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Hübel K, Bower M, Aurer I, Bastos-Oreiro M, Besson C, Brunnberg U, Cattaneo C, Collins S, Cwynarski K, Dalla Pria A, Hentrich M, Hoffmann C, Kersten MJ, Montoto S, Navarro JT, Oksenhendler E, Re A, Ribera JM, Schommers P, von Tresckow B, Buske C, Dreyling M, Davies A. Human immunodeficiency virus-associated lymphomas: EHA-ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2024; 35:840-859. [PMID: 39232987 DOI: 10.1016/j.annonc.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 09/06/2024] Open
Affiliation(s)
- K Hübel
- Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - M Bower
- National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - I Aurer
- Department of Internal Medicine, University Hospital Centre, Zagreb; Medical School, University of Zagreb, Zagreb, Croatia
| | - M Bastos-Oreiro
- Department of Hematology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - C Besson
- Department of Clinical Haematology, Versailles Hospital, Versailles; UVSQ, Université Paris-Saclay, UFR Santé Simone Veil, Inserm, CESP, Villejuif, France
| | - U Brunnberg
- Department of Hematology and Oncology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - C Cattaneo
- Department of Medical Oncology, Division of Hematology, ASST - Spedali Civili, Brescia, Italy
| | | | - K Cwynarski
- Department of Haematology, University College Hospital, London, UK
| | - A Dalla Pria
- National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - M Hentrich
- Department of Hematology and Oncology, Red Cross Hospital Munich, Ludwig Maximilian University, Munich
| | | | - M J Kersten
- Department of Hematology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - S Montoto
- Department of Haemato-oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - J T Navarro
- Department of Hematology, Institut Català d'Oncologia, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Oksenhendler
- Department of Clinical Immunology, Hôpital Saint-Louis, APHP, Paris, France
| | - A Re
- Department of Medical Oncology, Division of Hematology, ASST - Spedali Civili, Brescia, Italy
| | - J-M Ribera
- Department of Hematology, Institut Català d'Oncologia, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - P Schommers
- Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - B von Tresckow
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center and German Cancer Consortium (DKTK partner site Essen), University Hospital Essen, University of Duisburg-Essen, Essen
| | - C Buske
- Institute of Experimental Cancer Research, Department of Internal Medicine III, Ulm Medical University, Ulm
| | - M Dreyling
- Department of Medicine III, Ludwig-Maximilians-University, Munich, Germany
| | - A Davies
- General Hospital, University Hospital NHS Trust, Southampton, UK
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Hübel K, Bower M, Aurer I, Bastos‐Oreiro M, Besson C, Brunnberg U, Cattaneo C, Collins S, Cwynarski K, Pria AD, Hentrich M, Hoffmann C, Kersten MJ, Montoto S, Navarro J, Oksenhendler E, Re A, Ribera J, Schommers P, von Tresckow B, Buske C, Dreyling M, Davies A. Human immunodeficiency virus-associated Lymphomas: EHA-ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Hemasphere 2024; 8:e150. [PMID: 39233903 PMCID: PMC11369492 DOI: 10.1002/hem3.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/10/2024] [Indexed: 09/06/2024] Open
Abstract
This EHA-ESMO Clinical Practice Guideline provides key recommendations for managing HIV-associated lymphomas.The guideline covers clinical, imaging and pathological diagnosis; staging and risk assessment; treatment and follow-up.The author group encompasses a multidisciplinary group of experts from different institutions and countries in Europe.Recommendations are based on available scientific data and the authors' collective expert opinion.
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Affiliation(s)
- Kai Hübel
- Department of Internal MedicineFaculty of Medicine and University Hospital CologneCologneGermany
| | - Mark Bower
- National Centre for HIV Malignancy, Chelsea and Westminster HospitalLondonUK
| | - Igor Aurer
- Department of Internal MedicineUniversity Hospital CentreZagrebCroatia
- Medical SchoolUniversity of ZagrebZagrebCroatia
| | | | - Caroline Besson
- Department of Clinical HaematologyVersailles HospitalVersaillesFrance
- UVSQ, Université Paris‐Saclay, UFR Santé Simone Veil, Inserm, CESPVillejuifFrance
| | - Uta Brunnberg
- Department of Hematology and OncologyGoethe University Frankfurt, University HospitalFrankfurtGermany
| | - Chiara Cattaneo
- Department of Medical Oncology, Division of HematologyASST ‐ Spedali CiviliBresciaItaly
| | | | - Kate Cwynarski
- Department of HaematologyUniversity College HospitalLondonUK
| | - Alessia D. Pria
- National Centre for HIV Malignancy, Chelsea and Westminster HospitalLondonUK
| | - Marcus Hentrich
- Department of Hematology and OncologyRed Cross Hospital Munich, Ludwig Maximilian UniversityMunichGermany
| | | | - Marie J. Kersten
- Department of HematologyAmsterdam University Medical Centers, Cancer Center AmsterdamAmsterdamThe Netherlands
| | - Silvia Montoto
- Department of Haemato‐Oncology, St Bartholomew's HospitalBarts Health NHS TrustLondonUK
| | - Jose‐Tomas Navarro
- Department of HematologyInstitut Català d'Oncologia, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Eric Oksenhendler
- Department of Clinical ImmunologyHôpital Saint‐Louis, APHPParisFrance
| | - Alessandro Re
- Department of Medical Oncology, Division of HematologyASST ‐ Spedali CiviliBresciaItaly
| | - Josep‐Maria Ribera
