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Forghieri F, Nasillo V, Bettelli F, Pioli V, Giusti D, Gilioli A, Mussini C, Tagliafico E, Trenti T, Cossarizza A, Maffei R, Barozzi P, Potenza L, Marasca R, Narni F, Luppi M. Acute Myeloid Leukemia in Patients Living with HIV Infection: Several Questions, Fewer Answers. Int J Mol Sci 2020; 21:E1081. [PMID: 32041199 PMCID: PMC7036847 DOI: 10.3390/ijms21031081] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/01/2020] [Accepted: 02/04/2020] [Indexed: 12/18/2022] Open
Abstract
Both human immunodeficiency virus (HIV) infection and acute myeloid leukemia (AML) may be considered relatively uncommon disorders in the general population, but the precise incidence of AML in people living with HIV infection (PLWH) is uncertain. However, life expectancy of newly infected HIV-positive patients receiving anti-retroviral therapy (ART) is gradually increasing, rivaling that of age-matched HIV-negative individuals, so that the occurrence of AML is also expected to progressively increase. Even if HIV is not reported to be directly mutagenic, several indirect leukemogenic mechanisms, mainly based on bone marrow microenvironment disruption, have been proposed. Despite a well-controlled HIV infection under ART should no longer be considered per se a contraindication to intensive chemotherapeutic approaches, including allogeneic hematopoietic stem cell transplantation, in selected fit patients with AML, survival outcomes are still generally unsatisfactory. We discussed several controversial issues about pathogenesis and clinical management of AML in PLWH, but few evidence-based answers may currently be provided, due to the limited number of cases reported in the literature, mainly as case reports or small retrospective case series. Prospective multicenter clinical trials are warranted to more precisely investigate epidemiology and cytogenetic/molecular features of AML in PLWH, but also to standardize and further improve its therapeutic management.
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Affiliation(s)
- Fabio Forghieri
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy; (V.N.); (F.B.); (V.P.); (D.G.); (A.G.); (R.M.); (P.B.); (L.P.); (R.M.); (F.N.); (M.L.)
| | - Vincenzo Nasillo
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy; (V.N.); (F.B.); (V.P.); (D.G.); (A.G.); (R.M.); (P.B.); (L.P.); (R.M.); (F.N.); (M.L.)
| | - Francesca Bettelli
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy; (V.N.); (F.B.); (V.P.); (D.G.); (A.G.); (R.M.); (P.B.); (L.P.); (R.M.); (F.N.); (M.L.)
| | - Valeria Pioli
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy; (V.N.); (F.B.); (V.P.); (D.G.); (A.G.); (R.M.); (P.B.); (L.P.); (R.M.); (F.N.); (M.L.)
| | - Davide Giusti
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy; (V.N.); (F.B.); (V.P.); (D.G.); (A.G.); (R.M.); (P.B.); (L.P.); (R.M.); (F.N.); (M.L.)
| | - Andrea Gilioli
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy; (V.N.); (F.B.); (V.P.); (D.G.); (A.G.); (R.M.); (P.B.); (L.P.); (R.M.); (F.N.); (M.L.)
| | - Cristina Mussini
- Section of Infectious Diseases, Department of Surgical, Medical, Dental and Morphological Sciences. University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy;
| | - Enrico Tagliafico
- Center for Genome Research, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, 41124 Modena, Italy;
| | - Tommaso Trenti
- Department of Laboratory Medicine and Pathology, Unità Sanitaria Locale, 41124 Modena, Italy;
| | - Andrea Cossarizza
- Section of Immunology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Rossana Maffei
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy; (V.N.); (F.B.); (V.P.); (D.G.); (A.G.); (R.M.); (P.B.); (L.P.); (R.M.); (F.N.); (M.L.)
| | - Patrizia Barozzi
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy; (V.N.); (F.B.); (V.P.); (D.G.); (A.G.); (R.M.); (P.B.); (L.P.); (R.M.); (F.N.); (M.L.)
