1
|
Souza ATD, Andrade FRD, Sarmento AC, Villarim CC, Araújo-Filho I, Medeiros KSD. Clinical features in Hodgkin lymphoma patients living with human immunodeficiency virus: A meta-analysis in the antiretroviral therapy era. Int J STD AIDS 2024; 35:786-795. [PMID: 38905613 DOI: 10.1177/09564624241259512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Abstract
OBJECTIVE Evaluate the clinical features in people with Hodgkin's lymphoma living with HIV (HIV-HL) during the combination ART (cART) era. DESIGN Systematic review and meta-analysis. METHODS The study was conducted in accordance with the recommendations of 2020 PRISMA and MOOSE statements. The protocol was prospectively registered through the PROSPERO (CRD42021289520). Manuscripts published until July 2023 were systematically searched in the PubMed, EMBASE, Cochrane Library, and Web of Science databases, with no language and year of publication restriction. Meta-analysis was performed to estimate a pooled proportion of each outcome using a random-effect analysis. Quality assessment was performed by using New-Castle Ottawa scale. Certainty of evidence was graded using the GRADE. RESULTS Sixteen cohorts, representing 3.882 HIV-HL patients, were included in this review. Our findings indicate that HIV-HL patients showed a 2-year overall survival (OS) of 92% (95% CI 0.87, 0.95). However, the 5-year overall survival decreased to 79% (95% CI 0.74, 0.83), with a high certainty of evidence according to GRADE. Additionally, the 5-year progression-free survival declined to 79% and complete remission rate increased to 81%. Our meta-analysis indicates an increase for B symptoms (80%, 95% CI 0.75, 0.84) and extranodal involvement in bone marrow (43%, 95% CI 0.30, 0.47) among HIV-HL patients. CONCLUSION The HIV-HL patients showed a 2-year OS of 92%. However, the 5-year OS decreased to 79%. The reported main cause of mortality among HIV-HL patients was progression of HL. Our systematic review and meta-analysis suggest that cART is associated with improved short-term survival of HIV-HL patients.
Collapse
Affiliation(s)
- Amaxsell Tb de Souza
- Instituto de Ensino, Pesquisa e Inovação, Liga Contra o Câncer, Natal, Brazil
- Faculty of Pharmacy, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Fernanda Ra de Andrade
- Instituto de Ensino, Pesquisa e Inovação, Liga Contra o Câncer, Natal, Brazil
- Department of Medicine, Health School, Potiguar University, Natal, Brazil
| | - Ayane Ca Sarmento
- Instituto de Ensino, Pesquisa e Inovação, Liga Contra o Câncer, Natal, Brazil
- Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal, Brazil
- Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Irami Araújo-Filho
- Instituto de Ensino, Pesquisa e Inovação, Liga Contra o Câncer, Natal, Brazil
- Department of Medicine, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Kleyton S de Medeiros
- Instituto de Ensino, Pesquisa e Inovação, Liga Contra o Câncer, Natal, Brazil
- Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
| |
Collapse
|
2
|
Kurosawa S, Yoshimura Y, Takada Y, Yokota T, Hibi M, Hirahara A, Yoshida T, Okubo S, Masuda M, So Y, Miyata N, Nakayama H, Sakurai A, Sato K, Ito C, Aisa Y, Nakazato T. A predictive model for HIV-related lymphoma. AIDS 2024; 38:1627-1637. [PMID: 38831732 PMCID: PMC11296280 DOI: 10.1097/qad.0000000000003949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/24/2024] [Accepted: 05/28/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVES To address the paucity of HIV-related lymphoma (HRL)-specific prognostic scores for the Japanese population by analyzing domestic cases of HRL and constructing a predictive model. DESIGN A single-center retrospective study coupled with a review of case reports of HRL. METHODS We reviewed all patients with HRL treated at our hospital between 2007 and 2023 and conducted a comprehensive search for case reports of HRL from Japan using public databases. A multivariate analysis for overall survival (OS) was performed using clinical parameters, leading to the formulation of the HIV-Japanese Prognostic Index (HIV-JPI). RESULTS A total of 19 patients with HRL were identified in our institution, whereas the literature review yielded 44 cases. In the HIV-JPI, a weighted score of 1 was assigned to the following factors: age at least 45 years, HIV-RNA at least 8.0×10 4 copies/ml, Epstein-Barr virus-encoded small RNA positivity, and Ann Arbor classification stage IV. The overall score ranged from 0 to 4. We defined the low-risk group as scores ranging from 0 to 2 and the high-risk group as scores ranging from 3 to 4. The 3-year OS probability of the high-risk group [30.8%; 95% confidence interval (CI): 9.5-55.4%) was significantly poorer than that of the low-risk group (76.8%; 95% CI: 52.8-89.7%; P < 0.01). CONCLUSION This retrospective analysis established pivotal prognostic factors for HRL in Japanese patients. The HIV-JPI, derived exclusively from Japanese patients, highlights the potential for stratified treatments and emphasizes the need for broader studies to further refine this clinical prediction model.
