.ccr-20-4167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 04/30/2021] [Accepted: 06/09/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE AIDS-related non-Hodgkin lymphoma (ARL) is the most common cancer in HIV-infected individuals in the United States and other countries in which HIV-positive persons have access to effective combination antiretroviral therapy (cART). Our prior work showed that pretreatment/postdiagnosis plasma levels of some cytokines, such as IL6, IL10, and CXCL13, have the potential to serve as indicators of clinical response to treatment and survival in ARL. The aims of this study were to identify novel prognostic biomarkers for response to treatment and/or survival in persons with ARL, including biomarkers of microbial translocation and inflammation. EXPERIMENTAL DESIGN We quantified plasma levels of several biomarkers (sCD14, LBP, FABP2, EndoCab IgM, IL18, CCL2/MCP-1, sCD163, IP-10/CXCL10, TARC/CCL17, TNFα, BAFF/BLyS, sTNFRII, sCD44, and sIL2Rα/sCD25) by multiplexed immunometric assays (Luminex) or ELISA in plasma specimens obtained from ARL patients enrolled in the AMC-034 trial, which compared infusional combination chemotherapy (EPOCH: etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone) with concurrent or sequential rituximab. Plasma was collected prior to the initiation of therapy (n = 57) and after treatment initiation (n = 55). RESULTS We found that several biomarkers decreased significantly after treatment, including TNFα, sCD25, LBP, and TARC (CCL17). Moreover, pretreatment plasma levels of BAFF, sCD14, sTNFRII, and CCL2/MCP-1 were univariately associated with overall survival, and pretreatment levels of BAFF, sTNFRII, and CCL2/MCP-1 were also associated with progression-free survival. CONCLUSIONS Our results suggest that patients with ARL who responded to therapy had lower pretreatment levels of inflammation and microbial translocation as compared with those who did not respond optimally.
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Affiliation(s)
- Laura E Martínez
- UCLA AIDS Institute and David Geffen School of Medicine, University of California, Los Angeles, California
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Shelly Lensing
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Di Chang
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Larry I Magpantay
- UCLA AIDS Institute and David Geffen School of Medicine, University of California, Los Angeles, California
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Ronald Mitsuyasu
- UCLA AIDS Institute and David Geffen School of Medicine, University of California, Los Angeles, California
| | - Richard F Ambinder
- Division of Hematologic Malignancies, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Joseph A Sparano
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Otoniel Martínez-Maza
- UCLA AIDS Institute and David Geffen School of Medicine, University of California, Los Angeles, California
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California
| | - Marta Epeldegui
- UCLA AIDS Institute and David Geffen School of Medicine, University of California, Los Angeles, California.
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California
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7
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Manyau MCP, Mudzviti T, Rusakaniko S, Mberi ET, Maponga CC, Morse GD. Survival of HIV-infected patients with high-grade non-Hodgkin's lymphomas: A retrospective study of experiences in Zimbabwe. PLoS One 2020; 15:e0239344. [PMID: 32941540 PMCID: PMC7498086 DOI: 10.1371/journal.pone.0239344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/04/2020] [Indexed: 12/24/2022] Open
Abstract
Background Rituximab in combination with chemotherapy is now widely accepted as standard of care for AIDS-related lymphomas (ARLs) of B-cell origin. However, the clinical impact of rituximab in resource limited settings remains unknown. Different settings and patient heterogeneity may affect the effect of any given treatment. The study objectives were to determine if rituximab use was associated with improved 18-month overall survival (OS) of patients with ARLs and to identify correlates of 18-month OS. Methods A retrospective review of medical records of adult HIV infected patients treated for high-grade large cell non-Hodgkin’s lymphoma with chemotherapy +/- rituximab between 2015–2017 was conducted. Vital status and disease progression/relapse at 18 months were determined. Survival functions were estimated using Kaplan-Meier methodology. Equality of survival functions were assessed using Log-rank tests and Cox regression analysis to identify risk factors for mortality. Results One hundred and twenty-four eligible medical records were identified. This was a cohort of black Africans with a median age of 42 (IQR: 33–47) and a 57% male gender distribution. Overall survival at 6, 12 and 18 months for the population was 75.9%, 44.0% and 30.6% respectively. Over the study period, 72.6% of patients were diagnosed with disease progression/ relapse. There was a higher rate of rituximab use in patients who were treated at a private institution and those with medical insurance. Rituximab use was not associated with a reduction in 18-month mortality [adjusted hazard ratio (aHR)1.28, (95% CI 0.63–2.60)]. Risk factors for 18-month mortality were male gender [aHR 1.89, (95% CI 1.04–3.43)], age 40+ years [aHR 2.49, (1.33–4.67)], receipt of <3 chemotherapy cycles [aHR 2.48, (95% CI 1.33–4.60)] and low socioeconomic status [aHR 2.44, (95% CI 1.28–4.67)]. Conclusions Predictors of mortality were male gender, older age, low socioeconomic status and receipt of a less than half of the recommended number of chemotherapy cycles. Rituximab use was not associated with an improvement in 18-month OS in Zimbabwean patients with ARLs.
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Affiliation(s)
- Maudy C. P. Manyau
- School of Pharmacy, College of Health Sciences, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe
- * E-mail:
| | - Tinashe Mudzviti
- School of Pharmacy, College of Health Sciences, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe
- Newlands Clinic, Highlands, Harare, Zimbabwe
| | - Simbarashe Rusakaniko
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe
| | - Elson T. Mberi
- Department of Hematology, College of Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe
| | - Charles C. Maponga
- School of Pharmacy, College of Health Sciences, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe
- Center for Integrated Global Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
- Translational Pharmacology Research Core, University at Buffalo, Buffalo, New York, United States of America
| | - Gene D. Morse
- Center for Integrated Global Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
- Translational Pharmacology Research Core, University at Buffalo, Buffalo, New York, United States of America
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Ramos JC, Sparano JA, Chadburn A, Reid EG, Ambinder RF, Siegel ER, Moore PC, Rubinstein PG, Durand CM, Cesarman E, Aboulafia D, Baiocchi R, Ratner L, Kaplan L, Capoferri AA, Lee JY, Mitsuyasu R, Noy A. Impact of Myc in HIV-associated non-Hodgkin lymphomas treated with EPOCH and outcomes with vorinostat (AMC-075 trial). Blood 2020; 136:1284-1297. [PMID: 32430507 PMCID: PMC7483436 DOI: 10.1182/blood.2019003959] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/14/2020] [Indexed: 12/11/2022] Open
Abstract
EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) is a preferred regimen for HIV-non-Hodgkin lymphomas (HIV-NHLs), which are frequently Epstein-Barr virus (EBV) positive or human herpesvirus type-8 (HHV-8) positive. The histone deacetylase (HDAC) inhibitor vorinostat disrupts EBV/HHV-8 latency, enhances chemotherapy-induced cell death, and may clear HIV reservoirs. We performed a randomized phase 2 study in 90 patients (45 per study arm) with aggressive HIV-NHLs, using dose-adjusted EPOCH (plus rituximab if CD20+), alone or with 300 mg vorinostat, administered on days 1 to 5 of each cycle. Up to 1 prior cycle of systemic chemotherapy was allowed. The primary end point was complete response (CR). In 86 evaluable patients with diffuse large B-cell lymphoma (DLBCL; n = 61), plasmablastic lymphoma (n = 15), primary effusion lymphoma (n = 7), unclassifiable B-cell NHL (n = 2), and Burkitt lymphoma (n = 1), CR rates were 74% vs 68% for EPOCH vs EPOCH-vorinostat (P = .72). Patients with a CD4+ count <200 cells/mm3 had a lower CR rate. EPOCH-vorinostat did not eliminate HIV reservoirs, resulted in more frequent grade 4 neutropenia and thrombocytopenia, and did not affect survival. Overall, patients with Myc+ DLBCL had a significantly lower EFS. A low diagnosis-to-treatment interval (DTI) was also associated with inferior outcomes, whereas preprotocol therapy had no negative impact. In summary, EPOCH had broad efficacy against highly aggressive HIV-NHLs, whereas vorinostat had no benefit; patients with Myc-driven DLBCL, low CD4, and low DTI had less favorable outcomes. Permitting preprotocol therapy facilitated accruals without compromising outcomes. This trial was registered at www.clinicaltrials.gov as #NCT0119384.
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MESH Headings
- Adult
- Aged
- Anti-HIV Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- CD4 Lymphocyte Count
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/adverse effects
- DNA, Viral/blood
- Doxorubicin/administration & dosage
- Doxorubicin/adverse effects
- Drug Administration Schedule
- Etoposide/administration & dosage
- Etoposide/adverse effects
- Female
- Genes, myc
- HIV Infections/drug therapy
- HIV-1/drug effects
- Herpesviridae Infections/complications
- Herpesviridae Infections/virology
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/isolation & purification
- Herpesvirus 8, Human/genetics
- Herpesvirus 8, Human/isolation & purification
- Histone Deacetylase Inhibitors/administration & dosage
- Histone Deacetylase Inhibitors/adverse effects
- Humans
- Kaplan-Meier Estimate
- Lymphoma, AIDS-Related/complications
- Lymphoma, AIDS-Related/drug therapy
- Lymphoma, AIDS-Related/genetics
- Lymphoma, AIDS-Related/virology
- Lymphoma, Non-Hodgkin/complications
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/genetics
- Lymphoma, Non-Hodgkin/virology
- Male
- Middle Aged
- Neutropenia/chemically induced
- Prednisone/administration & dosage
- Prednisone/adverse effects
- Progression-Free Survival
- Prospective Studies
- Rituximab/administration & dosage
- Rituximab/adverse effects
- Thrombocytopenia/chemically induced
- Treatment Outcome
- Vincristine/administration & dosage
- Vincristine/adverse effects
- Viral Load/drug effects
- Vorinostat/administration & dosage
- Vorinostat/adverse effects
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Affiliation(s)
- Juan C Ramos
- Department of Medicine, University of Miami School of Medicine, Miami, FL
| | - Joseph A Sparano
- Department of Oncology, Albert Einstein Comprehensive Cancer Center, Bronx, NY
| | - Amy Chadburn
- Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York, NY
| | - Erin G Reid
- Department of Medicine, University of California, San Diego, San Diego, CA
| | | | - Eric R Siegel
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Page C Moore
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Paul G Rubinstein
- Section of Hematology/Oncology, John H. Stroger Jr Hospital of Cook County, Chicago, IL
| | | | - Ethel Cesarman
- Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York, NY
| | - David Aboulafia
- Division of Hematology and Oncology, Virginia Mason Medical Center, Seattle, WA
| | - Robert Baiocchi
- Department of Internal Medicine, Ohio State University, Columbus, OH
| | - Lee Ratner
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Lawrence Kaplan
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | | | - Jeannette Y Lee
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Ronald Mitsuyasu
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Ariela Noy
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; and
- Department of Medicine, Weill Medical College of Cornell University, New York, NY
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9
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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10
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Castelli R, Schiavon R, Preti C, Ferraris L. HIV-Related Lymphoproliferative Diseases in the Era of Combination Antiretroviral Therapy. Cardiovasc Hematol Disord Drug Targets 2020; 20:175-180. [PMID: 32294049 PMCID: PMC8226149 DOI: 10.2174/1871529x20666200415121009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/18/2020] [Accepted: 01/18/2020] [Indexed: 11/22/2022]
Abstract
HIV-positive patients have a 60- to 200-fold increased incidence of Non-Hodgkin Lymphomas (NHL) because of their impaired cellular immunity. Some NHL are considered Acquired Immunodeficiency Syndrome (AIDS) defining conditions. Diffuse large B-cell Lymphoma (DLBC) and Burkitt Lymphoma (BL) are the most commonly observed, whereas Primary Effusion Lymphoma (PEL), Central Nervous System Lymphomas (PCNSL), Plasmablastic Lymphoma (PBL) and classic Hodgkin Lymphoma (HL) are far less frequent. Multicentric Castleman disease (MCD) is an aggressive lymphoproliferative disorder highly prevalent in HIV-positive patients and strongly associated with HHV-8 virus infection. In the pre-Combination Antiretroviral Therapy (CART) era, patients with HIV-associated lymphoma had poor outcomes with median survival of 5 to 6 months. By improving the immunological status, CART extended the therapeutic options for HIV positive patients with lymphomas, allowing them to tolerate standard chemotherapies regimen with similar outcomes to those of the general population. The combination of CART and chemotherapy/ immuno-chemotherapy treatment has resulted in a remarkable prolongation of survival among HIVinfected patients with lymphomas. In this short communication, we briefly review the problems linked with the treatment of lymphoproliferative diseases in HIV patients. Combination Antiretroviral Therapy (CART) not only reduces HIV replication and restores the immunological status improving immune function of the HIV-related lymphomas patients but allows patients to deal with standard doses of chemotherapies. The association of CART and chemotherapy allowed to obtain better results in terms of overall survival and complete responses. In the setting of HIVassociated lymphomas, many issues remain open and their treatment is complicated by the patient's immunocompromised status and the need to treat HIV concurrently.