| | - Leonardo Potenza
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy; (V.N.); (F.B.); (V.P.); (D.G.); (A.G.); (R.M.); (P.B.); (L.P.); (R.M.); (F.N.); (M.L.)
| | - Roberto Marasca
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy; (V.N.); (F.B.); (V.P.); (D.G.); (A.G.); (R.M.); (P.B.); (L.P.); (R.M.); (F.N.); (M.L.)
| | - Franco Narni
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy; (V.N.); (F.B.); (V.P.); (D.G.); (A.G.); (R.M.); (P.B.); (L.P.); (R.M.); (F.N.); (M.L.)
| | - Mario Luppi
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy; (V.N.); (F.B.); (V.P.); (D.G.); (A.G.); (R.M.); (P.B.); (L.P.); (R.M.); (F.N.); (M.L.)
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Hematopoietic stem cell transplantation in HIV-1-infected individuals: clinical challenges and the potential for viral eradication. Curr Opin Oncol 2013; 25:180-6. [PMID: 23385862 DOI: 10.1097/cco.0b013e32835d814a] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW We will review the evidence that hematopoietic stem cell transplantation is well tolerated and effective in HIV-1-infected individuals with high-risk hematologic malignancies. We will discuss the challenges of using blood and marrow transplant strategies in this population, as well as the potential impact that hematopoietic stem cell transplantation has on HIV-1 reservoirs and persistence. RECENT FINDINGS Advances in stem cell transplantation and the success of antiretroviral therapy (ART) have made it possible to extend curative cancer therapy to HIV-1-infected individuals with aggressive lymphoma and leukemia. Outcomes of autologous hematopoietic stem cell transplantation in HIV-1-infected individuals are similar to the general population. In allogeneic hematopoietic stem cell transplantation (alloHSCT), there are a growing number of successful case reports and the first national trial is ongoing. Infectious complications do not appear to be increased in patients on effective ART; however, drug interactions and drug interruptions are common. There is also renewed interest in the possibility that alloHSCT could lead to HIV-1 cure. SUMMARY HIV-1 infection is not a contraindication to blood and marrow transplantation and may offer unique benefits. Particular attention to preventing infectious complications, drug interactions, and drug interruptions in this patient population is required.
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Non-AIDS-defining hematological malignancies in HIV-infected patients: an epidemiological study in Japan. AIDS 2013; 27:279-83. [PMID: 23014520 DOI: 10.1097/qad.0b013e32835a5a7a] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To clarify the incidence and clinical outcomes of non-AIDS-defining hematological malignancies (NADHMs), excluding non-Hodgkin's lymphomas, in HIV-infected patients. DESIGN A nationwide epidemiological study was conducted to evaluate the incidence and clinical outcomes of NADHMs. METHODS Questionnaires were sent to 429 regional AIDS centers and 497 educational hospitals certified by the Japanese Society of Hematology. Data from 511 institutes were obtained. RESULTS From 1991 to 2010, 47 patients with NADHMs were detected (median age, 42.0 years; male, 93.6%). The median CD4-positive T-cell count was 255/μl, and the median duration from the diagnosis of HIV infection to development of hematological malignancy was 28.0 months. Most patients with acute leukemia were treated with standard induction chemotherapy. Complete remission rates and median overall survival periods for acute myeloblastic leukemia (AML) and acute lymphoblastic leukemia (ALL) were 70.0 and 85.7% and 13 and 16 months, respectively. Three of four patients with chronic-phase chronic myeloid leukemia (CML-CP) were well controlled with imatinib. Five patients (2 AML, 1 ALL, 1 accelerated-phase CML, and 1 myeloma) were treated with autologous or allogeneic stem-cell transplantation. Comparison of patients over the two periods (1991-2000 and 2001-2009) revealed a 4.5-fold increase in the incidence of hematological malignancies. CONCLUSION The incidence of NADHMs has increased in the past decade. The prognosis of these patients was similar to that of HIV-negative patients; therefore, standard chemotherapy may be a feasible treatment option for HIV-infected patients with hematological malignancies.
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