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Liu R, Zhao H, Xiao G, Tao Y, Tang X, Feng L, Liao B, Liu B, Guan J, Li L, Chen Z, He H, You H. Clinical Characteristics and Outcomes of AIDS-Related Burkitt Lymphoma in China: A Retrospective Single-Center Study. Technol Cancer Res Treat 2024; 23:15330338231214236. [PMID: 38179657 PMCID: PMC10771070 DOI: 10.1177/15330338231214236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/10/2023] [Accepted: 10/23/2023] [Indexed: 01/06/2024] Open
Abstract
Objectives: Studies on the prognosis and risk stratification of patients with acquired immune deficiency syndrome (AIDS) - related Burkitt lymphoma (AR-BL) are rare. We aim to construct a novel model to improve the risk assessment of these patients. Methods: We retrospectively analyzed the clinical data of 34 patients over the past 10 years and the factors associated with progression-free survival (PFS) and overall survival (OS) were evaluated in univariate and multivariate Cox models. Then, the novel model consisting of screened factors was compared with the existing models. Results: With a 37-month median follow-up, the overall 2-year PFS and OS rates were 40.50% and 36.18%, respectively. The OS of patients who received chemotherapy was better compared with those without chemotherapy (P = .0012). Treatment with an etoposide, prednisone, oncovin, cyclophosphamide, and hydroxydaunorubicin-based regimen was associated with longer OS and PFS compared with a cyclophosphamide, doxorubicin, vincristine, and prednisone-based regimen (OS, P = .0002; PFS, P = .0158). Chemotherapy (hazard ratio [HR] = 0.075; 95% confidence interval [CI], 0.009-0.614) and Eastern Cooperative Oncology Group Performance Status (ECOG PS) 2 to 4 (HR = 4.738; 95% CI, 1.178-19.061) were independent prognostic factors of OS in multivariate analysis and we established a novel prognostic risk stratification model named GZ8H model with chemotherapy and ECOG PS. Conclusion: GZ8H showed better stratification ability than the international prognostic index (IPI) or Burkitt lymphoma IPI (BL-IPI). Furthermore, the C-index of the nomogram used to predict OS was 0.884 in the entire cohort and the calibration curve showed excellent agreement between the predicted and actual results of OS. No human immunodeficiency virus-related factors were found to be associated with OS and PFS of AR-BL patients in our study. Overall, the clinical characteristics and outcomes in AR-BL were shown and prognostic factors for OS and PFS were identified in this study.
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Affiliation(s)
- Rongqiu Liu
- Laboratory for Excellence in Systems Biomedicine of Pediatric Oncology, Department of Pediatric Hematology and Oncology, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Han Zhao
- Infectious Diseases Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Guanying Xiao
- Infectious Diseases Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yu Tao
- Laboratory for Excellence in Systems Biomedicine of Pediatric Oncology, Department of Pediatric Hematology and Oncology, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoping Tang
- Infectious Diseases Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Lizhi Feng
- Infectious Diseases Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Baolin Liao
- Infectious Diseases Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Bo Liu
- Infectious Diseases Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jialong Guan
- Infectious Diseases Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Linghua Li
- Infectious Diseases Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zhimin Chen
- Infectious Diseases Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Haolan He
- Infectious Diseases Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Hua You
- Laboratory for Excellence in Systems Biomedicine of Pediatric Oncology, Department of Pediatric Hematology and Oncology, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Children's Hospital of Chongqing Medical University, Chongqing, China
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Huguet M, Navarro JT, Moltó J, Ribera JM, Tapia G. Diffuse Large B-Cell Lymphoma in the HIV Setting. Cancers (Basel) 2023; 15:3191. [PMID: 37370801 DOI: 10.3390/cancers15123191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Despite the widespread use of combined antiretroviral therapy (cART) and the subsequent decrease in AIDS-defining cancers, HIV-related lymphomas remain a leading cause of morbidity and mortality in people with HIV (PWH). Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma (NHL) subtype in PWH. This lymphoma is a heterogeneous disease including morphological variants and molecular subtypes according to the cell of origin or the mutation profile. In the pre-cART era, treatment with standard-dose chemotherapy induced high rates of toxicity and outcomes were very poor. The introduction of cART and the incorporation of infection prophylaxis allowed the use of conventional intensive chemotherapy regimens used in the general population, such as R-CHOP or R-EPOCH. The use of cART during chemotherapy treatment was initially controversial due to the potential risk of adverse drug-drug interactions. However, the availability of current cART regimens with less potential to cause drug interactions and evidence that cART improves survival rates in NHL strongly support the use of cART in PWH with DLBCL. Consequently, interdisciplinary collaboration between HIV specialists and hemato-oncologists for the management of potential interactions and overlapping toxicities between antiretroviral and antineoplastic drugs is crucial for the optimal treatment of PWH with NHL.
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Affiliation(s)
- Maria Huguet
- Department of Hematology, Institut Català d'Oncologia, Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Ctra. de Canyet, S/N, 08916 Badalona, Spain
- Josep Carreras Leukaemia Research Institute, 08916 Badalona, Spain
| | - José-Tomás Navarro
- Department of Hematology, Institut Català d'Oncologia, Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Ctra. de Canyet, S/N, 08916 Badalona, Spain
- Josep Carreras Leukaemia Research Institute, 08916 Badalona, Spain
| | - José Moltó
- Fundació Lluita Contra les Infeccions, Infectious Diseases Department, Germans Trias i Pujol University Hospital, Ctra. de Canyet, S/N, 08916 Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
| | - Josep-Maria Ribera
- Department of Hematology, Institut Català d'Oncologia, Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Ctra. de Canyet, S/N, 08916 Badalona, Spain
- Josep Carreras Leukaemia Research Institute, 08916 Badalona, Spain
| | - Gustavo Tapia
- Department of Pathology, Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Ctra. de Canyet, S/N, 08916 Badalona, Spain
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Rapiti N, Abdelatif N, Moosa MYS. Prognostic variables and 4-year survival outcomes in CD20 Positive AIDS-Related Lymphoma in the Anti-retroviral treatment era: A Retrospective Review from a Single Centre in KwaZulu-Natal, South Africa. PLoS One 2022; 17:e0272282. [PMID: 36048870 PMCID: PMC9436083 DOI: 10.1371/journal.pone.0272282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/16/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To describe 4-year survival outcomes and assess the value of established and additional relevant variables to predict complete response (CR), four-year progression-free survival (PFS) and overall survival (OS) of CD20 positive AIDS-Related Lymphoma (ARL) treated with standard combination chemotherapy. Method We performed a retrospective review of patients diagnosed with CD20 positive ARL between 2006 and 2016. All patients over 12 years of age who received at least one cycle of combination chemotherapy with curative intent were included in the analysis. Variables assessed included the International Prognostic Index (IPI), age-adjusted-IPI, age, gender, B symptoms, extent of disease, functional performance status, CD4 cell count, viral load, concurrent ART with chemotherapy, rituximab inclusion, and number of chemotherapy cycles used. Kaplan-Meier survival curves for OS and PFS at 4 years were compared for IPI and aaIPI using the log-rank test. A Cox proportional hazards model was used to investigate the effects of prognostic variables for patients achieving OS and PFS at 4 years and logistic regression for patients achieving CR. Results A total of 102 patients were included in the analysis. At year four of follow-up, the OS was 50% (n = 51) and PFS was 43% (n = 44). Attaining a CR and male gender were significantly associated with improved 4-year OS (p<0.001 and p = 0.028 respectively) and PFS (p<0.001 and 0.048 respectively). A viral load of < 50 copies/ml was associated with a higher complete response rate (aOR 6.10 [95% CI 1.15, 24.04], p = 0.01). Six or more cycles of chemotherapy was superior to fewer cycles for both PFS (aHR 0.17 [95% CI 0.10, 0.29]) and OS (aHR 0.12 [95% CI 0.07, 0.22]) with p-value < 0.001 for both PFS and OS. The Kaplan-Meier survival estimates demonstrated the prognostic utility of the IPI and aaIP for OS (p = 0.002 and 0.030 respectively) and the IPI for PFS (p = 0.002). Conclusion This study is a first from a high prevalence HIV area in KwaZulu-Natal, South Africa, and confirms the utility of the internationally accepted prognostic scoring systems in predicting survival in CD20 positive ARL in the local population.
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Affiliation(s)
- Nadine Rapiti
- Department of Haematology, NHLS/University of KwaZulu Natal/King Edward VIII Hospital, Durban, South Africa
- * E-mail:
| | - Nada Abdelatif
- Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa
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Prognostic nomogram incorporating radiological features for predicting overall survival in patients with AIDS-related non-Hodgkin lymphoma. Chin Med J (Engl) 2021; 135:70-78. [PMID: 34982056 PMCID: PMC8850812 DOI: 10.1097/cm9.0000000000001785] [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] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Acquired immune deficiency syndrome (AIDS)-related non-Hodgkin lymphoma (AR-NHL) is a high-risk factor for morbidity and mortality in patients with AIDS. This study aimed to determine the prognostic factors associated with overall survival (OS) and to develop a prognostic nomogram incorporating computed tomography imaging features in patients with acquired immune deficiency syndrome-related non-Hodgkin lymphoma (AR-NHL). METHODS A total of 121 AR-NHL patients between July 2012 and November 2019 were retrospectively reviewed. Clinical and radiological independent predictors of OS were confirmed using multivariable Cox analysis. A prognostic nomogram was constructed based on the above clinical and radiological factors and then provided optimum accuracy in predicting OS. The predictive accuracy of the nomogram was determined by Harrell C-statistic. Kaplan-Meier survival analysis was used to determine median OS. The prognostic value of adjuvant therapy was evaluated in different subgroups. RESULTS In the multivariate Cox regression analysis, involvement of mediastinal or hilar lymph nodes, liver, necrosis in the lesions, the treatment with chemotherapy, and the CD4 ≤100 cells/μL were independent risk factors for poor OS (all P < 0.050). The predictive nomogram based on Cox regression has good discrimination (Harrell C-index = 0.716) and good calibration (Hosmer-Lemeshow test, P = 0.620) in high- and low-risk groups. Only patients in the high-risk group who received adjuvant chemotherapy had a significantly better survival outcome. CONCLUSION A survival-predicting nomogram was developed in this study, which was effective in assessing the survival outcomes of patients with AR-NHL. Notably, decision-making of chemotherapy regimens and more frequent follow-up should be considered in the high-risk group determined by this model.