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Affiliation(s)
- Roberto Castelli
- Address correspondence to this author at the Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital Milan, Milan, Italy; Tel: +39/02/50319830; Fax: +39/02/50319828;, E-mail:
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11
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Milligan MG, Bigger E, Abramson JS, Sohani AR, Zola M, Kayembe MK, Medhin H, Suneja G, Lockman S, Chabner BA, Dryden-Peterson SL. Impact of HIV Infection on the Clinical Presentation and Survival of Non-Hodgkin Lymphoma: A Prospective Observational Study From Botswana. J Glob Oncol 2018; 4:1-11. [PMID: 30241264 PMCID: PMC6223476 DOI: 10.1200/jgo.17.00084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
PURPOSE Botswana has a high prevalence of HIV infection. Currently, there are few data regarding the sociodemographic factors, clinical characteristics, and outcomes of non-Hodgkin lymphoma (NHL)-an AIDS-defining cancer-in the country. PATIENTS AND METHODS This study used a prospective cancer registry to identify patients with a new diagnosis of NHL reporting for specialty cancer care at three hospitals in Botswana between October 2010 and August 2016. Treatment patterns and clinical outcomes were analyzed. RESULTS One hundred four patients with a new diagnosis of NHL were enrolled in this study, 72% of whom had HIV infection. Compared with patients not infected with HIV, patients infected with HIV were younger (median age, 53.9 v 39.1 years; P = .001) and more likely to present with an aggressive subtype of NHL (65.5% v 84.0%; P = .008). All patients infected with HIV received combined antiretroviral therapy throughout the course of the study, and similar chemotherapeutic regimens were recommended for all patients, regardless of subtype or HIV status (six to eight cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone; or cyclophosphamide, doxorubicin, vincristine, and prednisone plus rituximab). There was no difference in 1-year mortality among patients not infected with HIV and patients infected with HIV (unadjusted analysis, 52.9% v 37.1%; hazard ratio [HR], 0.73; P = .33; adjusted analysis, HR, 0.57; P = .14). However, when compared with a cohort of patients in the United States matched by subtype, stage, age, sex, and race, patients in Botswana fared worse (1-year mortality, 22.8% v 46.3%; HR, 1.89; P = .001). CONCLUSION Among patients with NHL reporting for specialty cancer care in Botswana, there is no association between HIV status and 1-year survival.
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Affiliation(s)
- Michael G. Milligan
- Michael G. Milligan, Jeremy S. Abramson,
Aliyah R. Sohani, Shahin Lockman, Bruce A.
Chabner, and Scott L. Dryden-Peterson, Harvard Medical
School; Elizabeth Bigger, Jeremy S. Abramson, and
Aliyah R. Sohani, Massachusetts General Hospital; Shahin
Lockman and Scott L. Dryden-Peterson, Brigham and
Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston,
MA; Michael G. Milligan, Elizabeth Bigger,
Shahin Lockman, Bruce A. Chabner, and Scott
L. Dryden-Peterson, Botswana Harvard AIDS Institute Partnership;
Musimar Zola, Princess Marina Hospital; Mukendi K.A. Kayembe and
Heluf Medhin, Botswana Ministry of Health, Gaborone, Botswana;
and Gita Suneja, Duke University, Durham, NC
| | - Elizabeth Bigger
- Michael G. Milligan, Jeremy S. Abramson,
Aliyah R. Sohani, Shahin Lockman, Bruce A.
Chabner, and Scott L. Dryden-Peterson, Harvard Medical
School; Elizabeth Bigger, Jeremy S. Abramson, and
Aliyah R. Sohani, Massachusetts General Hospital; Shahin
Lockman and Scott L. Dryden-Peterson, Brigham and
Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston,
MA; Michael G. Milligan, Elizabeth Bigger,
Shahin Lockman, Bruce A. Chabner, and Scott
L. Dryden-Peterson, Botswana Harvard AIDS Institute Partnership;
Musimar Zola, Princess Marina Hospital; Mukendi K.A. Kayembe and
Heluf Medhin, Botswana Ministry of Health, Gaborone, Botswana;
and Gita Suneja, Duke University, Durham, NC
| | - Jeremy S. Abramson
- Michael G. Milligan, Jeremy S. Abramson,
Aliyah R. Sohani, Shahin Lockman, Bruce A.
Chabner, and Scott L. Dryden-Peterson, Harvard Medical
School; Elizabeth Bigger, Jeremy S. Abramson, and
Aliyah R. Sohani, Massachusetts General Hospital; Shahin
Lockman and Scott L. Dryden-Peterson, Brigham and
Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston,
MA; Michael G. Milligan, Elizabeth Bigger,
Shahin Lockman, Bruce A. Chabner, and Scott
L. Dryden-Peterson, Botswana Harvard AIDS Institute Partnership;
Musimar Zola, Princess Marina Hospital; Mukendi K.A. Kayembe and
Heluf Medhin, Botswana Ministry of Health, Gaborone, Botswana;
and Gita Suneja, Duke University, Durham, NC
| | - Aliyah R. Sohani
- Michael G. Milligan, Jeremy S. Abramson,
Aliyah R. Sohani, Shahin Lockman, Bruce A.
Chabner, and Scott L. Dryden-Peterson, Harvard Medical
School; Elizabeth Bigger, Jeremy S. Abramson, and
Aliyah R. Sohani, Massachusetts General Hospital; Shahin
Lockman and Scott L. Dryden-Peterson, Brigham and
Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston,
MA; Michael G. Milligan, Elizabeth Bigger,
Shahin Lockman, Bruce A. Chabner, and Scott
L. Dryden-Peterson, Botswana Harvard AIDS Institute Partnership;
Musimar Zola, Princess Marina Hospital; Mukendi K.A. Kayembe and
Heluf Medhin, Botswana Ministry of Health, Gaborone, Botswana;
and Gita Suneja, Duke University, Durham, NC
| | - Musimar Zola
- Michael G. Milligan, Jeremy S. Abramson,
Aliyah R. Sohani, Shahin Lockman, Bruce A.
Chabner, and Scott L. Dryden-Peterson, Harvard Medical
School; Elizabeth Bigger, Jeremy S. Abramson, and
Aliyah R. Sohani, Massachusetts General Hospital; Shahin
Lockman and Scott L. Dryden-Peterson, Brigham and
Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston,
MA; Michael G. Milligan, Elizabeth Bigger,
Shahin Lockman, Bruce A. Chabner, and Scott
L. Dryden-Peterson, Botswana Harvard AIDS Institute Partnership;
Musimar Zola, Princess Marina Hospital; Mukendi K.A. Kayembe and
Heluf Medhin, Botswana Ministry of Health, Gaborone, Botswana;
and Gita Suneja, Duke University, Durham, NC
| | - Mukendi K.A. Kayembe
- Michael G. Milligan, Jeremy S. Abramson,
Aliyah R. Sohani, Shahin Lockman, Bruce A.
Chabner, and Scott L. Dryden-Peterson, Harvard Medical
School; Elizabeth Bigger, Jeremy S. Abramson, and
Aliyah R. Sohani, Massachusetts General Hospital; Shahin
Lockman and Scott L. Dryden-Peterson, Brigham and
Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston,
MA; Michael G. Milligan, Elizabeth Bigger,
Shahin Lockman, Bruce A. Chabner, and Scott
L. Dryden-Peterson, Botswana Harvard AIDS Institute Partnership;
Musimar Zola, Princess Marina Hospital; Mukendi K.A. Kayembe and
Heluf Medhin, Botswana Ministry of Health, Gaborone, Botswana;
and Gita Suneja, Duke University, Durham, NC
| | - Heluf Medhin
- Michael G. Milligan, Jeremy S. Abramson,
Aliyah R. Sohani, Shahin Lockman, Bruce A.
Chabner, and Scott L. Dryden-Peterson, Harvard Medical
School; Elizabeth Bigger, Jeremy S. Abramson, and
Aliyah R. Sohani, Massachusetts General Hospital; Shahin
Lockman and Scott L. Dryden-Peterson, Brigham and
Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston,
MA; Michael G. Milligan, Elizabeth Bigger,
Shahin Lockman, Bruce A. Chabner, and Scott
L. Dryden-Peterson, Botswana Harvard AIDS Institute Partnership;
Musimar Zola, Princess Marina Hospital; Mukendi K.A. Kayembe and
Heluf Medhin, Botswana Ministry of Health, Gaborone, Botswana;
and Gita Suneja, Duke University, Durham, NC
| | - Gita Suneja
- Michael G. Milligan, Jeremy S. Abramson,
Aliyah R. Sohani, Shahin Lockman, Bruce A.
Chabner, and Scott L. Dryden-Peterson, Harvard Medical
School; Elizabeth Bigger, Jeremy S. Abramson, and
Aliyah R. Sohani, Massachusetts General Hospital; Shahin
Lockman and Scott L. Dryden-Peterson, Brigham and
Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston,
MA; Michael G. Milligan, Elizabeth Bigger,
Shahin Lockman, Bruce A. Chabner, and Scott
L. Dryden-Peterson, Botswana Harvard AIDS Institute Partnership;
Musimar Zola, Princess Marina Hospital; Mukendi K.A. Kayembe and
Heluf Medhin, Botswana Ministry of Health, Gaborone, Botswana;
and Gita Suneja, Duke University, Durham, NC
| | - Shahin Lockman
- Michael G. Milligan, Jeremy S. Abramson,
Aliyah R. Sohani, Shahin Lockman, Bruce A.
Chabner, and Scott L. Dryden-Peterson, Harvard Medical
School; Elizabeth Bigger, Jeremy S. Abramson, and
Aliyah R. Sohani, Massachusetts General Hospital; Shahin
Lockman and Scott L. Dryden-Peterson, Brigham and
Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston,
MA; Michael G. Milligan, Elizabeth Bigger,
Shahin Lockman, Bruce A. Chabner, and Scott
L. Dryden-Peterson, Botswana Harvard AIDS Institute Partnership;
Musimar Zola, Princess Marina Hospital; Mukendi K.A. Kayembe and
Heluf Medhin, Botswana Ministry of Health, Gaborone, Botswana;
and Gita Suneja, Duke University, Durham, NC
| | - Bruce A. Chabner
- Michael G. Milligan, Jeremy S. Abramson,
Aliyah R. Sohani, Shahin Lockman, Bruce A.
Chabner, and Scott L. Dryden-Peterson, Harvard Medical
School; Elizabeth Bigger, Jeremy S. Abramson, and
Aliyah R. Sohani, Massachusetts General Hospital; Shahin
Lockman and Scott L. Dryden-Peterson, Brigham and
Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston,
MA; Michael G. Milligan, Elizabeth Bigger,
Shahin Lockman, Bruce A. Chabner, and Scott
L. Dryden-Peterson, Botswana Harvard AIDS Institute Partnership;
Musimar Zola, Princess Marina Hospital; Mukendi K.A. Kayembe and
Heluf Medhin, Botswana Ministry of Health, Gaborone, Botswana;
and Gita Suneja, Duke University, Durham, NC
| | - Scott L. Dryden-Peterson
- Michael G. Milligan, Jeremy S. Abramson,
Aliyah R. Sohani, Shahin Lockman, Bruce A.