Collapse
Affiliation(s)
| | - Yukihiro Yoshimura
- Division of Infectious Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | | | | | | | | | | | | | | | - Yuna So
- Division of Infectious Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Nobuyuki Miyata
- Division of Infectious Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | | | | | - Kosuke Sato
- Division of Infectious Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | | | | | | |
Collapse
|
3
|
Hodgkin lymphoma at Groote Schuur Hospital, South Africa: the effect of HIV and bone marrow infiltration. Ann Hematol 2018; 98:381-389. [PMID: 30397846 DOI: 10.1007/s00277-018-3533-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/19/2018] [Indexed: 12/14/2022]
Abstract
Human immunodeficiency virus (HIV) is associated with an increased risk of developing Hodgkin lymphoma (HL). South Africa (SA) has the highest HIV prevalence rate in the world. There is currently no outcome-based data for HIV-associated HL from SA. A bone marrow database was compiled of all bone marrow biopsies (BMB) reported at National Health Laboratory Service (NHLS) Groote Schuur Hospital (GSH) between January 2005 and December 2012. Patients who had a BMB performed for staging of HL or where HL was diagnosed on the BMB were included for further analysis. Clinical and laboratory data was extracted from medical and laboratory records. Primary outcome measures included histological subtype, bone marrow infiltration (BMI) by HL, CD4 count, HIV-viral load (HIV-VL), tuberculosis (TB) data, treatment with chemotherapy and 5-year overall survival (OS). The database included 6569 BMB and 219 patients of these had HL and were included for analysis. The median age at presentation (32 years) was similar in the HIV+ and HIV- populations. While males predominated in the HIV- group, females predominated in the HIV+ group (male:female ratio of 1.5:1 vs 0.7:1, respectively). The majority of patients (71%) were HIV negative (HIV-) and 29% were HIV positive (HIV+). The diagnosis of HL was made on BMB in 17% of cases. BMI was seen in 37% (82/219) overall, and was found in more HIV+ patients (61%; 39/64) than HIV- patients (28%; 43/155; p = 0.03). The histological subtype varied according to HIV status with nodular sclerosis classical Hodgkin lymphoma (NSCHL) being most frequent in the HIV- group and classical Hodgkin lymphoma (CHL)-unclassifiable the most frequent in the HIV+ group. HIV+ patients had a median CD4 count of 149 × 106/L and 39% were anti-retroviral therapy (cART) naive at HL diagnosis. HIV+ patients had received anti-TB therapy more frequently than HIV- patients (72% vs 17%; p = 0.007). More HIV+ patients did not receive chemotherapy than HIV- patients (31% vs 3%; p = 0.001). The 5-year OS was 56%. HIV+ patients with BMI had a 5-year OS of 18%. BMI, HIV status, low CD4 count, histological subtype and TB therapy had a statistical significant impact on 5-year OS (p < 0.01). The 5-year OS was 56%, with both BMI and HIV+ status being associated with poor survival. BMB provided the diagnosis of HL in 17% of cases, confirming its diagnostic utility in our setting. Our cohort showed similar survival outcomes to other countries in Africa, Asia and Central America with comparable socio-economic constraints to SA.