- Department of HematologyInstitut Català d'Oncologia, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Philipp Schommers
- Department of Internal MedicineFaculty of Medicine and University Hospital CologneCologneGermany
| | - Bastian von Tresckow
- Department of Hematology and Stem Cell TransplantationWest German Cancer Center and German Cancer Consortium (DKTK partner site Essen), University Hospital Essen, University of Duisburg‐EssenEssenGermany
| | - Christian Buske
- Institute of Experimental Cancer Research, Department of Internal Medicine IIIUlmGermany
| | - Martin Dreyling
- Department of Medicine IIILudwig‐Maximilians‐UniversityMunichGermany
| | - Andy Davies
- General Hospital, University Hospital NHS TrustSouthamptonUK
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Verdu-Bou M, Tapia G, Hernandez-Rodriguez A, Navarro JT. Clinical and Therapeutic Implications of Epstein-Barr Virus in HIV-Related Lymphomas. Cancers (Basel) 2021; 13:5534. [PMID: 34771697 PMCID: PMC8583310 DOI: 10.3390/cancers13215534] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 10/29/2021] [Indexed: 12/26/2022] Open
Abstract
The incidence of lymphomas is increased in people living with HIV (PLWH). Aggressive B-cell non-Hodgkin lymphomas (NHLs) are the most common and are considered an AIDS-defining cancer (ADC). Although Hodgkin lymphoma (HL) is not considered an ADC, its incidence is also increased in PLWH. Among all HIV-related lymphomas (HRL), the prevalence of Epstein-Barr virus (EBV) is high. It has been shown that EBV is involved in different lymphomagenic mechanisms mediated by some of its proteins, contributing to the development of different lymphoma subtypes. Additionally, cooperation between both HIV and EBV can lead to the proliferation of aberrant B-cells, thereby being an additional lymphomagenic mechanism in EBV-associated HRL. Despite the close relationship between EBV and HRL, the impact of EBV on clinical aspects has not been extensively studied. These lymphomas are treated with the same therapeutic regimens as the general population in combination with cART. Nevertheless, new therapeutic strategies targeting EBV are promising for these lymphomas. In this article, the different types of HRL are extensively reviewed, focusing on the influence of EBV on the epidemiology, pathogenesis, clinical presentation, and pathological characteristics of each lymphoma subtype. Moreover, novel therapies targeting EBV and future strategies to treat HRL harboring EBV are discussed.
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Affiliation(s)
- Miriam Verdu-Bou
- Lymphoid Neoplasms Group, Josep Carreras Leukaemia Research Institute, Can Ruti Campus, 08916 Badalona, Spain;
| | - Gustavo Tapia
- Department of Pathology, Germans Trias i Pujol Hospital, Universitat Autònoma de Barcelona, 08916 Badalona, Spain;
| | - Agueda Hernandez-Rodriguez
- Department of Microbiology, Germans Trias i Pujol Hospital, Universitat Autònoma de Barcelona, 08916 Badalona, Spain;
| | - Jose-Tomas Navarro
- Lymphoid Neoplasms Group, Josep Carreras Leukaemia Research Institute, Can Ruti Campus, 08916 Badalona, Spain;
- Department of Hematology, Institut Català d’Oncologia-Germans Trias i Pujol Hospital, 08916 Badalona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08916 Badalona, Spain
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4
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Arslan S, Litzow MR, Cummins NW, Rizza SA, Badley AD, Navarro W, Hashmi SK. Risks and Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation for Hematologic Malignancies in Patients with HIV Infection. Biol Blood Marrow Transplant 2019; 25:e260-e267. [PMID: 30926447 DOI: 10.1016/j.bbmt.2019.03.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 03/20/2019] [Indexed: 11/24/2022]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative therapy for hematologic malignancies in persons living with HIV (PLHIV), however, uncertainties exist in many domains related to their care, including optimal donor selection, conditioning regimen, immunosuppression for graft-versus-host disease (GVHD), and long-term outcomes. We undertook a comprehensive systematic review from multiple databases to evaluate the foregoing uncertainties. The final sample comprised 49 patients (median age at HCT, 34 years; 46 males [93.8%]). Acute GVHD (aGVHD) was reported in 19 patients (59.3%) in the overall cohort, with grade II in 12 (37.5%) and grade III in 2 (6.2%). In the entire cohort, overall survival (OS) was 81.6% at 6 months and 56.6% at 12 months. Among 32 patients, the OS at 6 months was 73.3% for patients who received myeloablative conditioning (MAC) and 88.2% for those who received reduced-intensity conditioning (RIC), and OS at 12 months was 53.3% for MAC and 58.8% for RIC. Twenty-four patients were alive in complete remission on long-term follow-up, with 25 deaths reported. Fifteen deaths (60%) occurred due to relapse, including 3 (12%) from infection, 2 (8%) from GVHD, and 5 (20%) from other causes, including renal failure, respiratory failure, and liver failure. To our knowledge, this is the largest series of allo-HCT in PLHIV reported to date, and our results indicate that clinical outcomes (including engraftment, infection rate, and survival) are not significantly different from those in patients without HIV (historical controls). RIC regimens are associated with a slightly greater likelihood of survival compared with MAC regimens. Prospective trials are critically needed to evaluate the optimal conditioning regimens, ideal donor source, and most appropriate GVHD prophylaxis.