Chabner, and Scott L. Dryden-Peterson, Harvard Medical
School; Elizabeth Bigger, Jeremy S. Abramson, and
Aliyah R. Sohani, Massachusetts General Hospital; Shahin
Lockman and Scott L. Dryden-Peterson, Brigham and
Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston,
MA; Michael G. Milligan, Elizabeth Bigger,
Shahin Lockman, Bruce A. Chabner, and Scott
L. Dryden-Peterson, Botswana Harvard AIDS Institute Partnership;
Musimar Zola, Princess Marina Hospital; Mukendi K.A. Kayembe and
Heluf Medhin, Botswana Ministry of Health, Gaborone, Botswana;
and Gita Suneja, Duke University, Durham, NC
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12
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Tan CRC, Barta SK, Lee J, Rudek MA, Sparano JA, Noy A. Combination antiretroviral therapy accelerates immune recovery in patients with HIV-related lymphoma treated with EPOCH: a comparison within one prospective trial AMC034. Leuk Lymphoma 2018; 59:1851-1860. [PMID: 29160731 PMCID: PMC5962410 DOI: 10.1080/10428194.2017.1403597] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Drug-drug interactions between cART and chemotherapy may impact HIV and lymphoma control or lead to increased toxicities. No prospective comparative data informs potential harms and benefits. In AMC034, HIV-associated high-grade B-cell NHL patients received DA-EPOCH with rituximab. cART was given with EPOCH or delayed until chemotherapy completion per investigator choice. Pharmacokinetic, immunological, and treatment effects of concurrent cART were evaluated. CD4 counts dropped during EPOCH in both groups but recovered to higher than baseline 6 months post-EPOCH only in the cART group. HIV viral load decreased during chemotherapy in the cART group but increased in the non-cART group. Incidence of grade ≥3 infectious, hematologic, or neurological toxicities was similar. Concurrent cART was not associated with 1-year EFS or OS. cART with EPOCH was well-tolerated and allowed for faster immune recovery. While we did not observe differences in outcome, the preponderance of evidence is in favor of combining cART with chemotherapy.
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Affiliation(s)
- Carlyn Rose C Tan
- a Department of Hematology/Oncology , Fox Chase Cancer Center , Philadelphia , PA , USA
| | - Stefan K Barta
- a Department of Hematology/Oncology , Fox Chase Cancer Center , Philadelphia , PA , USA
| | - Jeannette Lee
- b Department of Biostatistics , University of Arkansas for Medical Sciences , Little Rock , AR , USA
| | - Michelle A Rudek
- c Department of Oncology, School of Medicine , Johns Hopkins University , Baltimore , MD , USA
| | - Joseph A Sparano
- d Department of Oncology , Montefiore-Einstein Cancer Center, Montefiore Medical Center , Bronx , NY , USA
| | - Ariela Noy
- e Department of Medicine , Memorial Sloan-Kettering Cancer Center/Weill-Cornell Medical College , New York , NY , USA
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13
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Abstract
The management of AIDS-related malignancies demands that the cancer must be treated in the context of patients already suffering from a fatal disease. Management must be problem-orientated. The standard cancer treatment of such a patient may not be appropriate in the AIDS setting. The AIDS related malignancies are Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma (NHL) incuding primary cerebral lymphoma. Carcinoma of the cervix was recently added to this list, but has not been seen in this context in the UK.
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14
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Del Rosario M, Tsai H, Dasanu CA. Durable Complete Response of Primary CNS Lymphoma in an 80-Year-Old Patient with Retroviral Infection. Conn Med 2017; 81:223-226. [PMID: 29714407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
People aging with human immunodeficiencyvirus (HIV) present a unique set of challenges for their providers. Cardiovascular, metabolic, neurodegenerative, and renal disorders, and certain cancers are more common in this cohort, which is attributed to elevated rates of inflammation. Although survival remains compromised, integration of efficacious antiretrovirals and high-dose methotrexate (HD-MTX) was shown to improve clinical results in HIV-infected patients with primary central nervous system lymphoma (PCNSL). However, optimal management of PCNSL in the elderly is not known. We present the case of an 80-year-old patientwith HIV-associated PCNSL who achieved a durable complete response with HD-MTX andrituximab. He remains in complete remission 18 months after the diagnosis. Our case supports using the HD-MTX/rituximab combination in the very old subjects with HIV-related PCNSL.
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15
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Puzyreva LV, Safonov AD. [INFECTIONS CAUSED BY EPSTEIN-BARR VIRUS IN HIV-INFECTED PATIENTS]. Zh Mikrobiol Epidemiol Immunobiol 2016:108-116. [PMID: 30695397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The review is dedicated to features of clinical manifestations of infections caused by Epstein- Barr virus (EBV) in HIV-infected patients, problems of diagnostics and execution of antiviral therapy in the case of combination of these infections. Individuals at AIDS stage develop tumors, associated with EBV: non-Hodgkin's lymphomas, including Berkitt's,lymphoma, primary B-cell lymphoma,of CNS, nasopharyngeal carcinoma. Formation of lymphoid interstitial pneumonitis and leukoplakia is known to be associated with EBV. A large list of preparations that are inhibitors of EBV replication are currently known, however, there is no clear pathogenetically justified therapy scheme for patients with this infection against the background of HIV-infection.
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16
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Galli L, Chiappini E, Lippi A, de Martino M. Immune Recovery following Antineoplastic Chemotherapy and Highly Active Antiretroviral Therapy (Haart) in a Child with HIV-1 Infection Previously Unresponsive to Haart. Int J Immunopathol Pharmacol 2016; 19:919-22. [PMID: 17166413 DOI: 10.1177/039463200601900422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report the case of a perinatally HIV-1-infected child, previously immunologically unresponsive to antiretroviral treatments (including the highly active antiretroviral therapy), who instead developed a vigorous and long-lasting immune response after the highly active antiretroviral therapy was associated with antineoplastic chemotherapy undertaken for a B-cell non-Hodgkin bone lymphoma.
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Affiliation(s)
- L Galli
- Division of Paediatric Infectious Diseases, University of Florence, Anna Meyer Children's Hospital, Florence, Italy
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17
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Basavaraj A, Kadam M, Kadam DB. Primary Maxillary Sinus Plasmablastic Lymphoma in HIV/AIDS. J Assoc Physicians India 2016; 64:71-72. [PMID: 27735156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Classically, the HIV/AIDS-related lymphomas are of the B cell type and involve the central nervous system and the abdominal cavity. Primary maxillary sinus lymphoma is rare. Plasmablastic lymphoma (PBL) is an aggressive form of non-Hodgkinvs lymphoma, and is extremely rare. Here we present a case of plasmablastic lymphoma with primary site being maxillary sinus, a rare location.
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Affiliation(s)
| | | | - D B Kadam
- Professor and Head, Department of Medicine, Sassoon General Hospital, Pune, Maharashtra
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18
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Boons E, Vanstreels E, Jacquemyn M, Nogueira TC, Neggers JE, Vercruysse T, van den Oord J, Tamir S, Shacham S, Landesman Y, Snoeck R, Pannecouque C, Andrei G, Daelemans D. Human Exportin-1 is a Target for Combined Therapy of HIV and AIDS Related Lymphoma. EBioMedicine 2015; 2:1102-13. [PMID: 26501108 PMCID: PMC4588406 DOI: 10.1016/j.ebiom.2015.07.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/29/2015] [Accepted: 07/29/2015] [Indexed: 11/12/2022] Open
Abstract
Infection with HIV ultimately leads to advanced immunodeficiency resulting in an increased incidence of cancer. For example primary effusion lymphoma (PEL) is an aggressive non-Hodgkin lymphoma with very poor prognosis that typically affects HIV infected individuals in advanced stages of immunodeficiency. Here we report on the dual anti-HIV and anti-PEL effect of targeting a single process common in both diseases. Inhibition of the exportin-1 (XPO1) mediated nuclear transport by clinical stage orally bioavailable small molecule inhibitors (SINE) prevented the nuclear export of the late intron-containing HIV RNA species and consequently potently suppressed viral replication. In contrast, in CRISPR-Cas9 genome edited cells expressing mutant C528S XPO1, viral replication was unaffected upon treatment, clearly demonstrating the anti-XPO1 mechanism of action. At the same time, SINE caused the nuclear accumulation of p53 tumor suppressor protein as well as inhibition of NF-κB activity in PEL cells resulting in cell cycle arrest and effective apoptosis induction. In vivo, oral administration arrested PEL tumor growth in engrafted mice. Our findings provide strong rationale for inhibiting XPO1 as an innovative strategy for the combined anti-retroviral and anti-neoplastic treatment of HIV and PEL and offer perspectives for the treatment of other AIDS-associated cancers and potentially other virus-related malignancies.
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MESH Headings
- Acrylates/chemistry
- Acrylates/pharmacology
- Acrylates/therapeutic use
- Active Transport, Cell Nucleus/drug effects
- Animals
- Apoptosis/drug effects
- Base Sequence
- CRISPR-Cas Systems/genetics
- Cell Cycle Checkpoints/drug effects
- Cell Line
- Cell Nucleus/drug effects
- Cell Nucleus/metabolism
- Female
- HIV/drug effects
- HIV/isolation & purification
- Humans
- Karyopherins/antagonists & inhibitors
- Karyopherins/metabolism
- Lymphoma, AIDS-Related/drug therapy
- Mice, Nude
- Molecular Sequence Data
- Molecular Targeted Therapy
- NF-kappa B/metabolism
- Protein Binding/drug effects
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- RNA, Viral/metabolism
- Receptors, Cytoplasmic and Nuclear/antagonists & inhibitors
- Receptors, Cytoplasmic and Nuclear/metabolism
- Reproducibility of Results
- Triazoles/chemistry
- Triazoles/pharmacology
- Triazoles/therapeutic use
- Tumor Suppressor Protein p53/metabolism
- Virus Replication/drug effects
- Xenograft Model Antitumor Assays
- rev Gene Products, Human Immunodeficiency Virus/genetics
- rev Gene Products, Human Immunodeficiency Virus/metabolism
- Exportin 1 Protein
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Affiliation(s)
- Eline Boons
- KU Leuven, Department of Microbiology and Immunology, Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, B-3000 Leuven, Belgium
| | - Els Vanstreels
- KU Leuven, Department of Microbiology and Immunology, Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, B-3000 Leuven, Belgium
| | - Maarten Jacquemyn
- KU Leuven, Department of Microbiology and Immunology, Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, B-3000 Leuven, Belgium
| | - Tatiane C. Nogueira
- KU Leuven, Department of Microbiology and Immunology, Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, B-3000 Leuven, Belgium
| | - Jasper E. Neggers
- KU Leuven, Department of Microbiology and Immunology, Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, B-3000 Leuven, Belgium
| | - Thomas Vercruysse
- KU Leuven, Department of Microbiology and Immunology, Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, B-3000 Leuven, Belgium
| | - Joost van den Oord
- KU Leuven, Department of Imaging and Pathology, Translational Cell & Tissue Research, B-3000 Leuven, Belgium
| | | | | | | | - Robert Snoeck
- KU Leuven, Department of Microbiology and Immunology, Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, B-3000 Leuven, Belgium
| | - Christophe Pannecouque
- KU Leuven, Department of Microbiology and Immunology, Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, B-3000 Leuven, Belgium
| | - Graciela Andrei
- KU Leuven, Department of Microbiology and Immunology, Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, B-3000 Leuven, Belgium
| | - Dirk Daelemans
- KU Leuven, Department of Microbiology and Immunology, Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, B-3000 Leuven, Belgium
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19
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Srinivasan S, Takeshita K, Holkova B, Czuczman MS, Miller K, Bernstein ZP, Driscoll D, Chanan-Khan A. Clinical Characteristics of Gastrointestinal Lymphomas Associated with AIDS (GI-ARL) and the Impact of HAART. HIV Clinical Trials 2015; 5:140-5. [PMID: 15248138 DOI: 10.1310/bdhx-d9bc-ywvu-9nbr] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The gastrointestinal (GI) tract is the most common site of extranodal disease in patients with systemic non-Hodgkin's lymphoma (NHL). Patients with systemic NHL and GI involvement associated with AIDS (GI-ARL) have a significantly worse prognosis than those without AIDS. We studied whether the introduction of HAART is associated with improved survival in patients with GI-ARL. PATIENTS AND METHOD 36 patients with GI-ARL were identified from the tumor registries of a large municipal hospital in New York City and a tertiary care facility in western New York State. Of these, 28 patients did not receive HAART and 8 were treated with HAART. The primary endpoint was survival, which was defined as time from date of diagnosis of NHL until death from any cause. RESULTS Patients were analyzed based on whether or not they were treated with HAART. Kaplan-Meier analysis showed significantly better survival in patients with GI-ARL who were concurrently treated with HAART (p =.014). Median survival was 5 months for the no-HAART group and 30 months for the HAART group. CONCLUSION In patients with GI-ARL who were treated with chemotherapy, concurrent therapy with HAART therapy was associated with improved survival.