Collapse
|
4
|
Yotsumoto M, Ito Y, Hagiwara S, Terui Y, Nagai H, Ota Y, Ajisawa A, Uehira T, Tanuma J, Ohyashiki K, Okada S. HIV positivity may not have a negative impact on survival in Epstein-Barr virus-positive Hodgkin lymphoma: A Japanese nationwide retrospective survey. Oncol Lett 2018; 16:3923-3928. [PMID: 30128009 DOI: 10.3892/ol.2018.9132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 05/24/2018] [Indexed: 02/06/2023] Open
Abstract
There has been no comparative clinical study focused on differences in the clinical features of Epstein-Barr virus (EBV)+ Hodgkin lymphoma (HL) between HIV-positive and -negative cases. In a nationwide survey from 511 institutions in Japan, the present study investigated 16 EBV+ HIVpositive HL patients. To further clarify their characteristics in comparison with EBV+ HIVnegative HL (n=34) in the combination antiretroviral therapy era in Japan, the present study was performed. Results indicated that EBV+ HIVpositive HL frequently occurred in a younger population compared with EBV+ HIVnegative HL (P=0.0295), and that the EBV+ HIVpositive HL group was not associated with the nodular sclerosis subtype in the population who were below the age of 40. Notably, the EBV+ HIVpositive HL group had a significantly higher frequency of extra-nodal involvement (P=0.0214), including marrow invasion. In the advanced stage, 80% of those with EBV+ HIVpositive HL did not require dose-reduction and in the majority of cases, chemotherapy was completed. There were no significant differences in the complete remission rate (P=0.1961), overall survival (P=0.200) and progression-free survival (P=0.245) between EBV+ HIVpositive HL (median observational period, 23.5 months) and EBV+ HIVnegative HL (median observational period, 64.5 months), suggesting that HIV positivity may not have a negative impact on the clinical outcome of EBV+ HL. Notably, standard chemotherapy is effective and tolerable for EBV+ HL, regardless of HIV infection.
Collapse
Affiliation(s)
- Mihoko Yotsumoto
- Department of Laboratory Medicine, Tokyo Medical University Hospital, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Yoshikazu Ito
- Department of Hematology, Tokyo Medical University Hospital, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Shotaro Hagiwara
- Department of Hematology, Tokyo Women's Medical University Hospital, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Yasuhito Terui
- Department of Hematology Oncology, Cancer Institute Hospital of JFCR, Koto-ku, Tokyo 135-8550, Japan
| | - Hirokazu Nagai
- Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya-shi, Aichi 460-0001, Japan
| | - Yasunori Ota
- Department of Pathology, Teikyo University Hospital, Minato-ku, Tokyo 173-0003, Japan
| | - Atsushi Ajisawa
- Department of Infectious Diseases, Tokyo Metropolitan Toshima Hospital, Itabashi-ku, Tokyo 173-0015, Japan
| | - Tomoko Uehira
- Department of Infectious Diseases, National Hospital Organization Osaka National Hospital, Chuo-ku, Osaka 540-0006, Japan
| | - Junko Tanuma
- AIDS Clinical Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Kazuma Ohyashiki
- Department of Hematology, Tokyo Medical University Hospital, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Seiji Okada
- Division of Hematopoiesis, Center for AIDS Research, Kumamoto University, Chuo-ku, Kumamoto 860-8556, Japan
| |
Collapse
|
5
|
Nagaharu K, Masuya M, Kageyama Y, Yamaguchi T, Ito R, Kawakami K, Ito M, Katayama N. Successful treatment of primary bone marrow Hodgkin lymphoma with brentuximab vedotin: a case report and review of the literature. J Med Case Rep 2018; 12:151. [PMID: 29843820 PMCID: PMC5975584 DOI: 10.1186/s13256-018-1693-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/17/2018] [Indexed: 12/27/2022] Open
Abstract
Background Hodgkin lymphoma usually presents with sequential enlargement of peripheral lymph nodes, and bone marrow invasion rarely occurs (approximately 3–5%). However, several cases have been reported as “primary” bone marrow Hodgkin lymphoma, especially among patients with human immunodeficiency virus and the elderly. This type of Hodgkin lymphoma is characterized by no peripheral lymphadenopathies and has been reported to have poorer prognosis. Case presentation A 38-year-old Japanese man was admitted to our hospital because of fever of unknown origin and pancytopenia without lymphadenopathies. Bone marrow examination revealed Hodgkin cells mimicking abnormal cells. These were positive for CD30, EBER-1, CD15, PAX-5, and Bob-1 and negative for Oct-2, CD3, CD20, surface immunoglobulin, CD56. On the basis of systemic evaluation and bone marrow examination, he was diagnosed with primary bone marrow Hodgkin lymphoma. We initiated therapy with DeVIC (dexamethasone, etoposide, ifosfamide, and carboplatin) therapy, but remission was not achieved. Then, the patient was treated with brentuximab vedotin combined with systemic chemotherapy (Adriamycin, vinblastine and dacarbazine), which was effective. Conclusions There is no established treatment strategy for Hodgkin lymphoma, and therapeutic outcomes using ABVD (Adriamycin, bleomycin, vinblastine and dacarbazine)-like or CHOP (cyclophosphamide, Adriamycin, vincristine, and prednisone)-like regimens are reportedly poor. Only a few patients have been reported to achieve long-term remission. Through this case report, we suggest an alternative therapeutic option for primary bone marrow Hodgkin lymphoma.