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Affiliation(s)
- Shukaib Arslan
- Department of Hematology/Hematopoietic Stem Cell Transplant, City of Hope National Cancer Center, Duarte, California
| | - Mark R Litzow
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nathan W Cummins
- Division of Infectious Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Stacey A Rizza
- Division of Infectious Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Andrew D Badley
- Division of Infectious Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Willis Navarro
- Department of Blood and Marrow Transplant, University of California, San Francisco, California; Clinical Research and Development, Atara Biotherapeutics, San Francisco, California
| | - Shahrukh K Hashmi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
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Hiv and Lymphoma: from Epidemiology to Clinical Management. Mediterr J Hematol Infect Dis 2019; 11:e2019004. [PMID: 30671210 PMCID: PMC6328036 DOI: 10.4084/mjhid.2019.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/23/2018] [Indexed: 01/19/2023] Open
Abstract
Patients infected with human immunodeficiency virus (HIV) are at increased risk for developing both non-Hodgkin’s lymphoma (NHL) and Hodgkin’s lymphoma (HL). Even if this risk has decreased for NHL after the introduction of combination antiretroviral therapy (cART), they remain the most common acquired immune deficiency syndrome (AIDS)-related cancer in the developed world. They are almost always of B-cell origin, and some specific lymphoma types are more common than others. Some of these lymphoma types can occur in both HIV-uninfected and infected patients, while others preferentially develop in the context of AIDS. HIV-associated lymphoma differs from lymphoma in the HIV negative population in that they more often present with advanced disease, systemic symptoms, and extranodal involvement and are frequently associated with oncogenic viruses (Epstein-Barr virus and/or human herpesvirus-8). Before the introduction of cART, most of these patients could not tolerate the treatment strategies routinely employed in the HIV-negative population. The widespread use of cART has allowed for the delivery of full-dose and dose-intensive chemotherapy regimens with improved outcomes that nowadays can be compared to those seen in non-HIV infected patients. However, a great deal of attention should be paid to opportunistic infections and other infectious complications, cART-chemotherapy interactions, and potential cumulative toxicity. In the context of relatively sparse prospective and randomized trials, the optimal treatment of AIDS-related lymphomas remains a challenge, particularly in patients with severe immunosuppression. This paper will address epidemiology, pathogenesis, and therapeutic strategies in HIV-associated NHL and HL.
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Biology and management of primary effusion lymphoma. Blood 2018; 132:1879-1888. [DOI: 10.1182/blood-2018-03-791426] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 08/24/2018] [Indexed: 12/14/2022] Open
Abstract
Abstract
Primary effusion lymphoma (PEL) is a rare B-cell malignancy that most often occurs in immunocompromised patients, such as HIV-infected individuals and patients receiving organ transplantation. The main characteristic of PEL is neoplastic effusions in body cavities without detectable tumor masses. The onset of the disease is associated with latent infection of human herpes virus 8/Kaposi sarcoma–associated herpes virus, and the normal counterpart of tumor cells is B cells with plasmablastic differentiation. A condition of immunodeficiency and a usual absence of CD20 expression lead to the expectation of the lack of efficacy of anti-CD20 monoclonal antibody; clinical outcomes of the disease remain extremely poor, with an overall survival at 1 year of ∼30%. Although recent progress in antiretroviral therapy has improved outcomes of HIV-infected patients, its benefit is still limited in patients with PEL. Furthermore, the usual high expression of programmed death ligand 1 in tumor cells, one of the most important immune-checkpoint molecules, results in the immune escape of tumor cells from the host immune defense, which could be the underlying mechanism of poor treatment efficacy. Molecular-targeted therapies for the activating pathways in PEL, including NF-κB, JAK/STAT, and phosphatidylinositol 3-kinase/AKT, have emerged to treat this intractable disease. A combination of immunological recovery from immune deficiency, overcoming the immune escape, and the development of more effective drugs will be vital for improving the outcomes of PEL patients in the future.
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Abstract
Primary effusion lymphoma (PEL) is a rare and aggressive disease, affecting a unique population of patients who are often elderly or immunocompromised. PEL is associated with human herpesvirus type-8 infection and most commonly presents as malignant effusions of the body cavities. Patients diagnosed with PEL often have a compromised immune system from secondary conditions such as HIV. Chemotherapy has traditionally been the cornerstone of treatment for patients with a good performance status and no significant comorbidities. However, an optimal regimen does not exist. Most patients with PEL experience a relapse after frontline therapy within 6-8 months and subsequently require further treatment. In recent years, our understanding of the molecular drivers and environmental factors affecting the pathogenesis of PEL has expanded. This review will discuss the pathogenesis of PEL and various management approaches available in the frontline and relapsed setting as well as targeted agents that have shown promise in this disease.