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20
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Pereira R, Carvalho J, Patrício C, Farinha P. Sustained complete remission of primary effusion lymphoma with adjunctive ganciclovir treatment in an HIV-positive patient. BMJ Case Rep 2014; 2014:bcr-2014-204533. [PMID: 25312890 DOI: 10.1136/bcr-2014-204533] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Primary effusion lymphoma (PEL) is one of the least common of the AIDS-related lymphomas, accounting for less than 1-4% of cases. Clinical manifestations depend on the extent and distribution of disease and, as in the majority of patients no detectable mass lesion is found, symptoms are related to fluid accumulation, dyspnoea (pleural or pericardial effusions), abdominal distension (ascites) or joint swelling. The median survival after diagnosis, even with aggressive chemotherapy, remains poor and remissions are often of short duration. We present the case of a 31-year-old man with AIDS and diagnosis of PEL, in whom sustained and complete remission of the tumour was achieved with adjunctive ganciclovir therapy. Since the disease is so uncommon, there is a paucity of data to guide the treatment of these patients; ganciclovir might be a potential antiviral therapeutic option, as demonstrated by the 2-year remission achieved in our patient.
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Affiliation(s)
- Rui Pereira
- Department of Internal Medicine, Hospital de Santo António dos Capuchos, Lisboa, Portugal
| | - Joana Carvalho
- Department of Internal Medicine, Hospital de Santo António dos Capuchos, Lisboa, Portugal
| | - Catarina Patrício
- Department of Internal Medicine, Hospital de Santo António dos Capuchos, Lisboa, Portugal
| | - Pedro Farinha
- Department of Anatomic Pathology, Centro Hospitalar Lisboa Central, Lisboa, Portugal
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21
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Spittle M. AIDS and cancer. Trans Med Soc Lond 2014; 127:1-3. [PMID: 24941632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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22
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Shah NN, Harrison N, Stonecypher M, Frank D, Amorosa V, Svoboda J. Extracavitary primary effusion lymphoma initially presenting with hemophagocytic lymphohistocytosis. Clin Lymphoma Myeloma Leuk 2014; 14:e157-60. [PMID: 25027567 DOI: 10.1016/j.clml.2014.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 05/23/2014] [Indexed: 11/19/2022]
MESH Headings
- Adrenal Cortex Hormones/therapeutic use
- Adult
- Anti-HIV Agents/therapeutic use
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/administration & dosage
- Cytarabine/administration & dosage
- Diagnostic Imaging
- Doxorubicin/administration & dosage
- Early Diagnosis
- Epstein-Barr Virus Infections/complications
- Etoposide/administration & dosage
- Herpesviridae Infections/complications
- Herpesviridae Infections/virology
- Herpesvirus 8, Human/isolation & purification
- Humans
- Lymphohistiocytosis, Hemophagocytic/drug therapy
- Lymphohistiocytosis, Hemophagocytic/etiology
- Lymphoma, AIDS-Related/complications
- Lymphoma, AIDS-Related/diagnosis
- Lymphoma, AIDS-Related/drug therapy
- Lymphoma, Primary Effusion/complications
- Lymphoma, Primary Effusion/diagnosis
- Lymphoma, Primary Effusion/drug therapy
- Male
- Methotrexate/administration & dosage
- Prednisone/administration & dosage
- Remission Induction
- Rituximab
- Vincristine/administration & dosage
- Viremia/complications
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Affiliation(s)
- Nirav N Shah
- Division of Hematology/Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
| | - Neil Harrison
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Mark Stonecypher
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Dale Frank
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Valerianna Amorosa
- Department of Infectious Diseases, Philadelphia Veterans Affair Medical Center, Philadelphia, PA; Division of Infectious Diseases, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jakub Svoboda
- Division of Hematology/Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
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23
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Llitjos JF, Redheuil A, Puymirat E, Vedrenne G, Danchin N. AIDS-related primary cardiac lymphoma with right-sided heart failure and high-grade AV block: insights from magnetic resonance imaging. Ann Cardiol Angeiol (Paris) 2014; 63:99-101. [PMID: 23830566 DOI: 10.1016/j.ancard.2013.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 03/13/2013] [Indexed: 06/02/2023]
Abstract
A 44-year-old patient, with personal history of AIDS, was referred to our emergency unit with tachycardia and moderate signs of right-sided heart failure. The cardiac MRI study showed an impairment of the right ventricular free and inferior wall and the interventricular septum. The mass was characterized by notable heterogeneity with mixed areas of hypo- and hypersignal intensity in SSFP and T2-weighted images with fat saturation. There was global hyperenhancement of the mass after gadolinium contrast injection on T1-weighted images with and without fat saturation. The entire right coronary artery was included into the infiltrative mass. One day after the admission, the patient suddenly presented a paroxysmal third degree atrioventricular block, permanently corrected by an implanted cardiac pacemaker. Endomyocardial biopsy conformed the diagnosis of B-cell lymphoma. The patient died 4months after the diagnosis of acute heart failure with multi-organ dysfunction, after a short period of improvement under chemotherapy. We present this case to highlight the importance to consider that a large, solitary, right atrial mass in conjunction with pericardial effusion in a patient with HIV infection should lead to consider, as soon as possible, the diagnosis of lymphoma. MRI has explained the conduction disorders by showing the septal extension of the mass, and by demonstrating right coronary artery involvement.
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Affiliation(s)
- J-F Llitjos
- Cardiology intensive care unit, hôpital européen Georges-Pompidou, 20-40, rue Leblanc, 75015 Paris, France.
| | - A Redheuil
- Cardiovascular imaging, hôpital européen Georges-Pompidou, 20-40, rue Leblanc, 75015 Paris, France
| | - E Puymirat
- Cardiology intensive care unit, hôpital européen Georges-Pompidou, 20-40, rue Leblanc, 75015 Paris, France
| | - G Vedrenne
- Cardiology intensive care unit, hôpital européen Georges-Pompidou, 20-40, rue Leblanc, 75015 Paris, France
| | - N Danchin
- Cardiology intensive care unit, hôpital européen Georges-Pompidou, 20-40, rue Leblanc, 75015 Paris, France
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24
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Okame M, Takaya S, Sato H, Adachi E, Ohno N, Kikuchi T, Koga M, Oyaizu N, Ota Y, Fujii T, Iwamoto A, Koibuchi T. Complete regression of early-stage gastric diffuse large B-cell lymphoma in an HIV-1-infected patient following Helicobacter pylori eradication therapy. Clin Infect Dis 2014; 58:1490-2. [PMID: 24585569 DOI: 10.1093/cid/ciu111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michio Okame
- Departments of Infectious Diseases and Applied Immunology
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25
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Ajisawa A. [Immunodeficiency related malignant lymphoma: diagnosis and therapy of AIDS-related lymphoma]. Nihon Rinsho 2014; 72:542-546. [PMID: 24724417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIDS-related lymphoma (ARL) remains a significant burden for specialists in HIV/AIDS medicine. Pathological findings of ARL are often non-typical in various histological types. Diagnosis of correct histological type of ARL by the skilled pathologist is essential. Therapy of patients with ARL is the challenge of integrating treatment appropriate for the stage and histological subset of non-Hodgkin lymphoma. In addition to chemotherapy, essential components of an optimal ARL treatment strategy include antiretroviral therapy and prophylaxis for opportunistic infections.
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26
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Barta SK, Xue X, Wang D, Tamari R, Lee JY, Mounier N, Kaplan LD, Ribera JM, Spina M, Tirelli U, Weiss R, Galicier L, Boue F, Wilson WH, Wyen C, Oriol A, Navarro JT, Dunleavy K, Little RF, Ratner L, Garcia O, Morgades M, Remick SC, Noy A, Sparano JA. Treatment factors affecting outcomes in HIV-associated non-Hodgkin lymphomas: a pooled analysis of 1546 patients. Blood 2013; 122:3251-62. [PMID: 24014242 PMCID: PMC3821722 DOI: 10.1182/blood-2013-04-498964] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 08/27/2013] [Indexed: 12/27/2022] Open
Abstract
Limited comparative data exist for the treatment of HIV-associated non-Hodgkin lymphoma. We analyzed pooled individual patient data for 1546 patients from 19 prospective clinical trials to assess treatment-specific factors (type of chemotherapy, rituximab, and concurrent combination antiretroviral [cART] use) and their influence on the outcomes complete response (CR), progression free survival (PFS), and overall survival (OS). In our analysis, rituximab was associated with a higher CR rate (odds ratio [OR] 2.89; P < .001), improved PFS (hazard ratio [HR] 0.50; P < .001), and OS (HR 0.51; P < .0001). Compared with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), initial therapy with more dose-intense regimens resulted in better CR rates (ACVBP [doxorubicin, cyclophosphamide, vindesine, bleomycin and prednisolone]: OR 1.70; P < .04), PFS (ACVBP: HR 0.72; P = .049; "intensive regimens": HR 0.35; P < .001) and OS ("intensive regimens": HR 0.54; P < .001). Infusional etoposide, prednisone, infusional vincristine, infusional doxorubicin, and cyclophosphamide (EPOCH) was associated with significantly better OS in diffuse large B-cell lymphoma (HR 0.33; P = .03). Concurrent use of cART was associated with improved CR rates (OR 1.89; P = .005) and trended toward improved OS (HR 0.78; P = .07). These findings provide supporting evidence for current patterns of care where definitive evidence is unavailable.
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MESH Headings
- Anti-HIV Agents/therapeutic use
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antiretroviral Therapy, Highly Active
- Clinical Trials as Topic
- Cyclophosphamide/therapeutic use
- Doxorubicin/therapeutic use
- Drug Administration Schedule
- Etoposide/therapeutic use
- HIV/drug effects
- HIV Infections/complications
- HIV Infections/drug therapy
- HIV Infections/mortality
- HIV Infections/virology
- Humans
- Infusions, Intravenous
- Lymphoma, AIDS-Related/complications
- Lymphoma, AIDS-Related/drug therapy
- Lymphoma, AIDS-Related/mortality
- Lymphoma, AIDS-Related/virology
- Lymphoma, Non-Hodgkin/complications
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/mortality
- Lymphoma, Non-Hodgkin/virology
- Prednisone/therapeutic use
- Rituximab
- Survival Analysis
- Treatment Outcome
- Vincristine/therapeutic use
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27
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Gopal S, Patel MR, Yanik EL, Cole SR, Achenbach CJ, Napravnik S, Burkholder GA, Reid EG, Rodriguez B, Deeks SG, Mayer KH, Moore RD, Kitahata MM, Richards KL, Eron JJ. Association of early HIV viremia with mortality after HIV-associated lymphoma. AIDS 2013; 27:2365-73. [PMID: 23736149 PMCID: PMC3773290 DOI: 10.1097/qad.0b013e3283635232] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the association between early HIV viremia and mortality after HIV-associated lymphoma. DESIGN Multicenter observational cohort study. SETTING Center for AIDS Research Network of Integrated Clinical Systems cohort. PARTICIPANTS HIV-infected patients with lymphoma diagnosed between 1996 and 2011, who were alive 6 months after lymphoma diagnosis and with at least two HIV RNA values during the 6 months after lymphoma diagnosis. EXPOSURE Cumulative HIV viremia during the 6 months after lymphoma diagnosis, expressed as viremia copy-6-months. MAIN OUTCOME MEASURE All-cause mortality between 6 months and 5 years after lymphoma diagnosis. RESULTS Of 224 included patients, 183 (82%) had non-Hodgkin lymphoma (NHL) and 41 (18%) had Hodgkin lymphoma. At lymphoma diagnosis, 105 (47%) patients were on antiretroviral therapy (ART), median CD4⁺ cell count was 148 cells/μl (interquartile range 54-322), and 33% had suppressed HIV RNA (<400 copies/ml). In adjusted analyses, mortality was associated with older age [adjusted hazard ratio (AHR) 1.37 per decade increase, 95% CI 1.03-1.83], lymphoma occurrence on ART (AHR 1.63, 95% CI 1.02-2.63), lower CD4⁺ cell count (AHR 0.75 per 100 cells/μl increase, 95% CI 0.64-0.89), and higher early cumulative viremia (AHR 1.35 per log₁₀ copies × 6-months/ml, 95% CI 1.11-1.65). The detrimental effect of early cumulative viremia was consistent across patient groups defined by ART status, CD4⁺ cell count, and histology. CONCLUSION Exposure to each additional 1-unit log₁₀ in HIV RNA throughout the 6 months after lymphoma diagnosis was associated with a 35% increase in subsequent mortality. These results suggest that early and effective ART during chemotherapy may improve survival.
