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Re A, Cattaneo C, Montoto S. Treatment management of haematological malignancies in people living with HIV. LANCET HAEMATOLOGY 2020; 7:e679-e689. [PMID: 32791044 DOI: 10.1016/s2352-3026(20)30115-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/15/2020] [Accepted: 04/06/2020] [Indexed: 01/10/2023]
Abstract
Although the incidence of HIV-associated lymphomas decreased after the introduction of effective combination antiretroviral therapy, they became the most common AIDS-related cancer in high-income countries. Moreover, as people living with HIV live longer, a wide range of non-AIDS-related cancer has emerged, including other haematological malignancies. Nonetheless, combination antiretroviral therapy has offered people with HIV the opportunity to receive the same therapies as those provided to the general population, and intensive curative therapies have become the standard. However, several population-based studies highlight a major health-care disparity between people with HIV and those without, with people who are HIV positive often excluded from using innovative therapies and participating in prospective trials. In addition, patients from low-income countries frequently receive inappropriate treatment. The hope is that with increased awareness of effective curative options these disparities will decrease, and people with HIV will be given the same therapeutic opportunities and enrolled in clinical trials alongside patients who are HIV negative.
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Affiliation(s)
- Alessandro Re
- Department of Hematology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy.
| | - Chiara Cattaneo
- Department of Hematology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Silvia Montoto
- Department of Haemato-Oncology, St Bartholomew's Hospital, London, UK
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Yoshinaga N, Kanda J, Aisa Y, Hagiwara S, Mori T, Fukuda T, Ishida Y, Hashimoto H, Iwato K, Kanda Y, Kurokawa M, Nakazawa H, Ota S, Uchida N, Ichinohe T, Atsuta Y, Takaori-Kondo A. Impact of HIV Infection on Transplant Outcomes after Autologous Peripheral Blood Stem Cell Transplantation: A Retrospective Study of Japanese Registry Data. Biol Blood Marrow Transplant 2018; 24:1596-1601. [PMID: 29551446 DOI: 10.1016/j.bbmt.2018.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 03/08/2018] [Indexed: 12/18/2022]
Abstract
Autologous stem cell transplantation (ASCT) is a treatment option for HIV-positive patients with non-Hodgkin lymphoma (NHL) and multiple myeloma (MM). However, the prognosis after ASCT in HIV-positive Japanese patients remains unclear. The aim of this study was to evaluate the impact of HIV infection on transplant outcomes after ASCT in Japan. Using the national database of the Japan Society for Hematopoietic Cell Transplantation, we retrospectively evaluated patients with NHL (n = 3862) and MM (n = 2670) who underwent their first ASCT between 2001 and 2014. The presence of HIV antibody was used to diagnose HIV infection. Fifty-six patients with NHL (1.4%) and 23 with MM (.8%) were positive for HIV antibody. Among patients with NHL overall survival (OS) was lower in HIV-positive patients than in HIV-negative patients (5-year OS: HIV-positive patients, 44% versus HIV-negative patients, 65%; P < .001). In a multivariate analysis HIV infection was significantly associated with an increased risk of overall mortality (hazard ratio, 2.30; P < .001). The incidence of relapse was higher in HIV-positive patients (P = .036), whereas there was a similar incidence of nonrelapse mortality (P = .879). OS in patients with MM was similar between those with/without HIV infection (5-year OS: HIV-positive patients, 61% versus HIV-negative patients, 63%; P = .988). HIV infection was associated with a higher risk of overall mortality and relapse after ASCT for NHL in a Japanese population.
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Affiliation(s)
- Noriyoshi Yoshinaga
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Junya Kanda
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshinobu Aisa
- Department of Hematology, Yokohama Municipal Citizen's Hospital, Kanagawa, Japan
| | - Shotaro Hagiwara
- Division of Hematology, Tokyo Women's Medical University, Tokyo, Japan; Cell Processing Center National Center for Global Health and Medicine, Tokyo, Japan
| | - Takehiko Mori
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Yoji Ishida
- Division of Hematology and Oncology, Department of Internal Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Hisako Hashimoto
- Department of Hematology/Division of Stem Cell Transplantation, Kobe General Hospital/Institute of Biomedical Research and Innovation, Kobe, Japan
| | - Koji Iwato
- Department of Hematology, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Mineo Kurokawa
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideyuki Nakazawa
- Division of Hematology, Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Shuichi Ota
- Department of Hematology, Sapporo Hokuyu Hospital, Hokkaido, Japan
| | - Naoyuki Uchida
- Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan; Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akifumi Takaori-Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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Hütter G. Stem cell transplantation in strategies for curing HIV/AIDS. AIDS Res Ther 2016; 13:31. [PMID: 27625700 PMCID: PMC5020531 DOI: 10.1186/s12981-016-0114-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/17/2016] [Indexed: 01/08/2023] Open
Abstract
HIV-1 can persist in a latent form in resting memory CD4+ cells and macrophages carrying an integrated copy of the HIV genome. Because of the presence of these stable reservoir cells, eradication by antiretroviral therapy is unlikely and in order to achieve eradication, alternative treatment options are required. Stem cell transplantation has been considered previously to effect the clinical course of HIV-infection but in practice eradication or virus control was not achievable. However, modifications of stem cell transplantation using natural or artificial resistant cell sources, combination with new techniques of gene editing or generating cytotoxic anti HIV effector cells have stimulated this field of HIV cell therapy substantially. Here, we look back on 30 years of stem cell therapy in HIV patients and discuss most recent developments in this direction.