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Affiliation(s)
- Mayur Narkhede
- Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC, USA,
| | - Shagun Arora
- Division of Hematology and Oncology, University of California, San Francisco, CA, USA
| | - Chaitra Ujjani
- Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC, USA,
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Gruffaz M, Zhou S, Vasan K, Rushing T, Michael QL, Lu C, Jung JU, Gao SJ. Repurposing Cytarabine for Treating Primary Effusion Lymphoma by Targeting Kaposi's Sarcoma-Associated Herpesvirus Latent and Lytic Replications. mBio 2018; 9:mBio.00756-18. [PMID: 29739902 PMCID: PMC5941074 DOI: 10.1128/mbio.00756-18] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/11/2018] [Indexed: 02/05/2023] Open
Abstract
Oncogenic Kaposi's sarcoma-associated herpesvirus (KSHV) is etiologically linked to primary effusion lymphoma (PEL), an aggressive and nontreatable malignancy commonly found in AIDS patients. In this study, we performed a high-throughput screening of 3,731 characterized compounds and identified cytarabine, approved by the FDA for treating numerous types of cancer, as a potent inhibitor of KSHV-induced PEL. We showed the high efficacy of cytarabine in the growth inhibition of various PEL cells by inducing cell cycle arrest and apoptosis. Cytarabine inhibited host DNA and RNA syntheses and therefore induced cellular cytotoxicity. Furthermore, cytarabine inhibited viral DNA and RNA syntheses and induced the rapid degradation of KSHV major latent protein LANA (latency-associated nuclear antigen), leading to the suppression of KSHV latent replication. Importantly, cytarabine effectively inhibited active KSHV replication and virion production in PEL cells. Finally, cytarabine treatments not only effectively inhibited the initiation and progression of PEL tumors but also induced regression of grown PEL tumors in a xenograft mouse model. Altogether, our study has identified cytarabine as a novel therapeutic agent for treating PEL as well as eliminating KSHV persistent infection.IMPORTANCE Primary effusion lymphoma is an aggressive malignancy caused by Kaposi's sarcoma-associated herpesvirus. The outcome of primary effusion lymphoma is dismal without specific treatment. Through a high-throughput screening of characterized compounds, we identified an FDA-approved compound, cytarabine, as a potent inhibitor of primary effusion lymphoma. We showed that cytarabine induced regression of PEL tumors in a xenograft mouse model. Cytarabine inhibited host and viral DNA and RNA syntheses, resulting in the induction of cytotoxicity. Of interest, cytarabine induced the degradation of KSHV major latent protein LANA, hence suppressing KSHV latent replication, which is required for PEL cell survival. Furthermore, cytarabine inhibited KSHV lytic replication program, preventing virion production. Our findings identified cytarabine as a novel therapeutic agent for treating PEL as well as for eliminating KSHV persistent infection. Since cytarabine is already approved by the FDA, it might be an ideal candidate for repurposing for PEL therapy and for further evaluation in advanced clinical trials.
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MESH Headings
- Animals
- Antigens, Viral/genetics
- Antigens, Viral/metabolism
- Antiviral Agents/administration & dosage
- Apoptosis/drug effects
- Cell Line, Tumor
- Cytarabine/administration & dosage
- DNA Replication/drug effects
- Female
- Herpesvirus 8, Human/drug effects
- Herpesvirus 8, Human/genetics
- Herpesvirus 8, Human/physiology
- Humans
- Lymphoma, Primary Effusion/drug therapy
- Lymphoma, Primary Effusion/physiopathology
- Lymphoma, Primary Effusion/virology
- Mice, Inbred NOD
- Mice, SCID
- Nuclear Proteins/genetics
- Nuclear Proteins/metabolism
- Sarcoma, Kaposi/drug therapy
- Sarcoma, Kaposi/physiopathology
- Sarcoma, Kaposi/virology
- Virus Latency/drug effects
- Virus Replication/drug effects
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Affiliation(s)
- Marion Gruffaz
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Shenghua Zhou
- Eli and Edythe Broad CIRM Center for Regenerative Medicine and Stem Cell Research, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Karthik Vasan
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Teresa Rushing
- Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Qing Liu Michael
- Eli and Edythe Broad CIRM Center for Regenerative Medicine and Stem Cell Research, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Chu Lu
- Department of Microbiology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jae U Jung
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Shou-Jiang Gao
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Laboratory of Human Virology and Oncology, Shantou University Medical College, Shantou, Guangdong, China
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9
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Miralles P, Navarro JT, Berenguer J, Gómez Codina J, Kwon M, Serrano D, Díez-Martín JL, Villà S, Rubio R, Menárguez J, Ribera Santasusana JM. GESIDA/PETHEMA recommendations on the diagnosis and treatment of lymphomas in patients infected by the human immunodeficiency virus. Med Clin (Barc) 2018; 151:39.e1-39.e17. [PMID: 29357988 DOI: 10.1016/j.medcli.2017.11.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/21/2017] [Accepted: 11/02/2017] [Indexed: 01/20/2023]
Abstract
The incidence of non-Hodgkin's lymphoma and Hodgkin's lymphoma is higher in patients with HIV infection than in the general population. Following the introduction of combination antiretroviral therapy (cART), the prognostic significance of HIV-related variables has decreased, and lymphoma-related factors have become more pronounced. Currently, treatments for lymphomas in HIV-infected patients do not differ from those used in the general population. However, differentiating characteristics of seropositive patients, such as the need for cART and specific prophylaxis and treatment of certain opportunistic infections, should be considered. This document updates recommendations on the diagnosis and treatment of lymphomas in HIV infected patients published by GESIDA/PETHEMA in 2008.