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Affiliation(s)
- Satish Gopal
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Monita R. Patel
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elizabeth L. Yanik
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stephen R. Cole
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Sonia Napravnik
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Erin G. Reid
- University of California at San Diego, San Diego, California
| | | | - Steven G. Deeks
- University of California at San Francisco, San Francisco, California
| | | | | | | | - Kristy L. Richards
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joseph J. Eron
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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28
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de Witt P, Maartens DJ, Uldrick TS, Sissolak G. Treatment outcomes in AIDS-related diffuse large B-cell lymphoma in the setting roll out of combination antiretroviral therapy in South Africa. J Acquir Immune Defic Syndr 2013; 64:66-73. [PMID: 23797692 PMCID: PMC3797444 DOI: 10.1097/qai.0b013e3182a03e9b] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Long-term survival for patients with AIDS-related diffuse large B-cell lymphoma (DLBCL) is feasible in settings with available combination antiretroviral therapy (cART). However, given limited oncology resources, outcomes for AIDS-associated DLBCL in South Africa are unknown. METHODS We performed a retrospective analysis of survival in patients with newly diagnosed AIDS-related DLBCL treated at a tertiary teaching hospital in Cape Town, South Africa, with cyclophosphamide, doxorubicin, vincristine, and oral prednisone (CHOP) or CHOP-like chemotherapy (January 2004 until December 2010). HIV-related and lymphoma-related prognostic factors were evaluated. RESULTS Thirty-six patients evaluated; median age 37.3 years, 52.8% men, and 61.1% black South Africans. Median CD4 count 184 cells per microliter (in 27.8% this was <100 cells/μL), 80% high risk according to the age-adjusted International Prognostic Index. Concurrent Mycobacterium tuberculosis in 25%. Two-year overall survival (OS) was 40.5% (median OS 10.5 months, 95% confidence interval: 6.5 to 31.8). Eastern Cooperative Oncology Group performance status of 2 or more (25.4% vs 50.0%, P = 0.01) and poor response to cART (18.0% vs 53.9%, P = 0.03) predicted inferior 2-year OS. No difference in 2-year OS was demonstrated in patients coinfected with M. tuberculosis (P = 0.87). CONCLUSIONS Two-year OS for patients with AIDS-related DLBCL treated with CHOP like regimens and cART is comparable to that seen in the United States and Europe. Important factors effecting OS in AIDS-related DLBCL in South Africa include performance status at presentation and response to cART. Patients with comorbid M. tuberculosis or hepatitis B seropositivity seem to tolerate CHOP in our setting. Additional improvements in outcomes are likely possible.
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Affiliation(s)
- Pieter de Witt
- Department of Internal Medicine, Stellenbosch University, Cape Town, South Africa, USA
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29
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Tanaka S, Nagata N, Mine S, Igari T, Kobayashi T, Sugihara J, Honda H, Teruya K, Kikuchi Y, Oka S, Uemura N. Endoscopic appearance of AIDS-related gastrointestinal lymphoma with c- MYC rearrangements: Case report and literature review. World J Gastroenterol 2013; 19:4827-4831. [PMID: 23922484 PMCID: PMC3732859 DOI: 10.3748/wjg.v19.i29.4827] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 05/12/2013] [Accepted: 06/20/2013] [Indexed: 02/06/2023] Open
Abstract
Acquired immune deficiency syndrome (AIDS)-related lymphoma (ARL) remains the main cause of AIDS-related deaths in the highly active anti-retroviral therapy (HAART) era. Recently, rearrangement of MYC is associated with poor prognosis in patients with diffuse large B-cell lymphoma. Here, we report a rare case of gastrointestinal (GI)-ARL with MYC rearrangements and coinfected with Epstein-Barr virus (EBV) infection presenting with various endoscopic findings. A 38-year-old homosexual man who presented with anemia and was diagnosed with an human immunodeficiency virus infection for the first time. GI endoscopy revealed multiple dish-like lesions, ulcerations, bloody spots, nodular masses with active bleeding in the stomach, erythematous flat lesions in the duodenum, and multiple nodular masses in the colon and rectum. Magnified endoscopy with narrow band imaging showed a honeycomb-like pattern without irregular microvessels in the dish-like lesions of the stomach. Biopsy specimens from the stomach, duodenum, colon, and rectum revealed diffuse large B-cell lymphoma concomitant with EBV infection that was detected by high tissue EBV-polymerase chain reaction levels and Epstein-Barr virus small RNAs in situ hybridization. Fluorescence in situ hybridization analysis revealed a fusion between the immunoglobulin heavy chain (IgH) and c-MYC genes, but not between the IgH and BCL2 loci. After 1-mo of treatment with HAART and R-CHOP, endoscopic appearance improved remarkably, and the histological features of the biopsy specimens revealed no evidence of lymphoma. However, he died from multiple organ failure on the 139th day after diagnosis. The cause of his poor outcome may be related to MYC rearrangement. The GI tract involvement in ARL is rarely reported, and its endoscopic findings are various and may be different from those in non-AIDS GI lymphoma; thus, we also conducted a literature review of GI-ARL cases.
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MESH Headings
- Adult
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antiretroviral Therapy, Highly Active
- Biopsy
- Cyclophosphamide/administration & dosage
- Doxorubicin/administration & dosage
- Endoscopy, Gastrointestinal
- Fatal Outcome
- Gastrointestinal Neoplasms/drug therapy
- Gastrointestinal Neoplasms/genetics
- Gastrointestinal Neoplasms/pathology
- Gastrointestinal Neoplasms/virology
- Gene Rearrangement
- Herpesvirus 4, Human/isolation & purification
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Lymphoma, AIDS-Related/drug therapy
- Lymphoma, AIDS-Related/genetics
- Lymphoma, AIDS-Related/pathology
- Lymphoma, AIDS-Related/virology
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/virology
- Male
- Neoplasms, Multiple Primary/drug therapy
- Neoplasms, Multiple Primary/genetics
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/virology
- Predictive Value of Tests
- Prednisone/administration & dosage
- Proto-Oncogene Proteins c-myc/genetics
- Rituximab
- Time Factors
- Treatment Outcome
- Vincristine/administration & dosage
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30
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Stander S, Holmes H, Dreyer WP, Afrogheh A, Mohamed N, Hille J, Osman N. Oral medicine case book 49: Plasmablastic lymphoma. SADJ 2013; 68:184-186. [PMID: 23971300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- S Stander
- Division of Oral Medicine and Periodontics, University of the Western Cape
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31
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Tajima K, Kohno K, Shiono Y, Suzuki I, Kato Y, Hiroshima Y, Yamamoto M, Ohtake H, Iwaba A, Yamakawa M, Kato T. Acute kidney injury and inflammatory immune reconstitution syndrome in mixed genotype (A/E) hepatitis B virus co-infection in HIV-associated lymphoma. Int J Clin Exp Pathol 2013; 6:536-542. [PMID: 23411777 PMCID: PMC3563184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 12/29/2012] [Indexed: 06/01/2023]
Abstract
We report a first case of HIV-associated lymphoma (HAL) presenting with acute kidney injury (AKI) and inflammatory immune reconstitution syndrome (IRIS). A 39-year-old male, treated with nonsteroidal anti-inflammatory drugs (NSAIDs) for one month prior to admission, developed AKI, left testicular tumor, and recurrent swelling of the right parotid gland. A resected testicular tumor exhibited features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma. Renal biopsy showed hydro-degeneration of renal tubules, interstitial inflammatory cells, and a small number of lymphoma cells in the sub-capsule, compatible with acute interstitial nephritis. His renal dysfunction rapidly recovered following chemotherapy and combination antiretroviral therapy (cART). He developed pneumonia concomitantly with a decrease in HIV-RNA level and an increase in CD4+ cells after the first cycle of chemotherapy, which spontaneously resolved after the second cycle of chemotherapy without additional anti-infection drugs; thus, his pneumonia fulfilled the diagnostic criteria for IRIS. We suggest that IRIS may frequently develop during chemotherapy for HAL, but may be overlooked. He was coinfected with hepatitis B virus (HBV), which genotypes known as is associated with liver-related mortality and response to antiviral therapy; recently, an intimate interplay between HIV and HBV in the onset of lymphoma has been reported. Therefore, we addressed the HBV genotype in the patient. The analysis revealed that he exhibited a mixed genotype (A/E) not native to Japan and primarily found in Europe and North America or West Africa. These findings suggest that universal vaccination for juveniles against HBV is warranted in Japan.
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Affiliation(s)
- Katsushi Tajima
- Department of Radiation Emergency Medicine, National Institute of Radiological Sciences Chiba, Japan.
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32
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Park J, Kim TM, Hwang JH, Kim NH, Choe PG, Song KH, Kim ES, Park SW, Kim HB, Kim NJ, Park WB, Oh MD. Risk factors for febrile neutropenia during chemotherapy for HIV-related lymphoma. J Korean Med Sci 2012; 27:1468-71. [PMID: 23255844 PMCID: PMC3524424 DOI: 10.3346/jkms.2012.27.12.1468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 09/20/2012] [Indexed: 11/20/2022] Open
Abstract
We evaluated risk factors for neutropenic fever and febrile prolonged neutropenia during vincristine-including chemotherapy to treat HIV-related lymphoma to investigate whether protease inhibitor (PI) treatment is associated with infectious complications due to drug interactions with chemotherapeutic agents. We included all HIV patients who received chemotherapy including vincristine for lymphoma at a single referral center in 1999-2010. Neutropenic fever was defined as absolute neutrophil count < 500 cells/µL with body temperature over 38℃; and prolonged neutropenia was defined if it persisted over 7 days. CODOX-M/IVAC and Stanford regimens were considered high-risk regimens for prolonged neutropenia. We analyzed 48 cycles of chemotherapy in 17 HIV patients with lymphoma. There were 22 neutropenic fever and 12 febrile prolonged neutropenia events. In multivariate analysis, neutropenic fever was associated with old age and low CD4 cell count, but not with PI use or ritonavir-boosted PI use. Low CD4 cell count and high-risk regimens were associated with febrile prolonged neutropenia. Neutropenic fever and febrile prolonged neutropenia is associated with old age, low CD4 cell count, and high-risk regimens, but not PI use, in HIV patients undergoing chemotherapy including vincristine for lymphoma.
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Affiliation(s)
- Jinyong Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong-Hwan Hwang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nak-Hyun Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung-ho Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Gopal S, Martin KE, Richards KL, Eron JJ. Clinical presentation, treatment, and outcomes among 65 patients with HIV-associated lymphoma treated at the University of North Carolina, 2000-2010. AIDS Res Hum Retroviruses 2012; 28:798-805. [PMID: 22011066 PMCID: PMC3399569 DOI: 10.1089/aid.2011.0259] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
HIV increases risk of non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL). The effect of HIV on presentation, treatment, and outcomes of NHL and HL in routine care in the combination antiretroviral therapy (cART) merits further characterization. We performed a retrospective analysis of HIV-infected patients with NHL and HL receiving care at the University of North Carolina at Chapel Hill from January 1, 2000 until December 31, 2010. Statistical analyses were conducted using SAS, version 9.2 (SAS Institute Inc). Sixty-five HIV-infected patients with NHL and HL were identified. Patients with non-CNS NHL and HL presented with advanced disease (85% stage III or IV) and adverse prognostic features. Patients completed 87% of planned chemotherapy cycles, and 68% of patients completed stage-appropriate therapy. Dose reduction, interruption, and/or delay occurred during more than 25% of administered cycles in 64% of patients. Infectious complications, febrile neutropenia, and myelosuppression accounted for 78% of deviations from planned cumulative dose and dose intensity. Primary CNS lymphoma (PCNSL) was associated with poor prognosis, but 2-year overall survival was 66% for all non-CNS lymphoma. Among patients surviving at least 2 years, 75% had CD4 count >200 cells/μl and 79% had HIV viral load <400 copies/ml at last follow-up. Despite advanced disease and difficulty tolerating chemotherapy with optimal cumulative dose and dose intensity, most patients with non-CNS HIV-associated lymphoma survived more than 2 years after diagnosis, the majority with suppressed HIV RNA.
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Affiliation(s)
- Satish Gopal
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7305, USA.
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Ullerup-Aagaard H, Müllertz KM. [Disseminated B-cell lymphoma with cardial involvement in an HIV positive patient]. Ugeskr Laeger 2012; 174:1382-1383. [PMID: 22579094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 44 year-old Somali woman was admitted with chest pain, shortness of breath and weight loss. A transthoracic echocardiography showed extensive intracardiac tumour masses. A transvenous biopsy was performed yielding the diagnosis diffuse large B-cell lymphoma. Thoracic and abdominal computed tomography showed dissemination to several organs. The patient was tested HIV positive and initiated on chemotherapy and antiretroviral therapy. After five months no tumour masses could be visualised by a repeated echocardiographic examination. Unfortunately, the patient died a few months later from cerebral metastasis.