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5
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de Carvalho PS, Leal FE, Soares MA. Clinical and Molecular Properties of Human Immunodeficiency Virus-Related Diffuse Large B-Cell Lymphoma. Front Oncol 2021; 11:675353. [PMID: 33996608 PMCID: PMC8117347 DOI: 10.3389/fonc.2021.675353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/14/2021] [Indexed: 12/15/2022] Open
Abstract
Non-Hodgkin lymphoma is the most common malignancy affecting people living with HIV (PLWH). Among its several subtypes, diffuse large B-cell lymphoma (DLBCL) is an important manifestation within the HIV-infected compartment of the population. Since HIV is able to modulate B cells and promote lymphomagenesis through direct and indirect mechanisms, HIV-related DLBCL has specific characteristics. In this review, we address the clinical and molecular properties of DLBCL disease in the context of HIV infection, as well as the mechanisms by which HIV is able to modulate B lymphocytes and induce their transformation into lymphoma.
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Affiliation(s)
- Pedro S de Carvalho
- Programa de Oncovirologia, Instituto Nacional do Câncer, Rio de Janeiro, Brazil
| | - Fabio E Leal
- Programa de Oncovirologia, Instituto Nacional do Câncer, Rio de Janeiro, Brazil
| | - Marcelo A Soares
- Programa de Oncovirologia, Instituto Nacional do Câncer, Rio de Janeiro, Brazil.,Departamento de Genética, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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6
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Wu J, Miao Y, Qian C, Tao P, Wang X, Dong X, Li X, Lou J, Liang J, Xu W, Li J, Min H. Clinical characteristics and outcomes in HIV-associated diffuse large B-cell lymphoma in China: A retrospective single-center study. J Cancer 2021; 12:2903-2911. [PMID: 33854591 PMCID: PMC8040883 DOI: 10.7150/jca.51027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 03/03/2021] [Indexed: 12/12/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection is associated with an increased risk of aggressive lymphoma, especially diffuse large B cell lymphoma (DLBCL). There are few data regarding HIV-associated DLBCL in China. Therefore, we analyzed the characteristics and outcomes of patients with HIV-associated DLBCL from our center. We retrospectively studied HIV-infected patients with DLBCL from 2011 to 2019. Data on HIV infection and lymphoma characteristics, treatments and outcomes were retrieved and analyzed. In 78 patients with HIV-associated DLBCL, most had poor performance status (PS) (74%), elevated lactate dehydrogenase (LDH) levels (95%), B symptoms (74%), advanced Ann Arbor stages (81%), bulky diseases (64%) and extranodal involvement (70%) at diagnosis. The median CD4+ T cell count was 162/µl, and 26 patients were already on combination antiretroviral therapy (cART) treatment at diagnosis of DLBCL. Elevated whole blood EBV DNA copy number was detected in 38 patients (66%, 38/58). Of the 45 patients evaluated at the end of treatment, 26 (58%) achieved CR, 6 (13%) achieved PR and 6 (13%) experienced progressive disease. The 2-year progression-free survival (PFS) and overall survival (OS) rates were 56.4% and 62.7%, respectively. Factors associated with decreased PFS and OS in univariate analysis were unfavorable PS and high international prognostic index. Elevated EBV DNA copy number was inclined to be associated with worse outcome. We did not observe a significant difference in survival between R-EPOCH and R-CHOP regimens. In our population, patients with HIV-associated DLBCL presented with aggressive characteristics and exhibited poor survival outcomes, even in the modern cART era.
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Affiliation(s)
- Jiazhu Wu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
| | - Yi Miao
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
| | - Chuan Qian
- Department of Infectious Diseases, Yunnan Provincial Infectious Diseases Hospital/Yunnan AIDS Care Center, Kunming, 650000, China
| | - Pengfei Tao
- Department of Infectious Diseases, Yunnan Provincial Infectious Diseases Hospital/Yunnan AIDS Care Center, Kunming, 650000, China
| | - Xicheng Wang
- Department of Infectious Diseases, Yunnan Provincial Infectious Diseases Hospital/Yunnan AIDS Care Center, Kunming, 650000, China
| | - Xingqi Dong
- Department of Infectious Diseases, Yunnan Provincial Infectious Diseases Hospital/Yunnan AIDS Care Center, Kunming, 650000, China
| | - Xia Li
- Department of Infectious Diseases, Yunnan Provincial Infectious Diseases Hospital/Yunnan AIDS Care Center, Kunming, 650000, China
| | - Jincheng Lou
- Department of Infectious Diseases, Yunnan Provincial Infectious Diseases Hospital/Yunnan AIDS Care Center, Kunming, 650000, China
| | - Jinhua Liang
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
| | - Wei Xu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
| | - Jianyong Li
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.,Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
| | - Haiyan Min
- Department of Infectious Diseases, Yunnan Provincial Infectious Diseases Hospital/Yunnan AIDS Care Center, Kunming, 650000, China
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Kriegsmann K, Klee JS, Hensel M, Buss EC, Kriegsmann M, Cremer M, Ho AD, Egerer G, Wuchter P, Witzens-Harig M. Patients With Malignant Lymphoma and HIV Infection Experiencing Remission After First-Line Treatment Have an Excellent Prognosis. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:e581-e587. [PMID: 31377211 DOI: 10.1016/j.clml.2019.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 05/21/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Malignant lymphoma is still the leading cause of death among AIDS-related diseases. PATIENTS AND METHODS We performed a retrospective analysis of 50 HIV-positive lymphoma patients. The median interval between HIV and malignant lymphoma diagnosis was 4 years. Eight patients (16%) had Hodgkin lymphoma and 42 (84%) non-Hodgkin lymphoma. Among non-Hodgkin lymphoma patients, diffuse large B-cell lymphoma (n = 18, 42%), Burkitt lymphoma (n = 11, 26%), and plasmoblastic lymphoma (n = 5, 12%) were the most frequent entities. RESULTS Lymphoma was treated according to standard protocols. Forty-four patients (88%) received combination antiretroviral therapy, 2 (4%) were not treated, and in 4 (8%) the HIV treatment status was not clarified. Response to first-line therapy was complete response (CR) in 24 (56%), partial response (PR) in 15 (35%), and stable disease in 1 (2%). Three patients (7%) developed progressive disease, and 9 (18%) experienced relapse after CR or PR. At a median observation period of 31 (range, 0.4-192) months, the 1-, 2-, and 5-year overall survival was 87%, 79%, and 76%, respectively. At univariate analysis, remission status after first-line treatment was predictive of outcome, as the 2-year overall survival was 95%, 66%, and 0 for patients with CR, with PR, and with progressive disease (P < .001). Results of the multivariate analysis revealed lactate dehydrogenase concentration at lymphoma diagnosis (P = .046) and relapse (P = .050) to be independent factors for overall survival. CONCLUSION First-line treatment of lymphoma in HIV positive patients is crucial. Patients who experienced and maintained a first CR had a favorable prognosis.
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Affiliation(s)
- Katharina Kriegsmann
- Department of Hematology, Oncology and Rheumatology, Heidelberg University, Heidelberg, Germany.
| | - Julia S Klee
- Department of Hematology, Oncology and Rheumatology, Heidelberg University, Heidelberg, Germany
| | | | - Eike C Buss
- Department of Hematology, Oncology and Rheumatology, Heidelberg University, Heidelberg, Germany
| | - Mark Kriegsmann
- Institute of Pathology, Heidelberg University, Heidelberg, Germany
| | - Martin Cremer
- Department of Hematology, Oncology and Rheumatology, Heidelberg University, Heidelberg, Germany
| | - Anthony D Ho
- Department of Hematology, Oncology and Rheumatology, Heidelberg University, Heidelberg, Germany
| | - Gerlinde Egerer
- Department of Hematology, Oncology and Rheumatology, Heidelberg University, Heidelberg, Germany
| | - Patrick Wuchter
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany
| | - Mathias Witzens-Harig
- Department of Hematology, Oncology and Rheumatology, Heidelberg University, Heidelberg, Germany
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Gutiérrez-Saborido D, Gutiérrez-Valencia A, González Domenech CM, López Ruz MÁ, Raffo Márquez M, Omar M, Girón-González JA. Incidence of lymphoma in HIV-HCV-infected patients. Modifications in function of the anti-hepatitis C virus therapy. Ann Hematol 2019; 98:1953-1959. [PMID: 31025161 DOI: 10.1007/s00277-019-03700-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 04/15/2019] [Indexed: 12/13/2022]
Abstract
The change in the incidence of lymphomas in function of the presence or absence of sustained virological response after anti-hepatitis C therapy in a cohort of human immunodeficiency (HIV)-hepatitis C (HCV) viruses coinfected patients was analyzed. A prospective cohort of 755 HIV-HCV coinfected patients who received their first anti-HCV therapy, based on interferon + ribavirin schemas, was evaluated. Incidence and histologic types of lymphomas were analyzed in two periods: (1) before administration of anti-HCV therapy and (2) after anti-HCV therapy. The association between lymphoma incidence and demographic, HIV- (minimum CD4+ cell count and CD4+ cell count at diagnosis of lymphoma, antiretroviral therapy, maximal HIV load and HIV load at diagnosis of lymphoma) and HCV-related variables (HCV load, genotype, sustained viral response to anti-HCV therapy) were analyzed. A total of 13 lymphomas [incidence rate (95% confidence interval), 0.72 (0.33-1.11) × 1000 person-years, time from HIV diagnosis to lymphoma diagnosis (median, interquartile range), 15 (11-19) years] were diagnosed. Nine of them were non-Hodgkin and four Hodgkin lymphomas. The median CD4+ T cell count at diagnosis of lymphoma was 457/mm3, with only two cases with values lower than 200/mm3. The incidence rate of non-Hodgkin lymphomas was similar pre- and post-anti HCV therapy [0.33 (0.00-0.65) vs 0.68 (0.08-1.26) × 1000 person-years, respectively, p > 0.05]. Patients with sustained virologic HCV response showed similar incidence rate of lymphomas than that of those without anti-HCV response. In conclusion, anti-HCV therapy does not modify the incidence rate of lymphomas in HIV-HCV coinfected patients.