Collapse
Affiliation(s)
- Keiki Nagaharu
- Department of Hematology and Oncology, Suzuka General Hospital, Mie, Japan. .,Department of Hematology and Oncology, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu, Mie, 514-8507, Japan.
| | - Masahiro Masuya
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu, Mie, 514-8507, Japan
| | - Yuki Kageyama
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu, Mie, 514-8507, Japan
| | - Takanori Yamaguchi
- Department of Hematology and Oncology, Suzuka General Hospital, Mie, Japan
| | - Ryugo Ito
- Department of Hematology and Oncology, Suzuka General Hospital, Mie, Japan
| | - Keiki Kawakami
- Department of Hematology and Oncology, Suzuka General Hospital, Mie, Japan
| | - Masafumi Ito
- Department of Pathology, Japanese Red Cross Nagoya First Hospital, Aichi, Japan
| | - Naoyuki Katayama
- Department of Hematology and Oncology, Suzuka General Hospital, Mie, Japan
| |
Collapse
|
6
|
Fujiwara M, Yanagida S, Kakita H, Arima N. Elimination of Plasma Cytokines Markedly Improves Non-Septic Multiple Organ Dysfunction Syndrome in Human Immunodeficiency Virus-Associated Hodgkin Lymphoma. Ther Apher Dial 2017; 21:640-641. [PMID: 28714149 DOI: 10.1111/1744-9987.12574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 04/11/2017] [Accepted: 05/09/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Maki Fujiwara
- Department of Hematology, Medical Research Institute Kitano Hospital, Osaka, Japan.,Department of Nephrology, Medical Research Institute Kitano Hospital, Osaka, Japan
| | - Soshi Yanagida
- Department of Hematology, Shimada Municipal Hospital, Shizuoka, Japan
| | - Hiroko Kakita
- Department of Nephrology, Medical Research Institute Kitano Hospital, Osaka, Japan
| | - Nobuyoshi Arima
- Department of Hematology, Medical Research Institute Kitano Hospital, Osaka, Japan
| |
Collapse
|
7
|
Koizumi Y, Uehira T, Ota Y, Ogawa Y, Yajima K, Tanuma J, Yotsumoto M, Hagiwara S, Ikegaya S, Watanabe D, Minamiguchi H, Hodohara K, Murotani K, Mikamo H, Wada H, Ajisawa A, Shirasaka T, Nagai H, Kodama Y, Hishima T, Mochizuki M, Katano H, Okada S. Clinical and pathological aspects of human immunodeficiency virus-associated plasmablastic lymphoma: analysis of 24 cases. Int J Hematol 2016; 104:669-681. [PMID: 27604616 DOI: 10.1007/s12185-016-2082-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 08/15/2016] [Accepted: 08/16/2016] [Indexed: 11/29/2022]
Abstract
Plasmablastic lymphoma (PBL) is a rare AIDS-related malignancy with a poor prognosis. Little is known about this entity, and no standard treatment regimen has been defined. To establish an adequate treatment strategy, we investigated 24 cases of PBL arising in human immunodeficiency virus-positive individuals. Most of the patients were in the AIDS stage, with a median CD4 count of 67.5/µL. Lymph nodes (58 %), gastrointestinal tract (42 %), bone marrow (39 %), oral cavity (38 %), and CNS (18 %) were the most commonly involved sites. Histology findings for the following were positive at varying rates, as follows: CD10 (56 %); CD30 (39 %); CD38 (87 %); MUM-1 (91 %); CD138 (79 %); EBER (91 %); and LMP-1 (18 %). There was a marked increase in patients in 2011-12, and the cases found in that period appeared to be more aggressive, showing a higher rate of advanced-stage PBL. Fourteen cases were treated with CHOP, while the others were treated with more intensive regimens, including bortezomib and hematopoietic stem cell transplantation. The overall median survival time was 15 months. A CD4 count of >100/µL at diagnosis and attaining complete remission in the first-line chemotherapy were associated with better outcomes (P = 0.027 and 0.0016, respectively). Host immune status and chemosensitivity are associated with improved prognosis in PBL.