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MESH Headings
- Adult
- Anti-HIV Agents/therapeutic use
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antiretroviral Therapy, Highly Active
- Echocardiography
- Fatal Outcome
- Female
- Heart Neoplasms/diagnosis
- Heart Neoplasms/diagnostic imaging
- Heart Neoplasms/drug therapy
- Heart Neoplasms/mortality
- Humans
- Lymphoma, AIDS-Related/diagnosis
- Lymphoma, AIDS-Related/diagnostic imaging
- Lymphoma, AIDS-Related/drug therapy
- Lymphoma, AIDS-Related/mortality
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Neoplasm Staging
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Ajisawa A. [Immunodeficiency related malignant lymphoma]. Nihon Rinsho 2012; 70 Suppl 2:709-714. [PMID: 23134033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Atsushi Ajisawa
- Department of Infectious Disease, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital
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Castillo JJ, Echenique IA. Rituximab in combination with chemotherapy versus chemotherapy alone in HIV-associated non-Hodgkin lymphoma: a pooled analysis of 15 prospective studies. Am J Hematol 2012; 87:330-3. [PMID: 22308010 DOI: 10.1002/ajh.22275] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 11/29/2011] [Accepted: 12/06/2011] [Indexed: 11/08/2022]
Abstract
In HIV-positive patients with non-Hodgkin lymphoma (NHL), no benefit of adding rituximab to chemotherapy was seen in a randomized controlled trial (RCT). We performed a meta-analysis of prospective studies to ascertain outcomes in HIV-positive NHL patients treated with chemotherapy (chemo) versus rituximab and chemo (R-chemo). A literature search through September 2011 was performed using the key search "(HIV OR AIDS) AND lymphoma". The main outcomes were overall response rate (ORR), complete response rate (CRR) and 2-year overall survival (OS) and are reported as non-adjusted odds ratio (OR). We identified 15 prospective studies including 1,060 HIV-positive NHL patients, 675 treated with chemo and 385 with R-chemo. There was a higher proportion of HAART in R-chemo patients (82% vs. 68%; p < 0.01) but there were no differences in proportion of patients with advanced stage or high/high-intermediate age-adjusted International Prognostic Index (aaIPI) scores. Meta-analysis showed the OR for ORR, CRR and 2-year OS in patients treated with R-chemo was 1.39 (95% CI 0.79-2.47; p = 0.26), 1.66 (95% CI 0.98-2.82; p = 0.06) and 2.19 (95% CI 1.68-2.86; p < 0.001), respectively. HIV-positive lymphoma patients treated with R-chemo had higher odds for CR and 2-year OS when compared to chemo but also had a higher proportion of HAART usage.
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Affiliation(s)
- Jorge J Castillo
- Department of Medicine and Division of Hematology and Oncology, The Warren Alpert Medical School of Brown University, The Miriam Hospital, Providence, Rhode Island, USA.
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Abstract
Gamma-(γ)-herpes virus lymphomas comprise a heterogenous group of B-cell and T-cell neoplasms most commonly associated with Epstein-Barr virus and rarely human herpes virus-8 infection. Adult T-cell leukemia/lymphoma (ATLL) is a unique disease entity caused by the human T-cell lymphotrophic virus, type 1 (HTLV-I), the only retrovirus known to cause cancer in humans. Viral lymphomas behave aggressively and disproportionally affect immunocompromised individuals and those living in underdeveloped regions. These diseases are often difficult to treat with conventional approaches. Despite recent advancements using cytotoxic, lymphoma-specific, and adoptive therapies, the long-term outcome of patients with γ-herpesvirus lymphomas occurring in severely immunocompromised patients and ATLL continues to be poor. Lytic-inducing therapies targeting NF-κB, and viral and tumor cell epigenetic mechanisms afford the advantage of exploiting the intrinsic presence of oncogenic viruses to eradicate infected tumor cells. In this review, viral-related lymphomas and newly emerging clinical approaches targeting viral latency are discussed.
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Affiliation(s)
- Juan Carlos Ramos
- Department of Medicine, Division of Oncology-Hematology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Izidore S Lossos
- Department of Medicine, Division of Oncology-Hematology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
- Department of Molecular and Cellular Pharmacology, University of Miami, Miami, FL
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Varma R, Carroll SL, Jacobson IV, Milross CG, Post JJ. Combination antiretroviral therapy as treatment for human immunodeficiency virus-associated mucosa-associated lymphoid tissue type lymphoma of the nasopharynx. Intern Med J 2011; 41:437-8. [PMID: 21605299 DOI: 10.1111/j.1445-5994.2011.02480.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Marretta L, Stocker H, Drauz D, Mueller M, Masuhr A, Dieckmann S, Wong V, Koch A, Grueneisen A, Arastéh K, Weiss R. Treatment of HIV-related primary central nervous system lymphoma with AZT high dose, HAART, interleukin-2 and foscarnet in three patients. Eur J Med Res 2011; 16:197-205. [PMID: 21719392 PMCID: PMC3352191 DOI: 10.1186/2047-783x-16-5-197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 01/12/2011] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Combined immunomodulatory and antiviral treatment was administered to three patients with newly diagnosed HIV-associated primary central nervous system lymphoma (PCNSL) in an attempt to improve outcomes. PATIENTS AND METHODS Three patients from our institution who were recently diagnosed with HIV-associated PCNSL received intravenous azidothymidine (AZT) 1.6 gr. bid for two weeks, followed by oral AZT 250mg bid from day 15. In addition, complementary highly active antiretroviral therapy (HAART) with a second nucleoside reverse transcriptase inhibitor (NRTI) plus one protease inhibitor (PI) and interleukin 2 (IL-2) subcutaneously 2 million units twice daily (bid) plus foscarnet 90mg/kg bid were administered on days 1-14. One patient received anti-Epstein-Barr virus (EBV)-maintenance therapy with ganciclovir, followed by cidofovir. RESULTS All patients experienced progressive disease while on induction therapy, and switched early to whole-brain radiation therapy (WBRT) as second line-treatment. No grade 3 or 4 toxicities were observed. Two patients died on days 50 and 166 respectively due to progressive disease. The third patient with histo?logically proven lymphoproliferation and only suspected PCNSL remained alive at 53 months. He was on HAART and remained clinically and neurologically stable. CONCLUSION Although IL-2, HAART, high-dose AZT and foscarnet are used for other HIV-related conditions, they did not demonstrate benefit in lymphoma remission for 2 HIV- associated PCNSL patients. The third patient went into delayed remission after additional radiotherapy and was in good clinical and neurological health status over 53 months after diagnosis.
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Affiliation(s)
- Lore Marretta
- DRK-Kliniken Köpenick, Berlin, II. Innere Abteilung, Hämato-Onkologie, Salvador-Allende-Allee 2-8, 12559 Berlin, Germany.
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Wang CC, Castillo JJ. Management of HIV-associated lymphomas. Med Health R I 2011; 94:4-6. [PMID: 21290986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Chia-Ching Wang
- Department of Medicine, The Warren Alpert Medical School of Brown University/The Miriam Hospital, Providence, RI 02906, USA
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Yamamoto Y, Teruya K, Katano H, Niino H, Yasuoka A, Kimura S, Oka S. Rapidly Progressive Human Herpesvirus 8-associated Solid Anaplastic Lymphoma in a Patient with AIDS—Associated Kaposi Sarcoma. Leuk Lymphoma 2010; 44:1631-3. [PMID: 14565671 DOI: 10.3109/10428190309178791] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report a case of rapidly progressive solid lymphoma with anaplastic large cell morphology, followed by systemic Kaposi sarcoma in an adult patient with AIDS. The lymphoma cells expressed human herpesvirus 8 (HHV-8)-encoded latent and lytic proteins and Epstein-Barr virus-encoded small RNA, suggesting that this case could be categorized into HHV-8-associated solid lymphoma, a recently identified disease entity.
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MESH Headings
- Acquired Immunodeficiency Syndrome/drug therapy
- Adult
- Anti-HIV Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antiretroviral Therapy, Highly Active
- Cyclophosphamide/administration & dosage
- Disease Progression
- Doxorubicin/administration & dosage
- Doxorubicin/therapeutic use
- Epstein-Barr Virus Infections/complications
- Fatal Outcome
- Gastrointestinal Neoplasms/drug therapy
- Gastrointestinal Neoplasms/virology
- HIV-1
- Herpesviridae Infections/complications
- Herpesvirus 4, Human/isolation & purification
- Herpesvirus 8, Human/isolation & purification
- Humans
- Lamivudine/therapeutic use
- Lymphoma, AIDS-Related/drug therapy
- Lymphoma, AIDS-Related/virology
- Lymphoma, Large B-Cell, Diffuse/virology
- Male
- Neoplasms, Second Primary/drug therapy
- Neoplasms, Second Primary/virology
- Prednisone/administration & dosage
- Ritonavir/therapeutic use
- Saquinavir/therapeutic use
- Sarcoma, Kaposi/drug therapy
- Sarcoma, Kaposi/virology
- Skin Neoplasms/drug therapy
- Skin Neoplasms/virology
- Stavudine/therapeutic use
- Tumor Virus Infections/virology
- Vincristine/administration & dosage
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Affiliation(s)
- Yoshihiko Yamamoto
- AIDS Clinical Center, International Medical Center of Japan, Toyama 1-21-1, Toyama, Shinjuku, Tokyo 162-8655, Japan
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Suzuki K, Nakazato T, Sanada Y, Mihara A, Tachikawa N, Kurai H, Yoshimura Y, Hayashi H, Yoshida S, Kakimoto T. [Successful treatment with hyper-CVAD and highly active anti-retroviral therapy (HAART) for AIDS-related Burkitt lymphoma]. Rinsho Ketsueki 2010; 51:207-212. [PMID: 20379116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A 38-year-old man was admitted to our hospital because of continuous fever and right facial palsy. He was diagnosed as HIV positive. Abdominal CT scan showed a large mass in the ascending colon. Gallium scintigraphy demonstrated increased uptake in the ascending colon. Colonoscopy was performed and histological examination of the colon tumor revealed Burkitt's lymphoma (BL). He received highly active anti-retroviral therapy (HAART) and his facial palsy improved. Because CD4 count was significantly low at 31/microl, he was treated with dose-adjusted EPOCH (DA-EPOCH) combined with HAART. Although the tumor was decreased in size by DA-EPOCH, we changed to the combination of hyper-CVAD/MTX-Ara-C alternating therapy with HAART in order to increase dose intensity. Six cycles of hyper-CVAD/MTX-Ara-C were performed and complete remission was obtained. In the HAART era, the survival of patients with AIDS-related diffuse large cell lymphoma (DLCL) improved dramatically, whereas the survival of similarly treated patients with AIDS-related BL remained poor. Our case suggests that intensive chemotherapy with hyper-CVAD/MTX-Ara-C combined with HAART may be well tolerated and effective in AIDS-related BL.
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Affiliation(s)
- Kazuhito Suzuki
- Department of Hematology, Yokohama Municipal Citizen's Hospital, Japan
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Okada S. [Recent advances in the treatment of AIDS-related malignant lymphoma]. Nihon Rinsho 2010; 68:491-496. [PMID: 20229796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The use of highly active antiretroviral therapy (HAART) has been associated with a reduced risk of primary cerebral and systemic non-Hodgkin's lymphoma, and improved prognosis for those who develop HIV-associated non-Hodgkin's lymphoma or Hodgkin's lymphoma. However, the number of HIV-associated non-Hodgkin's lymphoma patients has increased with the increase of HIV-1 infected patients in Japan. Although the evidence currently supports an intensive and curative approach for the management of HIV-associated lymphoma, we must be vigilant about adverse effects and interaction of chemotherapeutic drugs, implementing infection prophylaxis and promptly recognizing, diagnosing, and treating bacterial, parasitic, fungal, and viral infections that may occur as a consequence of therapy.