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Affiliation(s)
- Pilar Miralles
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España.
| | - José Tomás Navarro
- Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autónoma de Barcelona, Badalona, Barcelona, España
| | - Juan Berenguer
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | | | - Mi Kwon
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - David Serrano
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - José Luis Díez-Martín
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - Salvador Villà
- Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autónoma de Barcelona, Badalona, Barcelona, España
| | | | - Javier Menárguez
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - José-María Ribera Santasusana
- Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autónoma de Barcelona, Badalona, Barcelona, España
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Kanakry JA, Ambinder RF. Virus-Associated Lymphoma. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00083-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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11
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How I treat patients with HIV-related hematological malignancies using hematopoietic cell transplantation. Blood 2017; 130:1976-1984. [PMID: 28882882 DOI: 10.1182/blood-2017-04-551606] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/28/2017] [Indexed: 12/20/2022] Open
Abstract
Hematopoietic cell transplantation (HCT) has now been shown to be safe and effective for selected HIV-infected patients with hematological malignancies. Autologous HCT is now the standard of care for patients with HIV-related lymphomas who otherwise meet standard transplant criteria. Limited data also support use of allogeneic HCT (alloHCT) in selected HIV-infected patients who meet standard transplant criteria. We recommend enrolling patients in clinical trials that offer access to CCR5Δ32 homozygous donors, if available. HIV-infected patients requiring HCT may also be considered for participation in trials evaluating the activity of gene-modified hematopoietic stem cells in conferring resistance to HIV infection. To be considered for HCT, patients must have HIV infection that is responsive to combination antiretroviral therapy (cART). Careful planning for the peri-HCT management of the cART can avoid risk of significant drug interactions and development of cART-resistant HIV. In general, we recommend against the use of boosted proteasome inhibitors and nonnucleotide reverse transcriptase inhibitors in the cART regimen, in favor of nucleoside reverse transcriptase inhibitors and integrase inhibitors (without cobicistat). After HCT, patients must be closely monitored for development of opportunistic infections (OI), such as cytomegalovirus. Prevention of OI should include prophylactic and pre-emptive antimicrobials.
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12
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Klepfish A, Zuckermann B, Schattner A. Primary effusion lymphoma in the absence of HIV infection--clinical presentation and management. QJM 2015; 108:481-8. [PMID: 25413797 DOI: 10.1093/qjmed/hcu232] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Indexed: 01/13/2023] Open
Abstract
Primary Effusion Lymphoma (PEL) is a rare type of Non-Hodgkin's Lymphoma caused by human herpesvirus type 8, also termed Kaposi's sarcoma-associated herpesvirus. It usually occurs in human immunodeficiency virus (HIV)-infected patients. A subset of patients is not infected with HIV and their treatment remains poorly defined. To clarify treatment issues in HIV-negative PEL patients, we report on two such patients who represent two opposing ends in the spectrum of treatment and review the literature regarding treatment options and patient outcomes. Either repeated cycles of chemotherapy or, surprisingly, drainage of the malignant effusions alone, proved very effective in our patients. The literature reveals additional treatment options which may be effective including immunochemotherapy, stem cell transplantation, antiviral treatment and immunomodulatory and targeted biological therapy. However, no controlled trials were found due to the rarity of the condition. In the absence of controlled trials, treatment decisions in PEL not associated with HIV must remain individual and patient-tailored.
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Affiliation(s)
- A Klepfish
- From the Blood Bank and Department of Hematology, Department of Cardio-Thoracic Surgery, Edith Wolfson Medical Centre, Holon and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv and The Faculty of Medicine, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - B Zuckermann
- From the Blood Bank and Department of Hematology, Department of Cardio-Thoracic Surgery, Edith Wolfson Medical Centre, Holon and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv and The Faculty of Medicine, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - A Schattner
- From the Blood Bank and Department of Hematology, Department of Cardio-Thoracic Surgery, Edith Wolfson Medical Centre, Holon and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv and The Faculty of Medicine, Hebrew University Hadassah Medical School, Jerusalem, Israel
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Castillo JJ, Chavez JC, Hernandez-Ilizaliturri FJ, Montes-Moreno S. CD20-negative diffuse large B-cell lymphomas: biology and emerging therapeutic options. Expert Rev Hematol 2015; 8:343-54. [DOI: 10.1586/17474086.2015.1007862] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Krishnan A, Zaia JA. HIV-associated non-Hodgkin lymphoma: viral origins and therapeutic options. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2014; 2014:584-589. [PMID: 25696915 DOI: 10.1182/asheducation-2014.1.584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
HIV infection is associated with an increased risk of malignancy, especially B-cell lymphoid malignancies. Many of these lymphomas are further driven by concomitant infection with viruses such as Epstein-Barr virus or Human Herpesvirus 8, the latter being implicated in uncommon types of lymphomas seen in the setting of HIV-1 infection. Treatment outcomes have improved due to infusional chemotherapy, high-dose chemotherapy, and effective antiretroviral therapy. Successful functional cure of HIV-1 infection has been demonstrated with the use of allogeneic hematopoietic stem cell transplantation. This result spurred a change in the field of HIV-1 management so that, ultimately, the goals of therapy would shift from not only curing the underlying lymphoma, but also curing the HIV-1 infection. Treatment options will be discussed with an emphasis on hematopoietic cell-based therapy for the underlying HIV infection.
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Affiliation(s)
- Amrita Krishnan
- Department of Hematology and Hematopoietic Cell Transplantation and
| | - John A Zaia
- Department of Virology, Beckman Research Institute, City of Hope Medical Center, Duarte, CA
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Abstract
In human immunodeficiency virus (HIV)-infected persons, the incidence of hematologic malignancies, including leukemia and lymphoma, is increased despite the use of successful antiretroviral therapy. Hematopoietic stem cell transplantation (SCT) is emerging as a safe and effective therapy for HIV-infected persons with hematologic malignancies. Management of these patients is complicated by drug-drug interactions involving antiretroviral therapy (ART) that may impact conditioning agent efficacy and metabolism of immunosuppressive medications and potentiate drug toxicities. As such, optimal strategies for ART remain controversial. We discuss recent advances, controversies, and future directions related to SCT in HIV-infected persons, including the investigation of allogeneic SCT as a strategy for HIV cure.