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Bibas M, Castillo JJ. Current knowledge on HIV-associated Plasmablastic Lymphoma. Mediterr J Hematol Infect Dis 2014; 6:e2014064. [PMID: 25408850 PMCID: PMC4235470 DOI: 10.4084/mjhid.2014.064] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 09/21/2014] [Indexed: 12/19/2022] Open
Abstract
HIV-associated PBL is an AIDS-defining cancer, classified by WHO as a distinct entity of aggressive DLBCL. To date less than 250 cases have been published, of them 17 are pediatric. The pathogenesis of this rare disease is related to immunodeficiency, chronic immune stimulation and EBV. Clinically is a rapid growing destructive disease mainly involving the oral cavity even if extraoral and extranodal sites are not infrequent. The diagnosis requires tissue mass or lymph node biopsy and core needle or fine needle biopsy is acceptable only for difficult access sites. Classically immunophenotype is CD45, CD20, CD79a negative and CD38, CD138, MUM1 positive, EBER and KI67 is >80%. Regarding the therapy, standard treatment is, usually, CHOP or CHOP-like regimens while more intensive regimens as CODOX-M/IVAC or DA-EPOCH are possible options. Use of cART is recommended during chemotherapy, keeping in mind the possible overlapping toxicities. Rituximab is not useful for this CD20 negative disease and CNS prophylaxis is mandatory. Intensification with ABMT in CR1 may be considered for fit patients. For refractory/relapsed patients, therapy is, usually, considered palliative, however, in chemo-sensitive disease, intensification + ABMT or new drugs as Bortezomib may be considered. Factors affecting outcome are achieving complete remission, PS, clinical stage, MYC, IPI score. Reported median PFS ranges between 6-7 months and median OS ranges between 11-13 months. Long term survivors are reported but mostly in pediatric patients. Finally, due to the scarcity of data on this subtype of NHL we suggest that the diagnosis and the management of HIV-positive PBL patients should be performed in specialized centers.
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Affiliation(s)
- Michele Bibas
- Clinical Department, Hematology, National Institute for Infectious Diseases “Lazzaro Spallanzani” Rome, Italy
| | - Jorge J. Castillo
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Harvard medical School, Boston, USA
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Li G, Lewis RD, Mishra N, Axiotis CA. A retrospective analysis of ten symptomatic multiple myeloma patients with HIV infection: a potential therapeutic effect of HAART in multiple myeloma. Leuk Res 2014; 38:1079-84. [PMID: 25064217 DOI: 10.1016/j.leukres.2014.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 06/19/2014] [Accepted: 07/06/2014] [Indexed: 11/16/2022]
Abstract
The impact of highly active anti-retroviral therapy (HAART) in multiple myeloma (MM) is unknown. Ten HIV+ and 28 HIV-negative patients were retrospectively identified out of 262 cases of MM diagnosed at Kings County Hospital Center since the introduction of HAART in 1996. The HIV+ MM patients on HAART had superior overall survival (OS) (Fisher exact, p=0.008; log-rank, p=0.012) and progression free survival (PFS) (Fisher exact, p=0.007; log-rank, p=0.009) than the HIV-negative MM patients. HAART alone blocked the production of serum M-protein. We propose that HARRT should be explored for the treatment of both HIV+ and HIV-negative MM patients.
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Affiliation(s)
- Geling Li
- Department of Pathology, SUNY Downstate Medical Center, Kings County Hospital Center, Brooklyn, NY, United States
| | - Robert D Lewis
- Department of Haematology/Oncology, SUNY Downstate Medical Center, Kings County Hospital Center, Brooklyn, NY, United States
| | - Nidhi Mishra
- Department of Haematology/Oncology, SUNY Downstate Medical Center, Kings County Hospital Center, Brooklyn, NY, United States
| | - Constantine A Axiotis
- Department of Pathology, SUNY Downstate Medical Center, Kings County Hospital Center, Brooklyn, NY, United States.
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