Comparison of CHOP treatment with specific short-intensive chemotherapy in AIDS-related Burkitt's lymphoma or leukemia

Role of 18F-FDG-PET/CT in the management of Burkitt lymphoma

Burkitt lymphoma (BL) is highly FDG-avid even though its usefulness in the management of these patients is still controversial.

AIM

We analyzed the role of positron emission tomography/computerized tomography (PET/CT) in staging newly diagnosed patients with BL and evaluating disease after first-line chemotherapy.

METHODS

Fifty-two PET/CTs were performed in 32 patients (20 at diagnosis, 27 after treatment, five to monitor residual disease). Involved areas were retrospectively compared with those observed in contrast-enhanced CT.

RESULTS

Discrepancies were found in 64.7% of patients for whom results of both tests at diagnosis were available (n = 17), most of them involving extranodal sites. Regarding response assessment, discrepancies were observed in 38% of patients with both tests (5/13): residual masses detected by CT with negative PET/CT. Of 27 patients with post-treatment PET/CT, 22 were in complete remission whereas one true-positive and four false-positive lesions (two nodal and two extranodal) were detected. With a median follow-up of 27 months, 22 patients with negative PET/CT did not relapse. Thus, negative predictive value (NPV) was 100%. With respect to positive predictive value (PPV), one of five patients with positive assays after treatment died due to progression while the remaining four had false-positive lesions. Nevertheless, for these four patients, mean SUVmax at nodal sites was 4.1 vs. 14.9 at diagnosis, while mean SUVmax at extranodal sites was 3.8 vs. 12.1. Thus, with a cutoff value for SUVmax < 66% of that observed at diagnosis, PPV was also 100%.

CONCLUSION

More accurate staging can be achieved using PET/CT. NPV reaches 100%, and using a ΔSUV < 66%, a high PPV is also observed.

Update on the treatment of HIV-associated hematologic malignancies

HIV is associated with an excess cancer risk, particularly of lymphoid malignancies. Modern therapeutics has changed the landscape of HIV disease and typical opportunistic complications of AIDS are now largely avoided. Although the risk of lymphoma has decreased, it still remains high. Nevertheless, treatment outcomes have improved due both to improvements in HIV medicine and in cancer therapeutics for the common lymphomas occurring in those with HIV infection. Other hematologic malignancies are rarely seen in HIV-infected patients, but the standardized risk ratio for many of these cancers is higher than in the background population. Principles of cancer care and appreciation for HIV infection as a comorbid condition can guide physicians in setting realistic goals and treatment for this patient population. In many cases, expected outcomes are very similar to the HIV-unrelated patients and therapeutic planning should be based on this understanding. Treatment tolerance can be predicted based on the status of the HIV disease and the cancer therapy being administered. For those hematologic cancers in which transplantation is part of standard care, this modality should be considered an option in those with HIV infection.

Numb chin syndrome with vagal and hypoglossal paralysis: an initial sign of an uncommon diagnosis

In this study, the case of a 58-year-old man with a 2-month history of left chin paresthesia with difficulty swallowing and chewing, and dysphonia is reported. He had an absence of the gag reflex, unilateral palatal palsy and deviation of the tongue upon attempted protrusion with unilateral atrophy. Magnetic resonance imaging of the skull base revealed a tumoral infiltration of the left side of Meckel's cave, involvement of the clivus with extension into the cavernous sinus and signs of focal leptomeningeal infiltration. The patient was eventually diagnosed with generalized Burkitt's lymphoma. In this study, the authors suggest an initial diagnostic workup that includes a computed tomography scan of the mandible and a magnetic resonance imaging of the skull base searching for malignancy in patients with isolated numb chin syndrome, a rare disorder often associated with cancer, especially breast cancer and lymphoma, with mandibular metastases, leptomeningeal seeding and metastases of the base of the skull explaining the origin of the syndrome in most cases.