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Affiliation(s)
- Ignacio A Echenique
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave, Suite 900, Chicago, IL, 60611, USA,
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Okada S, Goto H, Yotsumoto M. Current status of treatment for primary effusion lymphoma. Intractable Rare Dis Res 2014; 3:65-74. [PMID: 25364646 PMCID: PMC4214239 DOI: 10.5582/irdr.2014.01010] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 06/17/2014] [Accepted: 06/18/2014] [Indexed: 12/12/2022] Open
Abstract
Primary effusion lymphoma (PEL) is a rare and aggressive B-cell non-Hodgkin's lymphoma that usually presents with malignant effusions without tumor masses. An extracavitary or solid variant of PEL has also been described. Human herpes virus 8/Kaposi sarcoma-associated herpes virus (HHV-8/KSHV) is universally associated with the pathogenesis of PEL. More than 70% of cases occur with concurrent Epstein-Barr virus infection, but its relation to the pathogenesis is unknown. Patients are found in the context of immunosuppressive states (HIV-1 infection, post-organ transplantation). PEL is usually treated with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone)-like chemotherapy with antiretroviral therapy if HIV-1 is positive. However, it is generally resistant to chemotherapy with a short median survival of less than 6 months. The optimal treatment for PEL has not been established yet. More intensive chemotherapy, such as dose-adjusted EPOCH (DA-EPOCH; etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin) and CDE (cyclophosphamide, doxorubicin, etoposide) are expected to show a favorable prognosis. Recently, the molecular steps in KSHV/HHV-8-driven oncogenesis have begun to be revealed, and molecular targeting therapies such as proteasome, NF-κB, cytokines and surface antigens would provide evidence for their clinical use.
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Affiliation(s)
- Seiji Okada
- Division of Hematopoiesis, Center for AIDS Research, Kumamoto University, Kumamoto, Japan
- Address correspondence to: Dr. Seiji Okada, Division of Hematopoiesis, Center for AIDS Research, Kumamoto University, Japan 2-2-1 Honjo, Kumamoto, 860-0811, Japan. E-mail:
| | - Hiroki Goto
- Division of Hematopoiesis, Center for AIDS Research, Kumamoto University, Kumamoto, Japan
| | - Mihoko Yotsumoto
- Department of Laboratory Medicine, Tokyo Medical University, Tokyo, Japan
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Primary effusion lymphoma in an elderly patient effectively treated by lenalidomide: case report and review of literature. Blood Cancer J 2014; 4:e190. [PMID: 24608734 PMCID: PMC3972705 DOI: 10.1038/bcj.2014.6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 01/24/2014] [Indexed: 12/27/2022] Open
Abstract
Primary effusion lymphoma (PEL) is a rare aggressive subset of non-Hodgkin B-cell lymphoma. It is caused by Kaposi sarcoma-associated herpesvirus/human herpesvirus type 8 (KSHV/HHV8). It occurs mainly, but not exclusively, in HIV-positive patients. PEL predominantly develops in serous cavities and occasionally in extracavitary regions. PEL carries a very poor prognosis with a median survival time of <6 months. Indeed, currently used treatment modalities such as CHOP chemotherapy are far from achieving complete and sustainable remission. Therefore, there is no clear standard of care established in the treatment of PEL patients, stressing the need for novel-targeted approaches. Here, we have attempted a comprehensive assessment of the treatment of PEL, discussed avant-garde therapies and updated the state of preclinical research with promising clinical applications in the field. These include inhibitors of viral replication, modulators of cell signaling and inflammation, nuclear factor kappa B (NF-κB) and histone deacetylase inhibitors, and recently the combination of arsenic trioxide and interferon-alpha. Some of these targeted therapies have not yet reached clinical studies, although others were used in a few individual case reports with low numbers of patients. We also describe the first case of a 77-year-old, HIV-negative, HHV8-positive patient diagnosed with PEL limited to the pleural and peritoneal cavities. He received lenalidomide 25 mg/day for 21 days every 28 days. Treatment was well tolerated with no side effects. He rapidly improved after 1 month of treatment and progressively achieved complete remission persistent after 18 months of therapy. We believe that this review will bridge an important gap between classical chemotherapy and modern approaches of targeted therapy. Finally, our findings warrant further evaluation of lenalidomide in future prospective clinical studies.