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Affiliation(s)
- Daniel Gutiérrez-Saborido
- Unidad de Enfermedades Infecciosas. Hospital Universitario Puerta del Mar. Facultad de Medicina, Instituto para la Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Universidad de Cádiz, Avda Ana de Viya s/n, 11009, Cádiz, Spain
| | - Alicia Gutiérrez-Valencia
- Enfermedades Infecciosas, Microbiología y Medicina Preventiva. Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/CSIC, Universidad de Sevilla, Sevilla, Spain
| | - Carmen María González Domenech
- Hospital Universitario Virgen de la Victoria, Málaga. Departamento de Microbiología, Facultad de Farmacia, Universidad de Granada, Granada, Spain
| | - Miguel Ángel López Ruz
- Unidad Enfermedades Infecciosas, Facultad de Medicina. IBS, Hospital Universitario Virgen Nieves, Granada, Spain
| | | | - Mohamed Omar
- Unidad de Enfermedades Infecciosas, Complejo Hospitalario de Jaén, Jaén, Spain
| | - José Antonio Girón-González
- Unidad de Enfermedades Infecciosas. Hospital Universitario Puerta del Mar. Facultad de Medicina, Instituto para la Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Universidad de Cádiz, Avda Ana de Viya s/n, 11009, Cádiz, Spain.
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The clinical features and prognosis of 100 AIDS-related lymphoma cases. Sci Rep 2019; 9:5381. [PMID: 30926889 PMCID: PMC6441082 DOI: 10.1038/s41598-019-41869-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/18/2019] [Indexed: 12/14/2022] Open
Abstract
To improve outcomes and risk assessment, we systematically analyzed the clinical features of patients with acquired immunodeficiency syndrome (AIDS)-related lymphoma (ARL) and identified survival-associated factors. Data were collected from 100 patients diagnosed with ARL at the Henan Provincial Infectious Disease Hospital in China. The progression-free survival (PFS) duration and 2-year overall survival (OS) rate were determined. A multivariate analysis was used to evaluate the associations between survival and the following variables: sex, age, histological subtype, Ann Arbor stage, lactate dehydrogenase (LDH) level, primary site, baseline CD4+ count, use of chemotherapy, and age-adjusted international prognostic index IPI (aaIPI). The timing of combined antiretroviral therapy (cART) relative to chemotherapy was also assessed. The PFS duration and 2-year OS rate were significantly higher in the chemotherapy vs. the non-chemotherapy group (P < 0.001), but did not differ significantly between patients who received chemotherapy before vs. simultaneously as cART (P > 0.05). Age, aaIPI, chemotherapy, LDH level, and the Burkitt/Burkitt-like lymphoma subtype were significant prognostic factors for 2-year OS; the other factors were not associated with prognosis. Our results show that cART plus chemotherapy significantly improves the survival of patients with ARL and identifies several prognostic factors.
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10
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Cuellar LE, Anampa-Guzmán A, Holguín AM, Velarde J, Portillo-Alvarez D, Zuñiga-Ninaquispe MA, Luna-Reyes ER, Vásquez J, Jeter JM, Winkfield KM. Prognostic factors in HIV-positive patients with non-Hodgkin lymphoma: a Peruvian experience. Infect Agent Cancer 2018; 13:27. [PMID: 30083224 PMCID: PMC6069811 DOI: 10.1186/s13027-018-0200-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/19/2018] [Indexed: 12/02/2022] Open
Abstract
Background Non-Hodgkin lymphoma (NHL) is the most common cancer in people with HIV. Although 95% of HIV patients are in developing countries like Peru, the majority of these studies have been conducted in developed countries. In this study we aim to evaluate prognostic factors associated with outcomes in HIV positive patients undergoing systemic therapy for treatment of NHL. Methods This retrospective study includes patients with NHL seen in the Instituto Nacional de Enfermedades Neoplasicas (INEN) between 2004 to 2014. Patients were divided into two groups: antiretroviral therapy (ART) -naïve (n = 34) and those previously treated, ART-exposed (n = 13), at the time of diagnosis. All patients received chemotherapy and ART. The medical records were reviewed. Data were analyzed using t-test and chi-square test. Survival curves were estimated by the Kaplan-Meier method and comparison was done by log-rank test. Multivariate analysis for overall survival (OS) was performed with the Cox proportional hazard regression model. Results All ART-exposed patients were from the capital city (p = 0.039); they had significantly lower hemoglobin levels compared to ART-naïve patients (p = 0.026). The median OS was 47.7 months with a 5-yr OS of 36.1%. The median OS for ART naïve patients was significantly higher than that for ART-exposed patients (57.05 and 21.09 months, respectively; p = 0.018). Advanced stage and low serum albumin were associated with lower OS in both groups. Age > 60 was associated with worse outcomes in the ART-naïve cohort. Conclusions Advanced stage, low serum albumin and previous ART treatment were the primary prognostic factors associated with poorer outcomes in patients with NHL and HIV infection. In ART-naïve patients, age > 60 was associated with worse outcomes but in this cohort, older patients still had better overall outcomes than ART-exposed patients.
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Affiliation(s)
| | - Andrea Anampa-Guzmán
- 2Facultad de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | - Juan Velarde
- 1Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | | | | | | | - Jule Vásquez
- 1Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Joanne Marie Jeter
- 3Divisions of Human Genetics and Medical Oncology, The Ohio State University, Columbus, OH USA
| | - Karen Marie Winkfield
- 4Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston Salem, NC USA
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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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12
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Outcomes for HIV-associated diffuse large B-cell lymphoma in the modern combined antiretroviral therapy era. AIDS 2017; 31:2493-2501. [PMID: 28926410 DOI: 10.1097/qad.0000000000001652] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Non-Hodgkin's lymphoma (NHL) remains among the most frequent malignancies in persons living with HIV (PLWHIV). Survival among patients with HIV-associated diffuse large B-cell lymphoma (DLBCL), the most frequent NHL subtype, has improved markedly in recent years. We aimed to analyze characteristics and outcomes of DLBCL in HIV-infected patients in the era of modern combined antiretroviral therapy (cART). DESIGN PLWHIV with lymphoma were prospectively enrolled in the French ANRS-CO16 Lymphovir cohort between 2008 and 2015. We compared the patients treated with R-CHOP) (rituximab, cyclophosphamide, daunorubicin, vin-cristine, prednisolone) with HIV-negative DLBCL patients enrolled simultaneously in the R-CHOP arms of Lymphoma Study Association trials. RESULTS Among 110 PLWHIV with NHL, 52 (47%) had systemic DLBCL. These 52 cases had frequent extranodal disease (81%), poor performance status (35%) and advanced age-adjusted international prognostic index (aaIPI) (58%), and were mainly treated with R-CHOP (n = 44, 85%). Their median CD4 T-cell count was 233 cells/μl, and 79% of patients were on cART. The 2-year overall and progression-free survival rates were both 75% (95% confidence interval: 64%, 88%). Factors associated with progression or death in univariate analysis were poor performance status [hazard ratio: 3.3 (1.2, 8.9)], more than one extranodal site [hazard ratio: 3.4 (1.1, 10.5)] and an advanced aaIPI [hazard ratio: 3.7 (1.0, 13.1)]. Progression-free survival after R-CHOP therapy did not differ from that of the HIV-negative counterparts (P = 0.11). CONCLUSION In the recent cART era, despite frequent high-risk features, the 2-year overall survival of HIV-DLBCL patients reaches 75%. Outcomes after R-CHOP therapy are similar to those of HIV-negative patients with similar aaIPI.
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Chao C, Silverberg MJ, Chen LH, Xu L, Martínez-Maza O, Abrams DI, Zha HD, Haque R, Said J. Novel tumor markers provide improved prediction of survival after diagnosis of human immunodeficiency virus (HIV)-related diffuse large B-cell lymphoma. Leuk Lymphoma 2017; 59:321-329. [PMID: 28610450 DOI: 10.1080/10428194.2017.1334121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Existing prognostic tools for HIV + diffuse large B-cell lymphoma (DLBCL) fail to accurately predict patient outcomes. To develop a novel prognostic algorithm incorporating molecular tumor characteristics and HIV disease factors, we included 80 patients with HIV-related DLBCL diagnosed between 1996 and 2007. Immunohistochemistry staining was used to analyze the expression of 26 tumor markers. Clinical data were collected from medical records. Logistic regression and bootstrapping were used to select and assess stability of the prognostic model, respectively. Of the tumor markers examined, expression of cMYC, Ki 67, CD44, EBV, SKP2, BCL6, p53, CD20 and IgM were associated with two-year mortality. The final prognostic model, confirmed in bootstrapped samples, included IPI, circulating CD4 cell count, history of clinical AIDS, and expression of CD44, p53, IgM and EBV. This model incorporating HIV disease history and tumor markers, achieved better prediction for two-year mortality [AUC = 0.87, 95% CI: 0.78-0.96] compared with IPI alone [AUC = 0.63 (0.51-0.75)].
