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Celades C, Tuset M, Ambrosioni J, Calvo J, Lizondo T, Sabato S, Guardia A, Chapchap EC, Navarro JT, Molto J. Leveraging interdisciplinary management in people with HIV and lymphoid neoplasms. J Antimicrob Chemother 2024; 79:2493-2499. [PMID: 39045785 DOI: 10.1093/jac/dkae244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 06/22/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Drug-drug interactions between antiretroviral treatment (ART) and cytostatics may have a negative impact in the prognosis of people with HIV (PWH) and cancer. OBJECTIVE The objective of this study is to evaluate the impact of the implementation of interdisciplinary management and the type of ART in PWH diagnosed with lymphoid neoplasms. METHODS This is a multicentric, retrospective observational cohort study including PWH diagnosed with lymphoid neoplasm who started first-line chemotherapy between 2008 and 2020. Demographic, clinical and therapeutic variables were obtained from the electronic medical records and associated with 5-year progression-free survival (PFS) and overall survival (OS) using Cox proportional hazard models. RESULTS A total of 118 individuals were included. Boosted ART was being used in 55 (46.6%) cases at the time of neoplasm diagnosis. The Infectious Diseases or the Pharmacy Department was consulted before starting chemotherapy in 79/118 (66.9%) cases. Interdisciplinary management resulted in fewer subjects taking boosted ART (17.7% versus 71.8%, P < 0.001) and more subjects using unboosted integrase strand transfer inhibitor-based ART (74.7% versus 7.7%, P < 0.001). The use of boosted ART with chemotherapy was associated with worse 5-year PFS (P = 0.003) and 5-year OS (P = 0.016). There was a trend towards better 5-year PFS and OS when interdisciplinary management was implemented, with significant differences for individuals receiving boosted ART at neoplasm diagnosis (P = 0.0246 and P = 0.0329, respectively). CONCLUSIONS Our findings underscore the significant impact of the type of ART on the prognosis of PWH undergoing chemotherapy. Encouraging collaborative management between oncologists, pharmacists and HIV teams for these patients enhances PFS and OS rates.
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Affiliation(s)
- Carolina Celades
- Lymphoid Neoplasms Group, Josep Carreras Laukaemia Research Institute, Badalona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Montse Tuset
- Pharmacy Department, Division of Medicines, Hospital Clinic-Fundació de recerca Clinic Barcelona-Institut de investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
| | - Juan Ambrosioni
- HIV Unit, Infectious Diseases Department, Hospital Clinic-Fundació de recerca Clinic Barcelona-Institut de investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Júlia Calvo
- HIV Unit, Infectious Diseases Department, Hospital Clinic-Fundació de recerca Clinic Barcelona-Institut de investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
| | - Thais Lizondo
- Pharmacy Department, Division of Medicines, Hospital Clinic Barcelona, Barcelona, Spain
| | - Sofia Sabato
- Fundació Lluita Contra les Infeccions, Infectious Diseases Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Ares Guardia
- Hematology Department, Hospital Clinic-Fundació de recerca Clinic Barcelona-Institut de investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
| | | | - Jose Tomas Navarro
- Lymphoid Neoplasms Group, Josep Carreras Laukaemia Research Institute, Badalona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Institut Cataalà d'Oncologia-Germans Trias i Pujol Hospital, Badalona, Spain
| | - Jose Molto
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
- Fundació Lluita Contra les Infeccions, Infectious Diseases Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
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2
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Hübel K, Bower M, Aurer I, Bastos-Oreiro M, Besson C, Brunnberg U, Cattaneo C, Collins S, Cwynarski K, Dalla Pria A, Hentrich M, Hoffmann C, Kersten MJ, Montoto S, Navarro JT, Oksenhendler E, Re A, Ribera JM, Schommers P, von Tresckow B, Buske C, Dreyling M, Davies A. Human immunodeficiency virus-associated lymphomas: EHA-ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2024; 35:840-859. [PMID: 39232987 DOI: 10.1016/j.annonc.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 09/06/2024] Open
Affiliation(s)
- K Hübel
- Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - M Bower
- National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - I Aurer
- Department of Internal Medicine, University Hospital Centre, Zagreb; Medical School, University of Zagreb, Zagreb, Croatia
| | - M Bastos-Oreiro
- Department of Hematology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - C Besson
- Department of Clinical Haematology, Versailles Hospital, Versailles; UVSQ, Université Paris-Saclay, UFR Santé Simone Veil, Inserm, CESP, Villejuif, France
| | - U Brunnberg
- Department of Hematology and Oncology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - C Cattaneo
- Department of Medical Oncology, Division of Hematology, ASST - Spedali Civili, Brescia, Italy
| | | | - K Cwynarski
- Department of Haematology, University College Hospital, London, UK
| | - A Dalla Pria
- National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - M Hentrich
- Department of Hematology and Oncology, Red Cross Hospital Munich, Ludwig Maximilian University, Munich
| | | | - M J Kersten
- Department of Hematology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - S Montoto
- Department of Haemato-oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - J T Navarro
- Department of Hematology, Institut Català d'Oncologia, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Oksenhendler
- Department of Clinical Immunology, Hôpital Saint-Louis, APHP, Paris, France