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Serrano D, Miralles P, Balsalobre P, Kwon M, Rodriguez-Macias G, Gayoso J, Anguita J, Buño I, Berenguer J, Díez-Martín JL. Graft-versus-tumor effect after allogeneic stem cell transplantation in HIV-positive patients with high-risk hematologic malignancies. AIDS Res Hum Retroviruses 2013; 29:1340-5. [PMID: 23800257 DOI: 10.1089/aid.2013.0001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) is a well-established therapeutic option for hematological malignancies. Combination antiretroviral therapy (cART) has enabled the treatment of medical conditions in patients infected with the human immunodeficiency virus (HIV) in the same way as in the general population. Moreover, improvements in supportive care have allowed HIV-infected patients with life-threatening hematological disorders to be treated with Allo-HSCT. We report on four HIV-infected patients with hematological malignancies receiving an Allo-HSCT in our institution, and on the use of donor lymphocyte infusions to successfully treat post-Allo-HSCT relapse. Of note, one of them is the first HIV(+) patient to receive a "dual transplant" (unrelated umbilical cord blood stem cells combined with mobilized T cell-depleted CD34(+) stem cells from a mismatched third party donor). cART drugs interactions were satisfactorily managed. This approach provided long-term control of the hematological disease. Nevertheless, despite adequate immune reconstitution, infections were the main cause of morbidity and mortality after Allo-HSCT.
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Affiliation(s)
- David Serrano
- Department of Hematology-BMT Unit, H.G.U. Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Pilar Miralles
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
- Infectious Diseases Unit, H.G.U. Gregorio Marañón, Madrid, Spain
| | - Pascual Balsalobre
- Department of Hematology-BMT Unit, H.G.U. Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Mi Kwon
- Department of Hematology-BMT Unit, H.G.U. Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Gabriela Rodriguez-Macias
- Department of Hematology-BMT Unit, H.G.U. Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Jorge Gayoso
- Department of Hematology-BMT Unit, H.G.U. Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Javier Anguita
- Department of Hematology-BMT Unit, H.G.U. Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Ismael Buño
- Department of Hematology-BMT Unit, H.G.U. Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
| | - Juan Berenguer
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
- Infectious Diseases Unit, H.G.U. Gregorio Marañón, Madrid, Spain
| | - José L. Díez-Martín
- Department of Hematology-BMT Unit, H.G.U. Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute (IISGM), Madrid, Spain
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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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Hütter G, Zaia JA. Allogeneic haematopoietic stem cell transplantation in patients with human immunodeficiency virus: the experiences of more than 25 years. Clin Exp Immunol 2011; 163:284-95. [PMID: 21303358 DOI: 10.1111/j.1365-2249.2010.04312.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
For treatment of several malignancies, transplantation of allogeneic haematopoietic stem cells (HSCT) derived from bone marrow or peripheral blood has been used as a therapeutic procedure for decades. In the past, HSCT has been suggested as a treatment option for infection with the human immunodeficiency virus type 1 (HIV-1), but these attempts were mostly unsuccessful. Today, after the introduction of an active anti-retroviral therapy, the lifetime expectancy of HIV-infected patients has improved substantially, but nevertheless the incidence rate of malignancies in these patients has increased considerably. Therefore, it can be assumed that there will be a rising necessity for HIV-1-infected patients with malignancies for allogeneic HSCT. At the same time, there is increasing interest in treatment methods which might target the HIV-1 reservoir more effectively, and the question has been raised as to whether allogeneic HSCT could be linked to such strategies. In this paper the data of more than 25 years experience with allogeneic HSCT in patients with HIV-1 are reviewed and analysed.
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Affiliation(s)
- G Hütter
- Institute of Transfusion Medicine and Immunology, Heidelberg University, Mannheim, Germany.
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Michieli M, Mazzucato M, Tirelli U, De Paoli P. Stem Cell Transplantation for Lymphoma Patients with HIV Infection. Cell Transplant 2011; 20:351-70. [DOI: 10.3727/096368910x528076] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The advent of Highly Active Antiretroviral Therapy (HAART) has radically changed incidence characteristics and prognosis of HIV-positive patients affected by lymphomas. At this time there is consensus in the literature that, in first line, HIV-positive patients should always be treated with curative intent preferentially following the same approach used in the HIV-negative counterpart. On the contrary, an approach of salvage therapy in HIV-positive lymphomas is still a matter of debate given that for a wide range of relapsed or resistant HIV-negative Hodgkin's disease (HD) and non-Hodgkin lymphoma (NHL) patients, autologous peripheral or allogeneic stem cell transplantation are among the established options. In the pre-HAART era, therapeutic options derived from pioneering experiences gave only anecdotal success, either when transplantation was used to cure lymphomas or to improve HIV infection itself. Concerns relating to the entity, quality, and kinetics of early and late immune reconstitutions and the possible worsening of underlying viroimmunological conditions were additional obstacles. Currently, around 100 relapsed or resistant HIV-positive lymphomas have been treated with an autologous peripheral stem cell transplantation (APSCT) in the HAART era. Published data compared favorably with any previous salvage attempt showing a percentage of complete remission ranging from 48% to 90%, and overall survival ranging from 36% to 85% at median follow-up approaching 3 years. However, experiences are still limited and have given somewhat confounding indications, especially concerning timing and patients' selection for APSCT and feasibility and outcome for allogeneic stem cell transplant. Moreover, little data exist on the kinetics of immunological reconstitution after APSCT or relevant to the outcome of HIV infection. The aim of this review is to discuss current knowledge of the role of allogeneic and autologous stem cell transplantation as a modality in the cure of HIV and hemopoietic cancer patients. Several topics dealing with practical aspects concerning the management of APSCT in HIV-positive patients, including patient selection, timing of transplant, conditioning regimen, and relapse or nonrelapse mortality, are discussed. Data relating to the effects of mobilization and transplantation on virological parameters and pre- and posttransplant immune reconstitution are reviewed. Finally, in this review, we examine several ethical and legal issues relative to banking infected or potentially infected peripheral blood stem cells and we describe our experience and strategies to protect positive and negative donors/recipients and the health of caretakers.