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Affiliation(s)
- Chun Chao
- a Department of Research and Evaluation , Kaiser Permanente Southern California , Pasadena , CA , USA
| | - Michael J Silverberg
- b Division of Research , Kaiser Permanente Northern California , Oakland , CA , USA
| | - Lie-Hong Chen
- a Department of Research and Evaluation , Kaiser Permanente Southern California , Pasadena , CA , USA
| | - Lanfang Xu
- a Department of Research and Evaluation , Kaiser Permanente Southern California , Pasadena , CA , USA
| | - Otoniel Martínez-Maza
- c Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA , Los Angeles , CA , USA.,d Department of Microbiology, Immunology and Molecular Genetics, David Geffen School of Medicine at UCLA.,e Department of Epidemiology , UCLA Fielding School of Public Health , Los Angeles , CA , USA
| | - Donald I Abrams
- f San Francisco General Hospital , University of California , San Francisco , CA , USA.,g Department of Medicine , University of California , San Francisco , CA , USA
| | - Hongbin D Zha
- h Los Angeles Medical Center , Kaiser Permanente Southern California , Los Angeles , CA , USA
| | - Reina Haque
- a Department of Research and Evaluation , Kaiser Permanente Southern California , Pasadena , CA , USA
| | - Jonathan Said
- i Department of Pathology and Laboratory Medicine, School of Medicine , University of California , Los Angeles , CA , USA
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14
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Raffetti E, Donato F, Castelnuovo F, Ladisa N, Paraninfo G, Di Filippo E, Segala D, Cologni G, Bandera A, Zacchi F, Digiambenedetto S, Di Pietro M, Castelli F, Quiros-Roldan E. The prognostic role of systemic inflammatory markers on HIV-infected patients with non-Hodgkin lymphoma, a multicenter cohort study. J Transl Med 2015; 13:89. [PMID: 25886534 PMCID: PMC4562103 DOI: 10.1186/s12967-015-0446-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 02/24/2015] [Indexed: 01/04/2023] Open
Abstract
Background The systemic inflammatory response has been postulated as having prognostic significance in a wide range of different cancer types. We aimed to assess the prognostic role of inflammatory markers on survival in HIV-infected patients with Non-Hodgkin Lymphoma (NHL), and to compute a prognostic score based on inflammatory biomarkers. Methods We evaluated data on HIV patients with NLH diagnosis between 1998 and 2012 in a HIV Italian Cohort. Using Cox proportional regression model, we assessed the prognostic role of Neutrophil-Lymphocyte Ratio (NLR), Platelet-Lymphocyte Ratio (PLR), Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS), Prognostic Index (PI), and Prognostic Nutritional Index (PNI). We also computed a risk score equation, assigning patients to a derivation and a validation sample. The area under the curve (AUC) was use to evaluate the predictive ability of this score. Results 215 non-Hodgkin lymphoma cases (80.0% males) with a mean age of 43.2 years were included. Deaths were observed in 98 (45.6%) patients during a median follow up of 5 years. GPS, mGPS, PI and PNI were independently associated with risk of death. We also computed a mortality risk score which included PNI and occurrence of an AIDS event within six months from NHL diagnosis. The AUCs were 0.69 (95% CI 0.58 to 0.81) and 0.69 (95% CI 0.57 to 0.81) at 3 and 5 years of the follow-up, respectively. Conclusions GPS, mGPS, PI and PNI are independent prognostic factors for survival of HIV patients with NHL.
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Affiliation(s)
- Elena Raffetti
- Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy.
| | - Francesco Donato
- Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy.
| | - Filippo Castelnuovo
- Hospital Division of Infectious and Tropical Diseases, Spedali Civili Hospital, Brescia, Italy.
| | - Nicoletta Ladisa
- Department of Infectious Diseases, Polyclinic of Bari, University of Bari, Bari, Italy.
| | - Giuseppe Paraninfo
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
| | - Elisa Di Filippo
- Department of Infectious Diseases of Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Daniela Segala
- Department of Infectious Diseases, S. Anna Hospital, Ferrara, Italy.
| | - Giuliana Cologni
- Department of Infectious Diseases of Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Alessandra Bandera
- Department of Infectious Diseases, San Gerardo de' Tintori" Hospital, Monza, Italy.
| | - Fabio Zacchi
- Clinical Infectious Diseases, Istituti Ospitalieri, Cremona, Italy.
| | - Simona Digiambenedetto
- Institute of Clinical Infectious Diseases, Polyclinic A. Gemelli, University of Sacred Heart, Rome, Italy.
| | - Massimo Di Pietro
- Department of Infectious Diseases, SM. Annunziata Hospital, Florence, Italy.
| | - Francesco Castelli
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
| | - Eugenia Quiros-Roldan
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
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15
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Barta SK, Samuel MS, Xue X, Wang D, Lee JY, Mounier N, Ribera JM, Spina M, Tirelli U, Weiss R, Galicier L, Boue F, Little RF, Dunleavy K, Wilson WH, Wyen C, Remick SC, Kaplan LD, Ratner L, Noy A, Sparano JA. Changes in the influence of lymphoma- and HIV-specific factors on outcomes in AIDS-related non-Hodgkin lymphoma. Ann Oncol 2015; 26:958-966. [PMID: 25632071 DOI: 10.1093/annonc/mdv036] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 01/12/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We undertook the present analysis to examine the shifting influence of prognostic factors in HIV-positive patients diagnosed with aggressive non-Hodgkin lymphoma (NHL) over the last two decades. PATIENTS AND METHODS We carried out a pooled analysis from an existing database of patients with AIDS-related lymphoma. Individual patient data had been obtained prior from prospective phase II or III clinical trials carried out between 1990 until 2010 in North America and Europe that studied chemo(immuno)therapy in HIV-positive patients diagnosed with AIDS-related lymphomas. Studies had been identified by a systematic review. We analyzed patient-level data for 1546 patients with AIDS-related lymphomas using logistic regression and Cox proportional hazard models to identify the association of patient-, lymphoma-, and HIV-specific variables with the outcomes complete response (CR), progression-free survival, and overall survival (OS) in different eras: pre-cART (1989-1995), early cART (1996-2000), recent cART (2001-2004), and contemporary cART era (2005-2010). RESULTS Outcomes for patients with AIDS-related diffuse large B-cell lymphoma and Burkitt lymphoma improved significantly over time, irrespective of baseline CD4 count or age-adjusted International Prognostic Index (IPI) risk category. Two-year OS was best in the contemporary era: 67% and 75% compared with 24% and 37% in the pre-cART era (P < 0.001). While the age-adjusted IPI was a significant predictor of outcome in all time periods, the influence of other factors waxed and waned. Individual HIV-related factors such as low CD4 counts (<50/mm(3)) and prior history of AIDS were no longer associated with poor outcomes in the contemporary era. CONCLUSIONS Our results demonstrate a significant improvement of CR rate and survival for all patients with AIDS-related lymphomas. Effective HIV-directed therapies reduce the impact of HIV-related prognostic factors on outcomes and allow curative antilymphoma therapy for the majority of patients with aggressive NHL.
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Affiliation(s)
- S K Barta
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia.
| | - M S Samuel
- Department of Medical Oncology, Montefiore Medical Center, Bronx
| | - X Xue
- Department of Epidemiology and Population Health, Albert Einstein Cancer Center, Bronx
| | - D Wang
- Department of Epidemiology and Population Health, Albert Einstein Cancer Center, Bronx
| | - J Y Lee
- Department of Biostatistics, University of Arkansas, Little Rock, USA
| | - N Mounier
- Groupe d'Etude des Lymphomes de l'Adulte (GELA), France
| | - J-M Ribera
- ICO-Hospital Germans Trias i Pujol, Jose Carreras Research Institute and PETHEMA Group, Badalona, Spain
| | - M Spina
- Department of Medical Oncology, National Cancer Institute, Aviano, Italy
| | - U Tirelli
- Department of Medical Oncology, National Cancer Institute, Aviano, Italy
| | - R Weiss
- Private Practice for Hematology and Oncology, Bremen, Germany
| | - L Galicier
- Department of Immunology, Hopital St Louis, Assistance Publique-Hopitaux de Paris, Paris
| | - F Boue
- Department of Internal Medicine and Immunology, Hopital Antoine Beclere, Clamart, France
| | | | - K Dunleavy
- Department of Medical Oncology, National Cancer Institute, Bethesda, USA
| | - W H Wilson
- Department of Medical Oncology, National Cancer Institute, Bethesda, USA
| | - C Wyen
- Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - S C Remick
- Mary Babb Randolph Cancer Center, West Virginia University, Morgantown
| | - L D Kaplan
- Department of Hematology and Oncology, University of California San Francisco, San Francisco
| | - L Ratner
- Division of Oncology, Washington University School of Medicine, St Louis
| | - A Noy
- Memorial Sloan-Kettering Cancer Center and Weill Cornell, Lymphoma Service, New York, USA
| | - J A Sparano
- Department of Medical Oncology, Montefiore Medical Center, Bronx
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16
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Al-Malki MM, Castillo JJ, Sloan JM, Re A. Hematopoietic Cell Transplantation for Plasmablastic Lymphoma: A Review. Biol Blood Marrow Transplant 2014; 20:1877-84. [DOI: 10.1016/j.bbmt.2014.06.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/06/2014] [Indexed: 01/23/2023]
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17
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Barta SK, Xue X, Wang D, Lee JY, Kaplan LD, Ribera JM, Oriol A, Spina M, Tirelli U, Boue F, Wilson WH, Wyen C, Dunleavy K, Noy A, Sparano JA. A new prognostic score for AIDS-related lymphomas in the rituximab-era. Haematologica 2014; 99:1731-7. [PMID: 25150257 DOI: 10.3324/haematol.2014.111112] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
While the International Prognostic Index is commonly used to predict outcomes in immunocompetent patients with aggressive B-cell non-Hodgkin lymphomas, HIV-infection is an important competing risk for death in patients with AIDS-related lymphomas. We investigated whether a newly created prognostic score (AIDS-related lymphoma International Prognostic Index) could better assess risk of death in patients with AIDS-related lymphomas. We randomly divided a dataset of 487 patients newly diagnosed with AIDS-related lymphomas and treated with rituximab-containing chemoimmunotherapy into a training (n=244) and validation (n=243) set. We examined the association of HIV-related and other known risk factors with overall survival in both sets independently. We defined a new score (AIDS-related lymphoma International Prognostic Index) by assigning weights to each significant predictor [age-adjusted International Prognostic Index, extranodal sites, HIV-score (composed of CD4 count, viral load, and prior history of AIDS)] with three risk categories similar to the age-adjusted International Prognostic Index (low, intermediate and high risk). We compared the prognostic value for overall survival between AIDS-related lymphoma International Prognostic Index and age-adjusted International Prognostic Index in the validation set and found that the AIDS-related lymphoma International Prognostic Index performed significantly better in predicting risk of death than the age-adjusted International Prognostic Index (P=0.004) and better discriminated risk of death between each risk category (P=0.015 vs. P=0.13). Twenty-eight percent of patients were defined as low risk by the ARL-IPI and had an estimated 5-year overall survival (OS) of 78% (52% intermediate risk, 5-year OS 60%; 20% high risk, 5-year OS 50%).