| | - A Re
- Department of Medical Oncology, Division of Hematology, ASST - Spedali Civili, Brescia, Italy
| | - J-M Ribera
- Department of Hematology, Institut Català d'Oncologia, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - P Schommers
- Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - B von Tresckow
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center and German Cancer Consortium (DKTK partner site Essen), University Hospital Essen, University of Duisburg-Essen, Essen
| | - C Buske
- Institute of Experimental Cancer Research, Department of Internal Medicine III, Ulm Medical University, Ulm
| | - M Dreyling
- Department of Medicine III, Ludwig-Maximilians-University, Munich, Germany
| | - A Davies
- General Hospital, University Hospital NHS Trust, Southampton, UK
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3
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Lurain KA, Ramaswami R, Krug LT, Whitby D, Ziegelbauer JM, Wang HW, Yarchoan R. HIV-associated cancers and lymphoproliferative disorders caused by Kaposi sarcoma herpesvirus and Epstein-Barr virus. Clin Microbiol Rev 2024; 37:e0002223. [PMID: 38899877 PMCID: PMC11391709 DOI: 10.1128/cmr.00022-23] [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] [Indexed: 06/21/2024] Open
Abstract
SUMMARYWithin weeks of the first report of acquired immunodeficiency syndrome (AIDS) in 1981, it was observed that these patients often had Kaposi sarcoma (KS), a hitherto rarely seen skin tumor in the USA. It soon became apparent that AIDS was also associated with an increased incidence of high-grade lymphomas caused by Epstein-Barr virus (EBV). The association of AIDS with KS remained a mystery for more than a decade until Kaposi sarcoma-associated herpesvirus (KSHV) was discovered and found to be the cause of KS. KSHV was subsequently found to cause several other diseases associated with AIDS and human immunodeficiency virus (HIV) infection. People living with HIV/AIDS continue to have an increased incidence of certain cancers, and many of these cancers are caused by EBV and/or KSHV. In this review, we discuss the epidemiology, virology, pathogenesis, clinical manifestations, and treatment of cancers caused by EBV and KSHV in persons living with HIV.
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Affiliation(s)
- Kathryn A Lurain
- The HIV and AIDS Malignancy Branch, Center for Cancer Research, Bethesda, Maryland, USA
| | - Ramya Ramaswami
- The HIV and AIDS Malignancy Branch, Center for Cancer Research, Bethesda, Maryland, USA
| | - Laurie T Krug
- The HIV and AIDS Malignancy Branch, Center for Cancer Research, Bethesda, Maryland, USA
| | - Denise Whitby
- Viral Oncology Section, AIDS and Cancer Virus Program, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Joseph M Ziegelbauer
- The HIV and AIDS Malignancy Branch, Center for Cancer Research, Bethesda, Maryland, USA
| | - Hao-Wei Wang
- Laboratory of Pathology, National Cancer Institute, Bethesda, Maryland, USA
| | - Robert Yarchoan
- The HIV and AIDS Malignancy Branch, Center for Cancer Research, Bethesda, Maryland, USA
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4
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Vaughan J, Wiggill T, Mia Z, Patel M. Tumour-associated macrophages in diffuse large B-cell lymphoma: the prognostic and therapeutic impact in a South African centre with high HIV seroprevalence. Immunol Res 2024:10.1007/s12026-024-09537-x. [PMID: 39259401 DOI: 10.1007/s12026-024-09537-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 08/29/2024] [Indexed: 09/13/2024]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is a common malignancy among people living with HIV. Macrophage enrichment of the tumour microenvironment (TME) is a prognostic factor in DLBCL among immunocompetent people, with some studies reporting that macrophage enrichment predicts a superior response to rituximab therapy. The macrophage phenotype is also important, with reportedly poorer outcomes with enrichment of anti-inflammatory (M2) macrophages. To date, the relationship between the type/number of tumour macrophages and outcomes in HIV-associated DLBCL (HIV-DLBCL) has been poorly explored. In this study, we assessed tumour macrophage numbers in a South African cohort of patients with DLBCL and a high HIV-seropositivity rate. Immunohistochemistry for CD68 and CD163 was performed on the diagnostic biopsies of 79 patients with DLBCL. Relevant information was documented from the clinical records, including disease stage, international-prognostic index score, HIV-related parameters, C-reactive protein, ferritin levels and immune cell numbers (monocytes, lymphocytes and neutrophils). Survival analysis was performed using Kaplan-Meier survival estimates, and the correlation between tumour macrophage numbers and a variety of immunological parameters was assessed using Spearman's rho. Of the 79 patients included, 87.2% were living with HIV, and rituximab therapy was used in 46.9%. Tumour macrophage numbers were not related to HIV status, but low pro-inflammatory (M1) macrophage numbers (CD68 + CD163 -) were significantly associated with poorer outcomes (HR 2.02, p = 0.03). M2 macrophage (CD68 + CD163 +) enrichment was not predictive of survival but was associated with improved response to rituximab therapy (HR 0.19; p = 0.002). Macrophage numbers were marginally correlated with ferritin levels, which showed modest performance as a peripheral blood biomarker of the TME macrophage status (AUC 0.6 at a level of 374 µg/L), and high ferritin levels were associated with a superior response to rituximab-therapy (HR 0.28, p = 0.034). Pro-inflammatory macrophages are important in tumour control in HIV-DLBCL, while M2 macrophage enrichment improves the response to rituximab therapy. Ferritin shows promise as a biomarker for identifying patients more likely to benefit from rituximab therapy.