Collapse
Affiliation(s)
- Yusuke Koizumi
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan. .,Department of Hematology, Shiga University of Medical Science, Otsu, Shiga, Japan. .,Department of Infectious Diseases, Osaka National Hospital, Osaka, Osaka, Japan.
| | - Tomoko Uehira
- Department of Infectious Diseases, Osaka National Hospital, Osaka, Osaka, Japan
| | - Yasunori Ota
- Department of Pathology, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Yoshihiko Ogawa
- Department of Infectious Diseases, Osaka National Hospital, Osaka, Osaka, Japan
| | - Keishiro Yajima
- Department of Infectious Diseases, Osaka National Hospital, Osaka, Osaka, Japan
| | - Junko Tanuma
- AIDS Clinical Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Mihoko Yotsumoto
- Department of Laboratory Medicine, Tokyo Medical University, Tokyo, Japan
| | - Shotaro Hagiwara
- Department of Hematology, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Satoshi Ikegaya
- Department of Hematology and Oncology, University of Fukui Hospital, Fukui, Fukui, Japan
| | - Dai Watanabe
- Department of Infectious Diseases, Osaka National Hospital, Osaka, Osaka, Japan
| | - Hitoshi Minamiguchi
- Department of Hematology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Keiko Hodohara
- Department of Hematology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Kenta Murotani
- Division of Biostatistics, Clinical Research Center, Aichi Medical University, Nagakute, Aichi, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Hideho Wada
- Department of Hematology, Kawasaki Medical School, Kawasaki, Okayama, Japan
| | - Atsushi Ajisawa
- Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Takuma Shirasaka
- Department of Infectious Diseases, Osaka National Hospital, Osaka, Osaka, Japan
| | - Hirokazu Nagai
- Department of Hematology, Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Yoshinori Kodama
- Department of Pathology, Osaka National Hospital, Osaka, Osaka, Japan
| | - Tsunekazu Hishima
- Department of Pathology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Makoto Mochizuki
- Department of Pathology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Harutaka Katano
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Seiji Okada
- Center for AIDS Research, Kumamoto University, Kumamoto, Kumamoto, Japan
| |
Collapse
|
8
|
Katano H, Hishima T, Mochizuki M, Kodama Y, Oyaizu N, Ota Y, Mine S, Igari T, Ajisawa A, Teruya K, Tanuma J, Kikuchi Y, Uehira T, Shirasaka T, Koibuchi T, Iwamoto A, Oka S, Hasegawa H, Okada S, Yasuoka A. The prevalence of opportunistic infections and malignancies in autopsied patients with human immunodeficiency virus infection in Japan. BMC Infect Dis 2014; 14:229. [PMID: 24775713 PMCID: PMC4016795 DOI: 10.1186/1471-2334-14-229] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 04/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Opportunistic infections and malignancies such as malignant lymphoma and Kaposi sarcoma are significant complications of human immunodeficiency virus (HIV) infection. However, following the introduction of antiretroviral therapy in Japan in 1997, the incidence of clinical complications has decreased. In the present study, autopsy cases of HIV infection in Japan were retrospectively investigated to reveal the prevalence of opportunistic infections and malignancies. METHODS A total of 225 autopsy cases of HIV infection identified at 4 Japanese hospitals from 1985-2012 were retrospectively reviewed. Clinical data were collected from patient medical records. RESULTS Mean CD4 counts of patients were 77.0 cells/μL in patients who received any antiretroviral therapy during their lives (ART (+) patients) and 39.6 cells/μL in naïve patients (ART (-) patients). Cytomegalovirus infection (142 cases, 63.1%) and pneumocystis pneumonia (66 cases, 29.3%) were the most frequent opportunistic infections, and their prevalence was significantly lower in ART (+) patients than ART (-) patients. Non-Hodgkin lymphoma and Kaposi sarcoma were observed in 30.1% and 16.2% of ART (-) patients, and 37.9% and 15.2% of ART (+) patients, respectively. Malignant lymphoma was the most frequent cause of death, followed by cytomegalovirus infection regardless of ART. Non-acquired immunodeficiency syndrome (AIDS)-defining cancers such as liver and lung cancer caused death more frequently in ART (+) patients (9.1%) than in ART (-) patients (1.5%; P = 0.026). CONCLUSIONS The prevalence of infectious diseases and malignancies were revealed in autopsy cases of HIV infection in Japan. The prevalence of cytomegalovirus infection and pneumocystis pneumonia at autopsy were lower in ART (+) patients than ART (-) patients. Higher prevalence of non-AIDS defining malignancies among ART (+) patients than ART (-) patients suggests that onsets of various opportunistic infections and malignancies should be carefully monitored regardless of whether the patient is receiving ART.
Collapse
Affiliation(s)
- Harutaka Katano
- Department of Pathology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Ota Y, Hishima T, Mochizuki M, Kodama Y, Moritani S, Oyaizu N, Mine S, Ajisawa A, Tanuma J, Uehira T, Hagiwara S, Yajima K, Koizumi Y, Shirasaka T, Kojima Y, Nagai H, Yokomaku Y, Shiozawa Y, Koibuchi T, Iwamoto A, Oka S, Hasegawa H, Okada S, Katano H. Classification of AIDS-related lymphoma cases between 1987 and 2012 in Japan based on the WHO classification of lymphomas, fourth edition. Cancer Med 2014; 3:143-53. [PMID: 24407967 PMCID: PMC3930399 DOI: 10.1002/cam4.178] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 11/06/2013] [Accepted: 11/18/2013] [Indexed: 11/17/2022] Open
Abstract
The introduction of combined antiretroviral therapy (ART) has reduced the mortality of patients with human immunodeficiency virus-1 infection worldwide. However, malignant lymphoma is a severe and frequent complication seen in patients with acquired immunodeficiency syndrome (AIDS). The diagnostic criteria for some categories of AIDS-related lymphoma were revised in the World Health Organization International Classification of Lymphoma, fourth edition. The purpose of this study was to assess the clinicopathological characteristics of Japanese patients with AIDS-related lymphoma according to the revised classification. In this retrospective study, 207 AIDS-related lymphoma cases diagnosed between 1987 and 2012 in Japan were subjected to histological subtyping and clinicopathological analyses. Diffuse large B-cell lymphoma (DLBCL) was the predominant histological subtype throughout the study period (n = 104, 50%). Among the DLBCL cases, 24% were of the germinal center (GC) type and 76% were of the non-GC type. Non-GC-type cases showed a significantly lower 1-year survival rate (43%) than the GC-type cases (82%). Cases of Burkitt lymphoma (n = 57, 28%), plasmablastic lymphoma (n = 16, 8%), primary effusion lymphoma (n = 9, 4%), Hodgkin lymphoma (n = 8, 4%), and large B-cell lymphoma arising in Kaposi sarcoma-associated herpesvirus-associated multicentric Castleman disease (n = 2, 1%) were also observed. Hodgkin lymphoma was more common in patients receiving ART (11.1%) than in ART-naïve patients (1.4%). Statistical analyses identified CD10 negativity, BCL-6 negativity, Epstein–Barr virus positivity, and Kaposi sarcoma-associated herpesvirus positivity as risk factors for poor prognosis. This information will help in the early diagnosis of lymphoma in patients with AIDS.