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Affiliation(s)
| | - Xiaonan Xue
- Albert Einstein Cancer Center, Bronx, NY, USA
| | - Dan Wang
- Albert Einstein Cancer Center, Bronx, NY, USA
| | | | | | - Josep-Maria Ribera
- ICO-Hospital Germans Trias i Pujol, Jose Carreras Research Institute and PETHEMA Group, Badalona, Spain
| | - Albert Oriol
- ICO-Hospital Germans Trias i Pujol, Jose Carreras Research Institute and PETHEMA Group, Badalona, Spain
| | | | | | | | | | | | | | - Ariela Noy
- Memorial-Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
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Carbone A, Vaccher E, Gloghini A, Pantanowitz L, Abayomi A, de Paoli P, Franceschi S. Diagnosis and management of lymphomas and other cancers in HIV-infected patients. Nat Rev Clin Oncol 2014; 11:223-38. [PMID: 24614140 DOI: 10.1038/nrclinonc.2014.31] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Despite the introduction of highly active antiretroviral therapy or combination antiretroviral therapy (HAART and cART, respectively) patients infected with HIV might develop certain types of cancer more frequently than uninfected people. Lymphomas represent the most frequent malignancy among patients with HIV. Other cancer types that have increased in these patients include Kaposi sarcoma, cancer of the cervix, anus, lung and liver. In the post-HAART era, however, patients with HIV have experienced a significant improvement in their morbidity, mortality and life expectancy. This Review focuses on the different types of lymphomas that generally occur in patients with HIV. The combination of cART and antineoplastic treatment has resulted in remarkable prolongation of disease-free survival and overall survival among patients with HIV who develop lymphoma. However, the survival in these patients still lags behind that of patients with lymphoma who are not infected with HIV. We also provide an update of epidemiological data, diagnostic issues, and strategies regarding the most-appropriate management of patients with both HIV and lymphomas.
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Affiliation(s)
- Antonino Carbone
- Department of Pathology, Centro di Riferimento Oncologico Aviano (CRO), Istituto Nazionale Tumori, Italy
| | - Emanuela Vaccher
- Department of Medical Oncology, Centro di Riferimento Oncologico Aviano (CRO), Istituto Nazionale Tumori, Italy
| | - Annunziata Gloghini
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori Milano, Italy
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, USA
| | - Akin Abayomi
- Department of Pathology, Division of Haematology, Tygerberg Hospital, South Africa
| | - Paolo de Paoli
- Molecular Virology and Scientific Directorate, Centro di Riferimento Oncologico Aviano (CRO), Istituto Nazionale Tumori, Italy
| | - Silvia Franceschi
- Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, France
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19
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Patier JL, Moreno-Cobo MA, García-Cosío M, Montalbán Sanz C. [Non-Hodgkin lymphomas after remission of human immunodeficiency virus-associated lymphomas in the highly active antiretroviral therapy era]. Med Clin (Barc) 2013; 141:411-2. [PMID: 23540391 DOI: 10.1016/j.medcli.2013.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 01/24/2013] [Accepted: 01/31/2013] [Indexed: 11/25/2022]
Affiliation(s)
- José Luis Patier
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, España.
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20
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de Witt P, Maartens DJ, Uldrick TS, Sissolak G. Treatment outcomes in AIDS-related diffuse large B-cell lymphoma in the setting roll out of combination antiretroviral therapy in South Africa. J Acquir Immune Defic Syndr 2013; 64:66-73. [PMID: 23797692 PMCID: PMC3797444 DOI: 10.1097/qai.0b013e3182a03e9b] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Long-term survival for patients with AIDS-related diffuse large B-cell lymphoma (DLBCL) is feasible in settings with available combination antiretroviral therapy (cART). However, given limited oncology resources, outcomes for AIDS-associated DLBCL in South Africa are unknown. METHODS We performed a retrospective analysis of survival in patients with newly diagnosed AIDS-related DLBCL treated at a tertiary teaching hospital in Cape Town, South Africa, with cyclophosphamide, doxorubicin, vincristine, and oral prednisone (CHOP) or CHOP-like chemotherapy (January 2004 until December 2010). HIV-related and lymphoma-related prognostic factors were evaluated. RESULTS Thirty-six patients evaluated; median age 37.3 years, 52.8% men, and 61.1% black South Africans. Median CD4 count 184 cells per microliter (in 27.8% this was <100 cells/μL), 80% high risk according to the age-adjusted International Prognostic Index. Concurrent Mycobacterium tuberculosis in 25%. Two-year overall survival (OS) was 40.5% (median OS 10.5 months, 95% confidence interval: 6.5 to 31.8). Eastern Cooperative Oncology Group performance status of 2 or more (25.4% vs 50.0%, P = 0.01) and poor response to cART (18.0% vs 53.9%, P = 0.03) predicted inferior 2-year OS. No difference in 2-year OS was demonstrated in patients coinfected with M. tuberculosis (P = 0.87). CONCLUSIONS Two-year OS for patients with AIDS-related DLBCL treated with CHOP like regimens and cART is comparable to that seen in the United States and Europe. Important factors effecting OS in AIDS-related DLBCL in South Africa include performance status at presentation and response to cART. Patients with comorbid M. tuberculosis or hepatitis B seropositivity seem to tolerate CHOP in our setting. Additional improvements in outcomes are likely possible.
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Affiliation(s)
- Pieter de Witt
- Department of Internal Medicine, Stellenbosch University, Cape Town, South Africa, USA
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21
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Gilardin L, Copie-Bergman C, Galicier L, Meignin V, Brière J, Timsit JF, Bouchaud O, Gaulard P, Oksenhendler E, Gérard L. Peripheral T-cell lymphoma in HIV-infected patients: a study of 17 cases in the combination antiretroviral therapy era. Br J Haematol 2013; 161:843-51. [PMID: 23593987 DOI: 10.1111/bjh.12341] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 02/26/2013] [Indexed: 11/28/2022]
Abstract
Most cases of human immunodeficiency virus (HIV)-associated non-Hodgkin Lymphoma (NHL) are of B-cell origin; T-cell NHLs are rarely reported. Within a single centre prospective cohort of 370 HIV-NHL, 17 (5%) were of T-cell origin (82% male; median age, 39 years). Median CD4+ cell count was 0·194 × 10(9) /l and 41% had undetectable plasma HIV-RNA at lymphoma diagnosis. All patients received combination antiretroviral therapy during chemotherapy. All histological samples were centrally reviewed. The distribution of the histological subtypes differed from the general population with absence of angioimmunoblastic subtype. Lymphoma was disseminated in 14 patients, and seven patients had performance status >2. All patients received full-dose chemotherapy: eight standard and nine intensive regimens. Two patients who received intensive chemotherapy died during therapy. The complete remission rate was 53%; 62·5% with standard therapy and 44% with intensive therapy. After a median follow-up of 7·2 years, the median overall survival was 9·4 months. Most deaths (85%) occurred within the first year following diagnosis, as a consequence of lymphoma progression in 10/13 cases. In this rare but severe complication of HIV infection the use of intensive chemotherapy does not appear to be beneficial for response, with increased toxicity.
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Affiliation(s)
- Laurent Gilardin
- Département d'Immunologie Clinique, Hôpital Saint-Louis, AP-HP, Paris, France
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Zhong DT, Shi CM, Chen Q, Huang JZ, Liang JG. Study on effectiveness of gemcitabine, dexamethasone, and cisplatin (GDP) for relapsed or refractory AIDS-related non-Hodgkin's lymphoma. Ann Hematol 2012; 91:1757-63. [DOI: 10.1007/s00277-012-1518-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 06/21/2012] [Indexed: 12/01/2022]
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Tedeschi R, Bortolin MT, Bidoli E, Zanussi S, Pratesi C, Vaccher E, Tirelli U, De Paoli P. Assessment of immunovirological features in HIV related non-Hodgkin lymphoma patients and their impact on outcome. J Clin Virol 2012; 53:297-301. [PMID: 22244256 DOI: 10.1016/j.jcv.2011.12.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 12/13/2011] [Accepted: 12/19/2011] [Indexed: 12/25/2022]
Abstract
BACKGROUND Despite the era of highly active antiretroviral therapy, non-Hodgkin lymphoma (NHL) remains one of the main causes of death in HIV-infected patients, with a wide variation on the outcome. OBJECTIVES We investigated immunological status and EBV, HHV8, HIV viral load in a group of HIV-infected patients at diagnosis of NHL to evaluate their prognostic significance. STUDY DESIGN Eighty-one consecutive HIV+ NHL patients were studied. CD4 and CD8 cell counts, HHV8 DNA, EBV DNA, HIV RNA and HIV DNA were assessed at diagnosis and at 3 months after chemotherapy initiation. Hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) of disease free survival (DFS) and overall survival (OS) were computed according to CD4 and CD8 cell counts, EBV DNA, HIV RNA and HIV DNA. HRs were, thereafter, computed also for continuous variation of CD4, CD8 cell counts and EBV DNA. RESULTS In the multivariate analysis, CD4<160 and CD8<590 cell/μl and EBV DNA≥300 c/ml were independently associated to DFS (HR=2.98; 95%CI: 1.26-7.03; HR=2.65, 95%CI: 1.13-6.19; HR=4.01; 95%CI: 1.81-8.91) and OS (HR=3.32; 95%CI: 1.41-7.83; HR=4.62, 95%CI: 1.91-11.19; HR=3.11, 95%CI: 1.42-6.80). HRs for DFS and OS decreased continuously with increasing CD4 and CD8 cell counts, while they increased continuously with increasing EBV DNA levels. CONCLUSIONS The association with survival of low CD4 and CD8 cell counts and detectable EBV viremia, measured at lymphoma's diagnosis, identified three independent prognostic biomarkers that might help in the management of NHL HIV+ patients, offering complementary information in the ascertainment of their outcome.