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Affiliation(s)
- Seiji Okada
- Division of Hematopoiesis, Center for AIDS Research, Kumamoto University
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46
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Castillo JJ, Winer ES, Stachurski D, Perez K, Jabbour M, Milani C, Colvin G, Butera JN. Prognostic factors in chemotherapy-treated patients with HIV-associated Plasmablastic lymphoma. Oncologist 2010; 15:293-9. [PMID: 20167839 DOI: 10.1634/theoncologist.2009-0304] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Plasmablastic lymphoma (PBL) is a variant of diffuse large B-cell lymphoma commonly seen in the oral cavity of HIV-infected individuals. PBL has a poor prognosis, but prognostic factors in patients who have received chemotherapy have not been adequately evaluated. METHODS An extensive literature search rendered 248 cases of PBL, from which 157 were HIV(+). Seventy cases with HIV-associated PBL that received chemotherapy were identified. Whenever possible, authors of the original reports were contacted to complete clinicopathological data. Univariate analyses were performed calculating Kaplan-Meier estimates and compared using the log-rank test. RESULTS The mean age was 39 years, with a male predominance. The mean CD4(+) count was 165 cells/mm(3). Advanced clinical stage was seen in 51% and extraoral involvement was seen in 43% of the cases. The expression levels of CD20 and Epstein-Barr virus-encoded RNA were 13% and 86%, respectively. The overall survival duration was 14 months. In a univariate analysis, early clinical stage and a complete response to chemotherapy were associated with longer survival. There was no apparent difference in survival with regimens more intensive than cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). CONCLUSIONS Patients with HIV-associated PBL have a poor prognosis. Prognosis is strongly associated with achieving a complete clinical response to CHOP or CHOP-like chemotherapy. The role of more intensive regimens is currently unclear. Further research is needed to improve responses using novel therapeutic agents and strategies.
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Affiliation(s)
- Jorge J Castillo
- 164 Summit Avenue, Fain Building, Providence, Rhode Island 02906, USA.
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Corti M, Carolis LD, Solari R, Villafañe MF, Schtirbu R, Lewi D, Narbaitz M. Non Hodgkin's lymphoma with cutaneous involvement in AIDS patients: report of five cases and review of the literature. Braz J Infect Dis 2010; 14:81-85. [PMID: 20428660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2009] [Accepted: 10/10/2009] [Indexed: 05/29/2023] Open
Abstract
Cutaneous B cell lymphoma (CBCL) is a lymphoproliferative disorder of neoplastic B cell of the skin with a wide range of clinical manifestations. Commonly, the clinical features of CBCL are plaques, nodules, or ulcerative lesions. Skin is one of the common sites for extra-nodal lymphomas in patients with AIDS and B cell type is less common than T cell type. Only recently, the existence of B cell lymphomas presenting clinically in the skin without evidence of extra-cutaneous involvement has been accepted as primary CBCL. Here, we are presenting 5 patients with cutaneous involvement in the setting of HIV/AIDS disease. Two of them were primary cutaneous non-Hodgkin lymphomas. All were CBCL; 3 were immunoblastic, 1 was plasmablastic, and the other was a Burkitt lymphoma. We analyzed the epidemiological, clinical, virological, and immunological characteristics of this group of patients.
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Affiliation(s)
- Marcelo Corti
- Division of HIV/AIDS disease, Puán 381, 2 piso, C1406CQG Buenos Aires, Argentina.
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Mwanda WO, Orem J, Fu P, Banura C, Kakembo J, Onyango CA, Ness A, Reynolds S, Johnson JL, Subbiah V, Bako J, Wabinga H, Abdallah FK, Meyerson HJ, Whalen CC, Lederman MM, Black J, Ayers LW, Katongole-Mbidde E, Remick SC. Dose-modified oral chemotherapy in the treatment of AIDS-related non-Hodgkin's lymphoma in East Africa. J Clin Oncol 2009; 27:3480-8. [PMID: 19470940 PMCID: PMC2717754 DOI: 10.1200/jco.2008.18.7641] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 02/09/2009] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Africa is burdened by the AIDS epidemic and attendant increase in HIV/AIDS-related malignancies. Pragmatic approaches to therapeutic intervention could be of great value. Dose-modified oral chemotherapy for AIDS-related non-Hodgkin's lymphoma is one such approach. PATIENTS AND METHODS The oral regimen consisted of lomustine 50 mg/m(2) on day 1 (cycle 1 only), etoposide 100 mg/m(2) on days 1 to 3, and cyclophosphamide/procarbazine 50 mg/m(2) each on days 22 to 26 at 6-week intervals (one cycle) for two total cycles in HIV-infected patients with biopsy-proven non-Hodgkin's lymphoma. Results Forty-nine patients (21 in Uganda and 28 in Kenya) were treated. The majority of patients were female (59%) and had a poor performance status (63%); 69% of patients had advanced-stage disease; and 18 patients (37%) had access to antiretroviral therapy. In total, 79.5 cycles of therapy were administered. The regimen was well tolerated, had modest effects (decline) on CD4(+) lymphocyte counts (P = .077), and had negligible effects on HIV-1 viral replication. Four febrile neutropenia episodes and three treatment-related deaths (6% mortality rate) occurred. The overall objective response rate was 78% (95% CI, 62% to 88%); median follow-up time was 8.2 months (range, 0.1 to 71 months); median event-free and overall survival times were 7.9 months (95% CI, 3.3 to 13.0 months) and 12.3 months (95% CI, 4.9 to 32.4 months), respectively; and 33% of patients survived 5 years. CONCLUSION Dose-modified oral chemotherapy is efficacious, has comparable outcome to that in the United States in the pre-highly active antiretroviral therapy setting, has an acceptable safety profile, and is pragmatic in sub-Saharan Africa. The international collaboration has been highly successful, and subsequent projects should focus on strategies to optimize combination antiretroviral therapy and chemotherapy and follow-up tissue correlative studies.
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Affiliation(s)
- Walter O. Mwanda
- From the Department of Pathology, Section of Hematology and Blood Transfusion, Kenyatta National Hospital, University of Nairobi, College of Health Sciences, Nairobi, Kenya; Uganda Cancer Institute, Makerere University School of Medicine, Kampala; Uganda Virus Research Institute, Entebbe, Uganda; Center for AIDS Research, AIDS Malignancies Working Group; Case Comprehensive Cancer Center, Developmental Therapeutics Program and Clinical Trials Shared Resource; Departments of Biostatistics Epidemiology, Medicine, and Pathology; and Fogarty AIDS International Training and Research Program, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland; Department of Pathology, Ohio State University – AIDS and Cancer Specimen Resource, Columbus, OH; Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV; and Translational Genomics Research Institute, Phoenix, AZ
| | - Jackson Orem
- From the Department of Pathology, Section of Hematology and Blood Transfusion, Kenyatta National Hospital, University of Nairobi, College of Health Sciences, Nairobi, Kenya; Uganda Cancer Institute, Makerere University School of Medicine, Kampala; Uganda Virus Research Institute, Entebbe, Uganda; Center for AIDS Research, AIDS Malignancies Working Group; Case Comprehensive Cancer Center, Developmental Therapeutics Program and Clinical Trials Shared Resource; Departments of Biostatistics Epidemiology, Medicine, and Pathology; and Fogarty AIDS International Training and Research Program, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland; Department of Pathology, Ohio State University – AIDS and Cancer Specimen Resource, Columbus, OH; Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV; and Translational Genomics Research Institute, Phoenix, AZ
| | - Pingfu Fu
- From the Department of Pathology, Section of Hematology and Blood Transfusion, Kenyatta National Hospital, University of Nairobi, College of Health Sciences, Nairobi, Kenya; Uganda Cancer Institute, Makerere University School of Medicine, Kampala; Uganda Virus Research Institute, Entebbe, Uganda; Center for AIDS Research, AIDS Malignancies Working Group; Case Comprehensive Cancer Center, Developmental Therapeutics Program and Clinical Trials Shared Resource; Departments of Biostatistics Epidemiology, Medicine, and Pathology; and Fogarty AIDS International Training and Research Program, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland; Department of Pathology, Ohio State University – AIDS and Cancer Specimen Resource, Columbus, OH; Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV; and Translational Genomics Research Institute, Phoenix, AZ
| | - Cecilia Banura
- From the Department of Pathology, Section of Hematology and Blood Transfusion, Kenyatta National Hospital, University of Nairobi, College of Health Sciences, Nairobi, Kenya; Uganda Cancer Institute, Makerere University School of Medicine, Kampala; Uganda Virus Research Institute, Entebbe, Uganda; Center for AIDS Research, AIDS Malignancies Working Group; Case Comprehensive Cancer Center, Developmental Therapeutics Program and Clinical Trials Shared Resource; Departments of Biostatistics Epidemiology, Medicine, and Pathology; and Fogarty AIDS International Training and Research Program, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland; Department of Pathology, Ohio State University – AIDS and Cancer Specimen Resource, Columbus, OH; Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV; and Translational Genomics Research Institute, Phoenix, AZ
| | - Joweria Kakembo
- From the Department of Pathology, Section of Hematology and Blood Transfusion, Kenyatta National Hospital, University of Nairobi, College of Health Sciences, Nairobi, Kenya; Uganda Cancer Institute, Makerere University School of Medicine, Kampala; Uganda Virus Research Institute, Entebbe, Uganda; Center for AIDS Research, AIDS Malignancies Working Group; Case Comprehensive Cancer Center, Developmental Therapeutics Program and Clinical Trials Shared Resource; Departments of Biostatistics Epidemiology, Medicine, and Pathology; and Fogarty AIDS International Training and Research Program, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland; Department of Pathology, Ohio State University – AIDS and Cancer Specimen Resource, Columbus, OH; Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV; and Translational Genomics Research Institute, Phoenix, AZ
| | - Caren Auma Onyango
- From the Department of Pathology, Section of Hematology and Blood Transfusion, Kenyatta National Hospital, University of Nairobi, College of Health Sciences, Nairobi, Kenya; Uganda Cancer Institute, Makerere University School of Medicine, Kampala; Uganda Virus Research Institute, Entebbe, Uganda; Center for AIDS Research, AIDS Malignancies Working Group; Case Comprehensive Cancer Center, Developmental Therapeutics Program and Clinical Trials Shared Resource; Departments of Biostatistics Epidemiology, Medicine, and Pathology; and Fogarty AIDS International Training and Research Program, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland; Department of Pathology, Ohio State University – AIDS and Cancer Specimen Resource, Columbus, OH; Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV; and Translational Genomics Research Institute, Phoenix, AZ
| | - Anne Ness
- From the Department of Pathology, Section of Hematology and Blood Transfusion, Kenyatta National Hospital, University of Nairobi, College of Health Sciences, Nairobi, Kenya; Uganda Cancer Institute, Makerere University School of Medicine, Kampala; Uganda Virus Research Institute, Entebbe, Uganda; Center for AIDS Research, AIDS Malignancies Working Group; Case Comprehensive Cancer Center, Developmental Therapeutics Program and Clinical Trials Shared Resource; Departments of Biostatistics Epidemiology, Medicine, and Pathology; and Fogarty AIDS International Training and Research Program, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland; Department of Pathology, Ohio State University – AIDS and Cancer Specimen Resource, Columbus, OH; Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV; and Translational Genomics Research Institute, Phoenix, AZ
| | - Sherrie Reynolds
- From the Department of Pathology, Section of Hematology and Blood Transfusion, Kenyatta National Hospital, University of Nairobi, College of Health Sciences, Nairobi, Kenya; Uganda Cancer Institute, Makerere University School of Medicine, Kampala; Uganda Virus Research Institute, Entebbe, Uganda; Center for AIDS Research, AIDS Malignancies Working Group; Case Comprehensive Cancer Center, Developmental Therapeutics Program and Clinical Trials Shared Resource; Departments of Biostatistics Epidemiology, Medicine, and Pathology; and Fogarty AIDS International Training and Research Program, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland; Department of Pathology, Ohio State University – AIDS and Cancer Specimen Resource, Columbus, OH; Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV; and Translational Genomics Research Institute, Phoenix, AZ
| | - John L. Johnson
- From the Department of Pathology, Section of Hematology and Blood Transfusion, Kenyatta National Hospital, University of Nairobi, College of Health Sciences, Nairobi, Kenya; Uganda Cancer Institute, Makerere University School of Medicine, Kampala; Uganda Virus Research Institute, Entebbe, Uganda; Center for AIDS Research, AIDS Malignancies Working Group; Case Comprehensive Cancer Center, Developmental Therapeutics Program and Clinical Trials Shared Resource; Departments of Biostatistics Epidemiology, Medicine, and Pathology; and Fogarty AIDS International Training and Research Program, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland; Department of Pathology, Ohio State University – AIDS and Cancer Specimen Resource, Columbus, OH; Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV; and Translational Genomics Research Institute, Phoenix, AZ
| | - Vivek Subbiah