Collapse
Affiliation(s)
- Yasunori Ota
- Department of Pathology and Laboratory Medicine, Institute of Medical Science, The University of Tokyo, Shirokanedai 4-6-1, Minato-ku, Tokyo, 108-8639, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Spindle-shaped CD163+ rosetting macrophages replace CD4+ T-cells in HIV-related classical Hodgkin lymphoma. Mod Pathol 2013; 26:648-57. [PMID: 23307058 DOI: 10.1038/modpathol.2012.217] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Combination antiretroviral therapy is highly effective in HIV infection, leading to decreased incidences of AIDS-defining neoplasms. However, HIV patients still have a 10-fold increased risk of developing classical Hodgkin lymphoma compared with the general population. As Hodgkin- and Reed-Sternberg cells represent only a minority in the tumor infiltrate, the aim of the present study was to characterize the microenvironment of HIV-related classical Hodgkin lymphoma and compare it with classical Hodgkin lymphoma cases of immunocompetent individuals. The major morphologic differences were the presence of necrotic foci and the absence of epithelioid cell formation in HIV-related Hodgkin lymphoma. We observed a significantly decreased number of CD4+ T-cells and a significantly increased number of CD163+ macrophages in HIV-related Hodgkin lymphoma. Cases exhibiting a 'sarcomatoid' pattern of the reactive infiltrate exhibited significantly greater numbers of macrophages, associating the 'sarcomatoid' pattern to the presence of spindle-shaped macrophages. Whereas, rosetting of CD4+ T-cells around Hodgkin- and Reed-Sternberg cells was frequently observed in classical Hodgkin lymphoma in immunocompetent persons; rosetting in a subset of HIV-related Hodgkin lymphoma cases appeared to involve cytoplasmic protrusions of spindle-shaped macrophages. HIV-related Hodgkin lymphoma, therefore, is characterized by unique morphologic features, which should be recognized by pathologists.
Collapse
|
11
|
Current World Literature. Curr Opin Oncol 2013; 25:205-208. [DOI: 10.1097/cco.0b013e32835ec49f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Revannasiddaiah S, Susheela SP, Thakur P, Rastogi M. Hodgkin's lymphoma involving extranodal sites: potential association with HIV infection and the implications for clinical management. CHINESE JOURNAL OF CANCER 2013; 32:102. [PMID: 23369727 PMCID: PMC3845614 DOI: 10.5732/cjc.012.10220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Swaroop Revannasiddaiah
- Department of Radiation Therapy & Oncology, HCG-Bangalore Institute of Oncology, Bengaluru, Karnataka 560027, India;
| | - Sridhar Papaiah Susheela
- Department of Radiation Therapy & Oncology, HCG-Bangalore Institute of Oncology, Bengaluru, Karnataka 560027, India;
| | - Priyanka Thakur
- Department of Radiation Therapy & Oncology, Regional Cancer Center, Indira Gandhi Medical College, Shimla, Himachal Pradesh 171001, India
| | - Madhup Rastogi
- Department of Radiation Therapy & Oncology, Regional Cancer Center, Indira Gandhi Medical College, Shimla, Himachal Pradesh 171001, India
| |
Collapse
|
13
|
Kudo E, Taura M, Matsuda K, Shimamoto M, Kariya R, Goto H, Hattori S, Kimura S, Okada S. Inhibition of HIV-1 replication by a tricyclic coumarin GUT-70 in acutely and chronically infected cells. Bioorg Med Chem Lett 2013; 23:606-9. [PMID: 23290051 DOI: 10.1016/j.bmcl.2012.12.034] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 12/09/2012] [Accepted: 12/12/2012] [Indexed: 11/21/2022]
Abstract
The anti-HIV-1 activity of GUT-70, a natural product derived from the stem bark of Chlophyllum brasiliense, was evaluated. GUT-70 inhibited HIV-1 replication in both acutely and chronically infected cells through suppression of NF-κB. Our results strengthen the idea that NF-κB pathway is one of the potential targets to control HIV-1 replication and that GUT-70 could serve as a lead compound to develop novel therapeutic agents against HIV-1 infection.
Collapse
Affiliation(s)
- Eriko Kudo
- Division of Hematopoiesis, Center for AIDS Research, Kumamoto University, 2-2-1 Honjo, Kumamoto 860-0811, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
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.
Collapse
|