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Affiliation(s)
- Rosamaria Tedeschi
- Microbiology-Immunology and Virology Unit, Centro di Riferimento Oncologico, IRCCS, via F. Gallini 2, 33081 Aviano, Italy.
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The management of primary central nervous system lymphoma related to AIDS in the HAART era. Curr Opin Oncol 2011; 23:648-53. [DOI: 10.1097/cco.0b013e32834b6adc] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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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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Castillo JJ, Beltran BE, Bibas M, Bower M, Collins JA, Cwynarski K, Diez-Martin JL, Hernandez-Ilizaliturri F, Horwitz SM, Montoto S, Pantanowitz L, Ribera JM, Vose JM. Prognostic factors in patients with HIV-associated peripheral T-cell lymphoma: a multicenter study. Am J Hematol 2011; 86:256-61. [PMID: 21328430 DOI: 10.1002/ajh.21947] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Accepted: 11/23/2010] [Indexed: 11/07/2022]
Abstract
HIV infection has been associated with an increased risk of developing several types of malignancies, including aggressive peripheral T-cell lymphomas (PTCL). However, this is a rare occurrence with no more than a hundred cases reported in the literature. The purpose of this multicenter study is to describe the characteristics and to identify prognostic factors in patients with HIV-associated PTCL. Data from HIV-positive patients with a pathological diagnosis of non-primary cutaneous, non-leukemic PTCL were gathered retrospectively and are reported using descriptive statistics. Univariate and multivariate survival analyses were also performed. Fifty one patients were included in our analysis. Median age was 38 years with a 5:1 male-to-female ratio. Patients presented with a median CD4(+) count of 173 cells mm⁻³, and a median HIV viral load of 334,787 copies ml⁻¹. The median time from HIV diagnosis to PTCL diagnosis was 4.5 years. About 75% of patients presented with advanced clinical stage and 66% with B symptoms. The most common subtypes were PTCLU (61%) and anaplastic large cell lymphoma (ALCL, 22%). None of the ALCL patients tested expressed ALK. The median overall survival (OS) for the group was 12 months. In the multivariate survival analysis, the use of HAART and patients' performance status were independently associated with OS. HIV-associated PTCL presents predominantly in young men with low CD4(+) counts and high HIV viral loads. Both HIV-related and lymphoma-related factors were associated with OS.
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Affiliation(s)
- Jorge J Castillo
- Division of Hematology and Oncology, The Miriam Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
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Miralles P, Berenguer J, Ribera JM. Diagnóstico, profilaxis y tratamiento de la afectación del sistema nervioso central por linfoma no hodgkiniano en pacientes con infección por el virus de la inmunodeficiencia humana. Med Clin (Barc) 2010; 135:417-22. [DOI: 10.1016/j.medcli.2009.04.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Accepted: 04/29/2009] [Indexed: 11/28/2022]
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Survival of non-Hodgkin lymphoma patients with and without HIV infection in the era of combined antiretroviral therapy. AIDS 2010; 24:1765-70. [PMID: 20453630 DOI: 10.1097/qad.0b013e32833a0961] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the survival outcomes for non-Hodgkin lymphoma (NHL) in HIV-infected vs. uninfected patients from the same integrated healthcare system, and to identify prognostic factors for HIV-related NHL in the era of combined antiretroviral therapy. DESIGN A cohort study. METHODS Incident NHL diagnosed between 1996 and 2005 were identified from members of Kaiser Permanente California Health Plans. Two-year all-cause and lymphoma-specific mortality by HIV status were examined using multivariable Poisson regression. Among HIV-infected patients, prognostic factors of demographics, lymphoma, and HIV-related characteristics for the same outcomes were also examined. RESULTS A total of 259 HIV-infected and 8230 HIV-uninfected incident NHL patients were evaluated. Fifty-nine percent of HIV-infected patients died within 2 years after NHL diagnosis as compared with 30% of HIV-uninfected patients. HIV status was independently associated with a doubling of 2-year all-cause mortality (relative risk = 2.0, 95% confidence interval 1.7-2.3). This elevated mortality risk for HIV-infected patients was similar for all race groups, lymphoma stages, and histologic subtypes. HIV-infected patients with CD4 cell count below 200 cells/microl, prior AIDS-defining illness, or both were also at increased risk for lymphoma-specific mortality as compared with HIV-uninfected patients. Among HIV-infected NHL patients, significant prognostic factors for overall mortality included prior AIDS-defining illness and Burkitt's subtype. CONCLUSION HIV-infected patients with NHL in the combined antiretroviral therapy era continue to endure substantially higher mortality compared with HIV-uninfected patients with NHL. Better management and therapeutic approaches to extend survival time for HIV-related NHL are needed.
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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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Rosso R, Di Biagio A, Viscoli C. Infectious complications of cancer chemotherapy in HIV patients. Curr Infect Dis Rep 2010; 10:149-56. [PMID: 18462590 DOI: 10.1007/s11908-008-0026-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The outcome for HIV-infected patients with cancer has dramatically improved in the highly active antiretroviral therapy (HAART) era, probably due to improvements in immune status and bone marrow function that allow the possibility of increased drug-dose intensity with a higher complete remission rate. Although data regarding the optimal management of these cancers are lacking, current studies suggest that patients with HIV-associated malignancies could be treated using approaches similar to those for their counterparts in the general population (ie, with chemotherapy, radiation, and appropriate use of supportive measures). In the HAART era, the AIDS-related mortality rate has decreased by approximately 70%, and so the cause of the growing number of reports of cancers in HIV patients is unclear. Clearly, non-AIDS-defining malignancies account for more morbidity and mortality than AIDS-defining malignancies. Prevention strategies are needed to adequately deal with HIV-associated cancers in an aging and growing HIV-positive population.
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Affiliation(s)
- Raffaella Rosso
- Infectious Diseases Clinic, University of Genoa, San Martino Hospital, Largo R. Benzi 10, 16132, Genoa, Italy
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Castillo JJ, Winer ES, Stachurski D, Perez K, Jabbour M, Milani C, Colvin G, Butera JN. Prognostic factors in chemotherapy-treated patients with HIV-associated Plasmablastic lymphoma. Oncologist 2010; 15:293-9. [PMID: 20167839 DOI: 10.1634/theoncologist.2009-0304] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Plasmablastic lymphoma (PBL) is a variant of diffuse large B-cell lymphoma commonly seen in the oral cavity of HIV-infected individuals. PBL has a poor prognosis, but prognostic factors in patients who have received chemotherapy have not been adequately evaluated. METHODS An extensive literature search rendered 248 cases of PBL, from which 157 were HIV(+). Seventy cases with HIV-associated PBL that received chemotherapy were identified. Whenever possible, authors of the original reports were contacted to complete clinicopathological data. Univariate analyses were performed calculating Kaplan-Meier estimates and compared using the log-rank test. RESULTS The mean age was 39 years, with a male predominance. The mean CD4(+) count was 165 cells/mm(3). Advanced clinical stage was seen in 51% and extraoral involvement was seen in 43% of the cases. The expression levels of CD20 and Epstein-Barr virus-encoded RNA were 13% and 86%, respectively. The overall survival duration was 14 months. In a univariate analysis, early clinical stage and a complete response to chemotherapy were associated with longer survival. There was no apparent difference in survival with regimens more intensive than cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). CONCLUSIONS Patients with HIV-associated PBL have a poor prognosis. Prognosis is strongly associated with achieving a complete clinical response to CHOP or CHOP-like chemotherapy. The role of more intensive regimens is currently unclear. Further research is needed to improve responses using novel therapeutic agents and strategies.
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Affiliation(s)
- Jorge J Castillo
- 164 Summit Avenue, Fain Building, Providence, Rhode Island 02906, USA.