- From the Department of Pathology, Section of Hematology and Blood Transfusion, Kenyatta National Hospital, University of Nairobi, College of Health Sciences, Nairobi, Kenya; Uganda Cancer Institute, Makerere University School of Medicine, Kampala; Uganda Virus Research Institute, Entebbe, Uganda; Center for AIDS Research, AIDS Malignancies Working Group; Case Comprehensive Cancer Center, Developmental Therapeutics Program and Clinical Trials Shared Resource; Departments of Biostatistics Epidemiology, Medicine, and Pathology; and Fogarty AIDS International Training and Research Program, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland; Department of Pathology, Ohio State University – AIDS and Cancer Specimen Resource, Columbus, OH; Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV; and Translational Genomics Research Institute, Phoenix, AZ
| | - Jacob Bako
- From the Department of Pathology, Section of Hematology and Blood Transfusion, Kenyatta National Hospital, University of Nairobi, College of Health Sciences, Nairobi, Kenya; Uganda Cancer Institute, Makerere University School of Medicine, Kampala; Uganda Virus Research Institute, Entebbe, Uganda; Center for AIDS Research, AIDS Malignancies Working Group; Case Comprehensive Cancer Center, Developmental Therapeutics Program and Clinical Trials Shared Resource; Departments of Biostatistics Epidemiology, Medicine, and Pathology; and Fogarty AIDS International Training and Research Program, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland; Department of Pathology, Ohio State University – AIDS and Cancer Specimen Resource, Columbus, OH; Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV; and Translational Genomics Research Institute, Phoenix, AZ
| | - Henry Wabinga
- From the Department of Pathology, Section of Hematology and Blood Transfusion, Kenyatta National Hospital, University of Nairobi, College of Health Sciences, Nairobi, Kenya; Uganda Cancer Institute, Makerere University School of Medicine, Kampala; Uganda Virus Research Institute, Entebbe, Uganda; Center for AIDS Research, AIDS Malignancies Working Group; Case Comprehensive Cancer Center, Developmental Therapeutics Program and Clinical Trials Shared Resource; Departments of Biostatistics Epidemiology, Medicine, and Pathology; and Fogarty AIDS International Training and Research Program, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland; Department of Pathology, Ohio State University – AIDS and Cancer Specimen Resource, Columbus, OH; Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV; and Translational Genomics Research Institute, Phoenix, AZ
| | - Fatuma K. Abdallah
- From the Department of Pathology, Section of Hematology and Blood Transfusion, Kenyatta National Hospital, University of Nairobi, College of Health Sciences, Nairobi, Kenya; Uganda Cancer Institute, Makerere University School of Medicine, Kampala; Uganda Virus Research Institute, Entebbe, Uganda; Center for AIDS Research, AIDS Malignancies Working Group; Case Comprehensive Cancer Center, Developmental Therapeutics Program and Clinical Trials Shared Resource; Departments of Biostatistics Epidemiology, Medicine, and Pathology; and Fogarty AIDS International Training and Research Program, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland; Department of Pathology, Ohio State University – AIDS and Cancer Specimen Resource, Columbus, OH; Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV; and Translational Genomics Research Institute, Phoenix, AZ
| | - Howard J. Meyerson
- From the Department of Pathology, Section of Hematology and Blood Transfusion, Kenyatta National Hospital, University of Nairobi, College of Health Sciences, Nairobi, Kenya; Uganda Cancer Institute, Makerere University School of Medicine, Kampala; Uganda Virus Research Institute, Entebbe, Uganda; Center for AIDS Research, AIDS Malignancies Working Group; Case Comprehensive Cancer Center, Developmental Therapeutics Program and Clinical Trials Shared Resource; Departments of Biostatistics Epidemiology, Medicine, and Pathology; and Fogarty AIDS International Training and Research Program, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland; Department of Pathology, Ohio State University – AIDS and Cancer Specimen Resource, Columbus, OH; Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV; and Translational Genomics Research Institute, Phoenix, AZ
| | - Christopher C. Whalen
- From the Department of Pathology, Section of Hematology and Blood Transfusion, Kenyatta National Hospital, University of Nairobi, College of Health Sciences, Nairobi, Kenya; Uganda Cancer Institute, Makerere University School of Medicine, Kampala; Uganda Virus Research Institute, Entebbe, Uganda; Center for AIDS Research, AIDS Malignancies Working Group; Case Comprehensive Cancer Center, Developmental Therapeutics Program and Clinical Trials Shared Resource; Departments of Biostatistics Epidemiology, Medicine, and Pathology; and Fogarty AIDS International Training and Research Program, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland; Department of Pathology, Ohio State University – AIDS and Cancer Specimen Resource, Columbus, OH; Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV; and Translational Genomics Research Institute, Phoenix, AZ
| | - Michael M. Lederman
- From the Department of Pathology, Section of Hematology and Blood Transfusion, Kenyatta National Hospital, University of Nairobi, College of Health Sciences, Nairobi, Kenya; Uganda Cancer Institute, Makerere University School of Medicine, Kampala; Uganda Virus Research Institute, Entebbe, Uganda; Center for AIDS Research, AIDS Malignancies Working Group; Case Comprehensive Cancer Center, Developmental Therapeutics Program and Clinical Trials Shared Resource; Departments of Biostatistics Epidemiology, Medicine, and Pathology; and Fogarty AIDS International Training and Research Program, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland; Department of Pathology, Ohio State University – AIDS and Cancer Specimen Resource, Columbus, OH; Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV; and Translational Genomics Research Institute, Phoenix, AZ
| | - Jodi Black
- From the Department of Pathology, Section of Hematology and Blood Transfusion, Kenyatta National Hospital, University of Nairobi, College of Health Sciences, Nairobi, Kenya; Uganda Cancer Institute, Makerere University School of Medicine, Kampala; Uganda Virus Research Institute, Entebbe, Uganda; Center for AIDS Research, AIDS Malignancies Working Group; Case Comprehensive Cancer Center, Developmental Therapeutics Program and Clinical Trials Shared Resource; Departments of Biostatistics Epidemiology, Medicine, and Pathology; and Fogarty AIDS International Training and Research Program, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland; Department of Pathology, Ohio State University – AIDS and Cancer Specimen Resource, Columbus, OH; Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV; and Translational Genomics Research Institute, Phoenix, AZ
| | - Leona W. Ayers
- From the Department of Pathology, Section of Hematology and Blood Transfusion, Kenyatta National Hospital, University of Nairobi, College of Health Sciences, Nairobi, Kenya; Uganda Cancer Institute, Makerere University School of Medicine, Kampala; Uganda Virus Research Institute, Entebbe, Uganda; Center for AIDS Research, AIDS Malignancies Working Group; Case Comprehensive Cancer Center, Developmental Therapeutics Program and Clinical Trials Shared Resource; Departments of Biostatistics Epidemiology, Medicine, and Pathology; and Fogarty AIDS International Training and Research Program, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland; Department of Pathology, Ohio State University – AIDS and Cancer Specimen Resource, Columbus, OH; Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV; and Translational Genomics Research Institute, Phoenix, AZ
| | - Edward Katongole-Mbidde
- From the Department of Pathology, Section of Hematology and Blood Transfusion, Kenyatta National Hospital, University of Nairobi, College of Health Sciences, Nairobi, Kenya; Uganda Cancer Institute, Makerere University School of Medicine, Kampala; Uganda Virus Research Institute, Entebbe, Uganda; Center for AIDS Research, AIDS Malignancies Working Group; Case Comprehensive Cancer Center, Developmental Therapeutics Program and Clinical Trials Shared Resource; Departments of Biostatistics Epidemiology, Medicine, and Pathology; and Fogarty AIDS International Training and Research Program, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland; Department of Pathology, Ohio State University – AIDS and Cancer Specimen Resource, Columbus, OH; Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV; and Translational Genomics Research Institute, Phoenix, AZ
| | - Scot C. Remick
- From the Department of Pathology, Section of Hematology and Blood Transfusion, Kenyatta National Hospital, University of Nairobi, College of Health Sciences, Nairobi, Kenya; Uganda Cancer Institute, Makerere University School of Medicine, Kampala; Uganda Virus Research Institute, Entebbe, Uganda; Center for AIDS Research, AIDS Malignancies Working Group; Case Comprehensive Cancer Center, Developmental Therapeutics Program and Clinical Trials Shared Resource; Departments of Biostatistics Epidemiology, Medicine, and Pathology; and Fogarty AIDS International Training and Research Program, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, Cleveland; Department of Pathology, Ohio State University – AIDS and Cancer Specimen Resource, Columbus, OH; Mary Babb Randolph Cancer Center, West Virginia University School of Medicine, Morgantown, WV; and Translational Genomics Research Institute, Phoenix, AZ
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49
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Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection is known to be associated with an increased risk of non-Hodgkin's lymphoma (NHL). The majority of lymphomas (>80%) occurring during immunosuppression are aggressive B-cell in origin and have a high-to-intermediate histology grade. Treatment of NHL is not standardized. OBJECTIVES To assess the clinical effectiveness and safety of single agent or combination chemotherapy with or without immunochemotherapy (rituximab) and with or without highly active antiretroviral therapy (HAART) on overall survival (OS) and disease-free survival (DFS) for previously untreated patients with AIDS-related NHL. SEARCH STRATEGY The Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2009), MEDLINE (1966-March 6, 2009), EMBASE (1988-March 6, 2009), LlLACS (1982 to February 17, 2009), Gateway (March 6, 2009), and AIDSearch (2006 -February 2008) were used to identify published, potentially eligible trials. Further, we searched several electronic sources. For additional information see the Cochrane HIV/AIDS Group search strategy. SELECTION CRITERIA Randomized controlled trials (RCTs) assessing the effectiveness of systemic treatments for previously untreated AIDS-related NHL. There were no age or language restrictions. DATA COLLECTION AND ANALYSIS Authors independently assessed relevant studies for inclusion; four RCTs were selected. No meta-analysis was attempted due to clinical heterogeneity. MAIN RESULTS Four RCTs that included 857 patients (number range: 30 to 485) met the inclusion criteria. The studies have a high risk of bias; three RCTs were conducted in the United States and one was a multi-national, multi-centre RCT performed in France and Italy. One of the trials included only men. It was impossible to pool data for any of the outcomes due to the differences in the interventions assessed in these RCTs. Overall survival did not differ significantly between treatment groups. Disease free survival (DFS) was reported in two of the four RCTs, but it was not statistically significant between treatment groups. AUTHORS' CONCLUSIONS We found no evidence that the systemic interventions for untreated patients with AIDS-related NHL provide superior clinical effectiveness for improving OS, DSF, and tumour response rate; however, this conclusion is based on four RCTs with limited sample size and variable quality. More adequately powered RCTs that have low risk of bias are necessary to determine the real benefit or harm of interventions to treat this population. Overall survival (OS), DFS, and quality of life should be included as endpoints.
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Hoffmann C, Wolf E, Wyen C, Fätkenheuer G, Van Lunzen J, Stellbrink HJ, Stoehr A, Plettenberg A, Jaeger H, Noppeney R, Hentrich M, Goekbuget N, Hoelzer D, Horst HA. AIDS-associated Burkitt or Burkitt-like lymphoma: Short intensive polychemotherapy is feasible and effective. Leuk Lymphoma 2009; 47:1872-80. [PMID: 17065000 DOI: 10.1080/10428190600685467] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The objective was to evaluate the feasibility and efficacy of a short-term, multi-agent and dose intensive regimen in AIDS patients with Burkitt or Burkitt-like lymphoma (BL/BLL) and to compare its efficacy with that of a conventional regimen. This was a retrospective, multi-center cohort study of all HIV-1-infected patients diagnosed with BL/BLL between 1990 - 2004. Patients were assigned to two different chemotherapy approaches. Group A received a protocol which was adapted from the German multi-center study group for adult acute lymphoblastic leukemia (GMALL). Group B received a conventional CHOP-based chemotherapy. Fifty-one patients were included in the analysis. In group A (n = 20), significantly more patients achieved complete remission (75% vs 40%, P = 0.02) than in group B (n = 31). One-year survival in group A was 65% compared to 44% in group B (P = 0.17). In a multi-variable Cox regression analysis, treatment according to the GMALL protocol was significantly associated with prolonged survival with a relative hazard rate of 0.13 (95% CI 0.03 - 0.63, P = 0.01). In conclusion, the short and intensive GMALL protocol for B-ALL/NHL is feasible in patients with AIDS-BL/BLL. Outcome may be improved compared to patients treated with CHOP-based regimens. In the era of HAART, more intensive chemotherapy regimens should be considered in patients with highly aggressive lymphomas.
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