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Affiliation(s)
- Mariagrazia Michieli
- Cell Therapy and High Dose Chemotherapy Unit, Centro di Riferimento Oncologico, CRO IRCCS, Aviano, Italy
| | - Mario Mazzucato
- Stem Cell Collection and Processing Unit, Centro di Riferimento Oncologico, CRO IRCCS, Aviano, Italy
| | - Umberto Tirelli
- Medical Oncology A, Centro di Riferimento Oncologico, CRO IRCCS, Aviano, Italy
| | - Paolo De Paoli
- Scientific Directorate, Centro di Riferimento Oncologico, CRO IRCCS, Aviano, Italy
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Abstract
PURPOSE OF REVIEW HIV-infected individuals remain at an increased risk for developing malignancies despite the use of combined antiretroviral therapy. Lymphomas comprise a large proportion of the malignancies that affect the HIV-infected population in developed countries. This review summarizes the recent progress made in HIV lymphoma research published in 2009 through January 2010. RECENT FINDINGS The majority of investigation in this field has been in diffuse large B-cell lymphoma, with infusional therapy remaining promising. Rituximab likely improves complete response and possibly overall survival, but may be associated with increased infections in a subset of patients with very low CD4 cell counts. Risk factors associated with the development of lymphoma include low CD4 cell count and likely cumulative HIV viremia. Biologic insights have been realized regarding pathogenesis. SUMMARY Overall, the outcome for HIV lymphoma continues to improve as insights into the pathophysiology and treatment advance.
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Serrano D, Miralles P, Balsalobre P, Díez-Martin JL, Berenguer J. Hematopoietic Stem Cell Transplantation in Patients Infected With HIV. Curr HIV/AIDS Rep 2010; 7:175-84. [DOI: 10.1007/s11904-010-0050-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
The human herpesvirus 8 (HHV-8) is the oncogenic virus associated with Kaposi's sarcoma (KS) and lymphoproliferative disorders, namely, primary effusion lymphoma and multicentric Castleman's disease. KS is among the most common malignancies seen in HIV-infected patients despite the decreased incidence of KS in the era of highly active antiretroviral therapy. Advances in molecular pathology reveal HHV-8 tumorigenesis is mediated through molecular mimicry wherein viral-encoded proteins can activate several cellular signaling cascades while evading immune surveillance. This knowledge has led to the evolution of multiple therapeutic strategies against specific molecular targets. Many such therapeutic modalities have shown activity, but none have proven to be curative. Identifying possible prognostic factors is another active area of research. This review summarizes the recent developments in the fields of virus transmission, molecular biology, and treatment of HHV-8-related neoplasms.
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Affiliation(s)
- Meena Sunil
- Department of Hematology/Medical Oncology, Winship Cancer Institute, Emory University, Room 2054, 1365C Clifton Road, Atlanta, GA 30322 USA
| | - Erin Reid
- Hematology/Oncology, Moores Cancer Center, University of California, San Diego, 3855 Health Sciences, MC #0987 La Jolla, CA USA
| | - Mary Jo Lechowicz
- Department of Hematology/Medical Oncology, Winship Cancer Institute, Emory University, Room 2054, 1365C Clifton Road, Atlanta, GA 30322 USA
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Gupta V, Tomblyn M, Pedersen TL, Atkins HL, Battiwalla M, Gress RE, Pollack MS, Storek J, Thompson JC, Tiberghien P, Young JAH, Ribaud P, Horowitz MM, Keating A. Allogeneic hematopoietic cell transplantation in human immunodeficiency virus-positive patients with hematologic disorders: a report from the center for international blood and marrow transplant research. Biol Blood Marrow Transplant 2009; 15:864-71. [PMID: 19539219 DOI: 10.1016/j.bbmt.2009.03.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Accepted: 03/28/2009] [Indexed: 11/27/2022]
Abstract
The role of allogeneic hematopoietic cell transplantation (alloHCT) in human immunodeficiency virus (HIV)-positive patients is not known. Using the Center for International Blood and Marrow Transplant Research database, we retrospectively evaluated 23 HIV-positive patients undergoing matched sibling donor (n = 19) or unrelated donor (n = 4) alloHCT between 1987 and 2003. The median age at alloHCT was 32 years. Indications for alloHCT were diverse and included malignant (n = 21) and nonmalignant (n = 2) hematologic disorders. Nine patients (39%) underwent transplantation after 1996, the approximate year that highly active antiretroviral therapy became standard treatment. The median time to neutrophil engraftment was 16 days (range, 7 to 30 days), and the cumulative incidences of grade II-IV acute graft-versus-host disease (aGVHD) at 100 days, chronic GVHD (cGVHD), and survival at 2 years were 30% (95% confidence interval [CI] = 14% to 50%), 28% (95% CI = 12% to 48%), and 30% (95% CI = 14% to 50%), respectively. At a median follow-up of 59 months, 6 patients were alive. Survival appears to be better in the patients undergoing alloHCT after 1996; 4 of these 9 patients survived, compared with only 2 of 14 those undergoing transplantation before 1996. These data suggest that alloHCT is feasible for selected HIV-positive patients with malignant and nonmalignant disorders. Prospective studies are needed to evaluate the safety and efficacy of this modality in specific diseases in these patients.
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Affiliation(s)
- Vikas Gupta
- Division of Haematology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada.
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