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Perez K, Castillo J, Dezube BJ, Pantanowitz L. Human immunodeficiency virus-associated anaplastic large cell lymphoma. Leuk Lymphoma 2010; 51:430-8. [PMID: 20141444 DOI: 10.3109/10428190903572201] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Kimberly Perez
- Division of Hematology/Oncology, The Warren Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI 02906, USA
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Neoplasias y VIH en la tercera década de la epidemia. Med Clin (Barc) 2009; 133:750-1. [DOI: 10.1016/j.medcli.2009.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Accepted: 09/03/2009] [Indexed: 11/20/2022]
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Prognosis of HIV-associated non-Hodgkin lymphoma in patients starting combination antiretroviral therapy. AIDS 2009; 23:2029-37. [PMID: 19531926 DOI: 10.1097/qad.0b013e32832e531c] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We examined survival and prognostic factors of patients who developed HIV-associated non-Hodgkin lymphoma (NHL) in the era of combination antiretroviral therapy (cART). DESIGN AND SETTING Multicohort collaboration of 33 European cohorts. METHODS We included all cART-naive patients enrolled in cohorts participating in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) who were aged 16 years or older, started cART at some point after 1 January 1998 and developed NHL after 1 January 1998. Patients had to have a CD4 cell count after 1 January 1998 and one at diagnosis of the NHL. Survival and prognostic factors were estimated using Weibull models, with random effects accounting for heterogeneity between cohorts. RESULTS Of 67 659 patients who were followed up during 304 940 person-years, 1176 patients were diagnosed with NHL. Eight hundred and forty-seven patients (72%) from 22 cohorts met inclusion criteria. Survival at 1 year was 66% [95% confidence interval (CI) 63-70%] for systemic NHL (n = 763) and 54% (95% CI: 43-65%) for primary brain lymphoma (n = 84). Risk factors for death included low nadir CD4 cell counts and a history of injection drug use. Patients developing NHL on cART had an increased risk of death compared with patients who were cART naive at diagnosis. CONCLUSION In the era of cART two-thirds of patients diagnosed with HIV-related systemic NHL survive for longer than 1 year after diagnosis. Survival is poorer in patients diagnosed with primary brain lymphoma. More advanced immunodeficiency is the dominant prognostic factor for mortality in patients with HIV-related NHL.
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Martí-Carvajal AJ, Cardona AF, Lawrence A. Interventions for previously untreated patients with AIDS-associated non-Hodgkin's lymphoma. Cochrane Database Syst Rev 2009:CD005419. [PMID: 19588373 DOI: 10.1002/14651858.cd005419.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection is known to be associated with an increased risk of non-Hodgkin's lymphoma (NHL). The majority of lymphomas (>80%) occurring during immunosuppression are aggressive B-cell in origin and have a high-to-intermediate histology grade. Treatment of NHL is not standardized. OBJECTIVES To assess the clinical effectiveness and safety of single agent or combination chemotherapy with or without immunochemotherapy (rituximab) and with or without highly active antiretroviral therapy (HAART) on overall survival (OS) and disease-free survival (DFS) for previously untreated patients with AIDS-related NHL. SEARCH STRATEGY The Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2009), MEDLINE (1966-March 6, 2009), EMBASE (1988-March 6, 2009), LlLACS (1982 to February 17, 2009), Gateway (March 6, 2009), and AIDSearch (2006 -February 2008) were used to identify published, potentially eligible trials. Further, we searched several electronic sources. For additional information see the Cochrane HIV/AIDS Group search strategy. SELECTION CRITERIA Randomized controlled trials (RCTs) assessing the effectiveness of systemic treatments for previously untreated AIDS-related NHL. There were no age or language restrictions. DATA COLLECTION AND ANALYSIS Authors independently assessed relevant studies for inclusion; four RCTs were selected. No meta-analysis was attempted due to clinical heterogeneity. MAIN RESULTS Four RCTs that included 857 patients (number range: 30 to 485) met the inclusion criteria. The studies have a high risk of bias; three RCTs were conducted in the United States and one was a multi-national, multi-centre RCT performed in France and Italy. One of the trials included only men. It was impossible to pool data for any of the outcomes due to the differences in the interventions assessed in these RCTs. Overall survival did not differ significantly between treatment groups. Disease free survival (DFS) was reported in two of the four RCTs, but it was not statistically significant between treatment groups. AUTHORS' CONCLUSIONS We found no evidence that the systemic interventions for untreated patients with AIDS-related NHL provide superior clinical effectiveness for improving OS, DSF, and tumour response rate; however, this conclusion is based on four RCTs with limited sample size and variable quality. More adequately powered RCTs that have low risk of bias are necessary to determine the real benefit or harm of interventions to treat this population. Overall survival (OS), DFS, and quality of life should be included as endpoints.
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Balsalobre P, Díez-Martín JL, Re A, Michieli M, Ribera JM, Canals C, Rosselet A, Conde E, Varela R, Cwynarski K, Gabriel I, Genet P, Guillerm G, Allione B, Ferrant A, Biron P, Espigado I, Serrano D, Sureda A. Autologous Stem-Cell Transplantation in Patients With HIV-Related Lymphoma. J Clin Oncol 2009; 27:2192-8. [DOI: 10.1200/jco.2008.18.2683] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PurposePeripheral-blood autologous stem-cell transplantation (ASCT) in patients with HIV-related lymphoma (HIV-Ly) has been reported as a safe and useful procedure. Herein we report the European Group for Blood and Marrow Transplantation experience on patients with HIV-Ly undergoing ASCT.Patients and MethodsThis was a retrospective, multicentric, registry-based analysis.ResultsSince 1999, 68 patients from 20 institutions (median age, 41 years; range, 29 to 62 years) were included, diagnosed with non-Hodgkin's lymphoma (NHL; n = 50) or Hodgkin's lymphoma (n = 18). At the time of ASCT, 16 patients were in first complete remission (CR1); 44 patients were in CR more than 1, partial remission, or chemotherapy-sensitive relapse (chemo-S); and eight patients had chemotherapy-resistant disease. The median number of CD34+cells infused was 4.5 × 106/kg (range, 1.6 to 21.2 × 106/kg). Median time to neutrophil and platelet engraftment were 11 days (range, 8 to 36 days) and 14 days (range, 6 to 455 days), respectively, with a cumulative incidence (CI) at 1 year of 95.6% and 87%, respectively. CI of nonrelapse mortality (NRM) was 7.5% at 12 months after ASCT, mainly because of bacterial infections. CI of relapse was 30.4% at 24 months, statistically related with not being in CR at ASCT (relative risk [RR] = 3.6), NHL histology other than diffuse large B-cell lymphoma (RR = 3.4), and use of more than two previous treatment lines (RR = 3). At a median follow-up of 32 months (range, 2 to 81 months), progression-free survival (PFS) was 56%. Patients not in CR or with refractory disease at ASCT had poorer PFS (RR = 2.4 and 4.8, respectively).ConclusionSimilarly to HIV-negative patients with lymphoma, ASCT is a useful treatment for patients with HIV-Ly and is associated with low NRM, mainly when performed in early stages and chemo-S disease.
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Affiliation(s)
- Pascual Balsalobre
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - José L. Díez-Martín
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Alessandro Re
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Mariagrazia Michieli
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - José M. Ribera
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Carmen Canals
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Anne Rosselet
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Eulogio Conde
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Rosario Varela
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Kate Cwynarski
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Ian Gabriel
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Philippe Genet
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Gaelle Guillerm
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Bernardino Allione
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Augustin Ferrant
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Pierre Biron
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Ildefonso Espigado
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - David Serrano
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
| | - Anna Sureda
- From the Hospital General Universitario Gregorio Marañon, Madrid; Institut Catalá d'Oncologia, Hospital Universitari German Trias i Pujol, Badalona; European Group for Blood and Marrow Transplantation Lymphoma Working Party, Barcelona; Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander; Complejo Hospitalario Juan Canalejo, A Coruña; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Spedali Civili, Brescia; Centro di Riferimento Oncologico Istituto di Ricovero e Cura
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Castillo J, Pantanowitz L, Dezube BJ. HIV-associated plasmablastic lymphoma: lessons learned from 112 published cases. Am J Hematol 2008; 83:804-9. [PMID: 18756521 DOI: 10.1002/ajh.21250] [Citation(s) in RCA: 199] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Plasmablastic lymphoma (PBL) is a distinct subtype of non-Hodgkin B-cell lymphoma, originally described with a strong predilection to the oral cavity of human immunodeficiency virus (HIV)-infected individuals. Data regarding patient age and gender, HIV status, initiation of and response to highly active antiretroviral therapy (HAART), tumor extent, pathology, treatment, and outcome were extracted from 112 cases of PBL identified in the literature. The median age at presentation was 38 years with a male predominance of 7:1, and the median CD4+ count was 178 cells/mm(3). PBL presented on average 5 years after diagnosis of HIV. Common primary sites of presentation included the oral cavity, gastrointestinal tract, and lymph nodes. Most cases presented with either stage I or stage IV disease. There was a variable expression of B-cell markers in tumor cells, but plasma cell markers were expressed in all cases. EBV was detected in 74%. Chemotherapy was used to treat 55% patients and was combined with radiotherapy in 21% cases. Complete response was obtained in 66% of treated cases; the majority of these responses were seen after CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone). The refractory/relapsed disease rate was 54%. Death occurred in 53% of patients, with a median overall survival of 15 months. Sex, CD4+ count, viral load, clinical stage, EBV status, primary site of involvement, and use of CHOP failed to show an association with survival. PBL is an aggressive B-cell lymphoma that presents in both oral and extra-oral sites of chronically HIV-infected immunosuppressed young men.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antiretroviral Therapy, Highly Active/methods
- CD4 Lymphocyte Count
- Combined Modality Therapy/statistics & numerical data
- Cyclophosphamide/therapeutic use
- Doxorubicin/therapeutic use
- Herpesvirus 4, Human/isolation & purification
- Humans
- Lymphoma, AIDS-Related/epidemiology
- Lymphoma, AIDS-Related/mortality
- Lymphoma, AIDS-Related/therapy
- Lymphoma, Large-Cell, Immunoblastic/complications
- Lymphoma, Large-Cell, Immunoblastic/epidemiology
- Lymphoma, Large-Cell, Immunoblastic/mortality
- Lymphoma, Large-Cell, Immunoblastic/therapy
- Prednisone/therapeutic use
- Survival Analysis
- Vincristine/therapeutic use
- Viral Load
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Affiliation(s)
- Jorge Castillo
- Division of Hematology/Oncology, The Miriam Hospital, Brown University Warren Alpert Medical School, Providence, Rhode Island 02906, USA.
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Changes in Causes of Death Among Adults Infected by HIV Between 2000 and 2005: The “Mortalité 2000 and 2005” Surveys (ANRS EN19 and Mortavic). J Acquir Immune Defic Syndr 2008; 48:590-8. [DOI: 10.1097/qai.0b013e31817efb54] [Citation(s) in RCA: 277] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Zitvogel L, Apetoh L, Ghiringhelli F, André F, Tesniere A, Kroemer G. The anticancer immune response: indispensable for therapeutic success? J Clin Invest 2008; 118:1991-2001. [PMID: 18523649 DOI: 10.1172/jci35180] [Citation(s) in RCA: 456] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Although the impact of tumor immunology on the clinical management of most cancers is still negligible, there is increasing evidence that anticancer immune responses may contribute to the control of cancer after conventional chemotherapy. Thus, radiotherapy and some chemotherapeutic agents, in particular anthracyclines, can induce specific immune responses that result either in immunogenic cancer cell death or in immunostimulatory side effects. This anticancer immune response then helps to eliminate residual cancer cells (those that fail to be killed by chemotherapy) or maintains micrometastases in a stage of dormancy. Based on these premises, in this Review we address the question, How may it be possible to ameliorate conventional therapies by stimulating the anticancer immune response? Moreover, we discuss the rationale of clinical trials to evaluate and eventually increase the contribution of antitumor immune responses to the therapeutic management of neoplasia.
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41
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Characteristics and outcome of AIDS-related Hodgkin lymphoma before and after the introduction of highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2008; 27:699-705. [PMID: 18434957 DOI: 10.1097/qai.0b013e31815e722b] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We analyzed survival, therapeutic response, and prognostic factors in patients with HIV-related Hodgkin lymphoma (HL) treated or not with highly active antiretroviral therapy (HAART). METHODS This study included 104 patients with HL, treated (n = 83) or not (n = 21) with HAART. Outcomes and prognostic factors of complete remission (CR), overall survival (OS), and disease-free survival (DFS) were assessed by an intention-to-treat analysis of all patients who received at least 1 chemotherapy course. RESULTS No differences were found between groups at baseline in the specific characteristics of HIV and HL. The proportion of patients receiving appropriate-for-stage therapy for HL was similar for both groups. The CR rates in the HAART (-) and HAART (+) groups were 14 (70%) of 20 versus 71 (91%) of 78 (P = 0.023). The median OS in the HAART (-) group was 39 months (95% confidence interval [CI]: 0 to 89) and was not reached in the HAART (+) group (P = 0.0089). The median DFS in the HAART (-) group was 85 months (95% CI: 73 to 97) and was not reached in the HAART (+) group (P = 0.129). Factors independently associated with CR by logistic regression analysis were appropriate-for-stage therapy of HL, HAART, and baseline CD4 count > or =100 cells/microL. CR was the only factor independently associated with OS by Cox regression analysis. CONCLUSIONS The achievement of CR was independently associated with appropriate-for-stage therapy for HL, with HAART, and with a baseline CD4 count > or =100 cells/microL. The only variable independently associated with OS was the achievement of CR.
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Miralles P, Berenguer J, Ribera Santasusana JM, Calvo F, Díaz Mediavilla J, Díez-Martín JL, Gomez Codina J, López Aldeguer J, Rubio R, Santos J, Valencia E. Recomendaciones de GESIDA/PETHEMA sobre el diagnóstico y el tratamiento de los linfomas en pacientes infectados por el virus de la inmunodeficiencia humana. Med Clin (Barc) 2008; 130:300-11. [PMID: 18358123 DOI: 10.1157/13116574] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Pilar Miralles
- Servicio de Enfermedades Infecciosas/VIH, Hospital General Gregorio Marañón, Madrid, España.
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Ribera JM, Oriol A, Morgades M, González-Barca E, Miralles P, López-Guillermo A, Gardella S, López A, Abella E, García M. Safety and efficacy of cyclophosphamide, adriamycin, vincristine, prednisone and rituximab in patients with human immunodeficiency virus-associated diffuse large B-cell lymphoma: results of a phase II trial. Br J Haematol 2008; 140:411-9. [PMID: 18162120 DOI: 10.1111/j.1365-2141.2007.06943.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
MESH Headings
- Adult
- Aged
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antiretroviral Therapy, Highly Active
- CD4 Lymphocyte Count
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/adverse effects
- Doxorubicin/administration & dosage
- Doxorubicin/adverse effects
- Female
- Humans
- Lymphoma, AIDS-Related/drug therapy
- Lymphoma, AIDS-Related/immunology
- Lymphoma, AIDS-Related/pathology
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Neoplasm Staging
- Prednisone/administration & dosage
- Prednisone/adverse effects
- Prognosis
- Rituximab
- Survival Analysis
- Treatment Outcome
- Vincristine/administration & dosage
- Vincristine/adverse effects
- Viral Load
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Affiliation(s)
- Josep-Maria Ribera
- Haematology Department, Institut Català d'Oncologia-Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
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44
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Current Awareness in Hematological Oncology. Hematol Oncol 2007. [DOI: 10.1002/hon.798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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45
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Simcock M, Blasko M, Karrer U, Bertisch B, Pless M, Blumer L, Vora S, Robinson JO, Bernasconi E, Terziroli B, Moirandat-Rytz S, Furrer H, Hirschel B, Vernazza P, Sendi P, Rickenbach M, Bucher HC, Battegay M, Koller MT, Battegay M, Bernasconi E, Böni J, Bucher H, Bürgisser P, Cattacin S, Cavassini M, Dubs R, Egger M, Elzi L, Erb P, Fischer M, Flepp M, Fontana A, Francioli P, Furrer H, Gorgievski M, Günthard H, Hirsch H, Hirschel B, Hösli IH, Kahlert C, Kaiser L, Karrer U, Kind C, Klimkait T, Ledergerber B, Martinetti G, Martinez B, uUller NM, Nadal D, Opravil M, Paccaud F, Pantaleo G, Rickenbach M, Rudin C, Schmid P, Schultze D, Schüpbach J, Speck R, Taffé P, Tarr P, Telenti A, Trkola A, Vernazza P, Weber R, Yerly S. Treatment and Prognosis of AIDS-Related Lymphoma in the Era of Highly Active Antiretroviral Therapy: Findings from the Swiss HIV Cohort Study. Antivir Ther 2007. [DOI: 10.1177/135965350701200609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To assess the characteristics of combination antiretroviral therapy (cART) administered concomitantly with chemotherapy and to establish prognostic determinants of patients with AIDS-related non-Hodgkin's lymphoma. Methods The study included 91 patients with AIDS-related non-Hodgkin's lymphoma from the Swiss HIV Cohort Study enrolled between January 1997 and October 2003, excluding lymphomas of the brain. We extracted AIDS-related non-Hodgkin's lymphoma- and HIV-specific variables at the time of lymphoma diagnosis as well as treatment changes over time from charts and from the Swiss HIV Cohort Study database. Cox regression analyses were performed to study predictors of overall and progression-free survival. Results During a median follow up of 1.6 years, 57 patients died or progressed. Thirty-five patients stopped chemotherapy prematurely (before the sixth cycle) usually due to disease progression; these patients had a shorter median survival than those who completed six or more cycles (14 versus 28 months). Interruptions of cART decreased from 35% before chemotherapy to 5% during chemotherapy. Factors associated with overall survival were CD4+ T-cell count (<100 cells/μl) (hazard ratio [HR] 2.95 [95% confidence interval (CI) 1.53–5.67], hepatitis C seropositivity (HR 2.39 [95% CI 1.01–5.67]), the international prognostic index score (HR 1.98–3.62 across categories) and Burkitt histological subtypes (HR 2.56 [95% CI 1.13–5.78]). Conclusions Interruptions of cART were usually not induced by chemotherapy. The effect of cART interruptions on AIDS-related non-Hodgkin's lymphoma prognosis remains unclear, however, hepatitis C seropositivity emerged as a predictor of death beyond the well-known international prognostic index score and CD4+ T-cell count.
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Affiliation(s)
- Mathew Simcock
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
- Basel Institute for Clinical Epidemiology, University Hospital Basel, Switzerland
| | - Monika Blasko
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Urs Karrer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland
| | - Barbara Bertisch
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland
| | - Miklos Pless
- Division of Oncology, University Hospital Basel, Switzerland
| | - Liisa Blumer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Samir Vora
- Division of Infectious Diseases, University Hospital Geneva, Switzerland
| | | | | | | | | | - Hansjakob Furrer
- Division of Infectious Diseases, University Hospital Bern, Switzerland
| | - Bernard Hirschel
- Division of Infectious Diseases, University Hospital Geneva, Switzerland
| | | | - Pedram Sendi
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
- Basel Institute for Clinical Epidemiology, University Hospital Basel, Switzerland
| | - Martin Rickenbach
- Data Centre of the Swiss HIV Cohort Study, University Hospital Lausanne, Switzerland
| | - Heiner C Bucher
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
- Basel Institute for Clinical Epidemiology, University Hospital Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Michael T Koller
- Basel Institute for Clinical Epidemiology, University Hospital Basel, Switzerland
| | - M Battegay
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - E Bernasconi
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - J Böni
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - H Bucher
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - Ph Bürgisser
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - S Cattacin
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - M Cavassini
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - R Dubs
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - M Egger
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - L Elzi
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - P Erb
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - M Fischer
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - M Flepp
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - A Fontana
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - P Francioli
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - H Furrer
- Chairman of the Clinical and Laboratory Committee
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - C Rudin
- Chairman of the Mother & Child Substudy
| | - P Schmid
- Chairman of the Scientific Board
| | | | | | - R Speck
- Chairman of the Scientific Board
| | - P Taffé
- Chairman of the Scientific Board
| | - P Tarr
- Chairman of the Scientific Board
| | | | - A Trkola
- Chairman of the Scientific Board
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Noteworthy Features of HIV-associated T-cell Non-Hodgkin lymphoma. HIV & AIDS REVIEW 2007. [DOI: 10.1016/s1730-1270(10)60057-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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