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Affiliation(s)
- Jenifer Vaughan
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- National Health Laboratory Services, Johannesburg, South Africa.
| | - Tracey Wiggill
- National Health Laboratory Services, Johannesburg, South Africa
- Immunology Unit, Division of Medical Microbiology and Immunology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Zainab Mia
- National Health Laboratory Services, Johannesburg, South Africa
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Moosa Patel
- Clinical Haematology Unit, Department of Medicine, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Hübel K, Bower M, Aurer I, Bastos‐Oreiro M, Besson C, Brunnberg U, Cattaneo C, Collins S, Cwynarski K, Pria AD, Hentrich M, Hoffmann C, Kersten MJ, Montoto S, Navarro J, Oksenhendler E, Re A, Ribera J, Schommers P, von Tresckow B, Buske C, Dreyling M, Davies A. Human immunodeficiency virus-associated Lymphomas: EHA-ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Hemasphere 2024; 8:e150. [PMID: 39233903 PMCID: PMC11369492 DOI: 10.1002/hem3.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/10/2024] [Indexed: 09/06/2024] Open
Abstract
This EHA-ESMO Clinical Practice Guideline provides key recommendations for managing HIV-associated lymphomas.The guideline covers clinical, imaging and pathological diagnosis; staging and risk assessment; treatment and follow-up.The author group encompasses a multidisciplinary group of experts from different institutions and countries in Europe.Recommendations are based on available scientific data and the authors' collective expert opinion.
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Affiliation(s)
- Kai Hübel
- Department of Internal MedicineFaculty of Medicine and University Hospital CologneCologneGermany
| | - Mark Bower
- National Centre for HIV Malignancy, Chelsea and Westminster HospitalLondonUK
| | - Igor Aurer
- Department of Internal MedicineUniversity Hospital CentreZagrebCroatia
- Medical SchoolUniversity of ZagrebZagrebCroatia
| | | | - Caroline Besson
- Department of Clinical HaematologyVersailles HospitalVersaillesFrance
- UVSQ, Université Paris‐Saclay, UFR Santé Simone Veil, Inserm, CESPVillejuifFrance
| | - Uta Brunnberg
- Department of Hematology and OncologyGoethe University Frankfurt, University HospitalFrankfurtGermany
| | - Chiara Cattaneo
- Department of Medical Oncology, Division of HematologyASST ‐ Spedali CiviliBresciaItaly
| | | | - Kate Cwynarski
- Department of HaematologyUniversity College HospitalLondonUK
| | - Alessia D. Pria
- National Centre for HIV Malignancy, Chelsea and Westminster HospitalLondonUK
| | - Marcus Hentrich
- Department of Hematology and OncologyRed Cross Hospital Munich, Ludwig Maximilian UniversityMunichGermany
| | | | - Marie J. Kersten
- Department of HematologyAmsterdam University Medical Centers, Cancer Center AmsterdamAmsterdamThe Netherlands
| | - Silvia Montoto
- Department of Haemato‐Oncology, St Bartholomew's HospitalBarts Health NHS TrustLondonUK
| | - Jose‐Tomas Navarro
- Department of HematologyInstitut Català d'Oncologia, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Eric Oksenhendler
- Department of Clinical ImmunologyHôpital Saint‐Louis, APHPParisFrance
| | - Alessandro Re
- Department of Medical Oncology, Division of HematologyASST ‐ Spedali CiviliBresciaItaly
| | - Josep‐Maria Ribera
- Department of HematologyInstitut Català d'Oncologia, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Philipp Schommers
- Department of Internal MedicineFaculty of Medicine and University Hospital CologneCologneGermany
| | - Bastian von Tresckow
- Department of Hematology and Stem Cell TransplantationWest German Cancer Center and German Cancer Consortium (DKTK partner site Essen), University Hospital Essen, University of Duisburg‐EssenEssenGermany
| | - Christian Buske
- Institute of Experimental Cancer Research, Department of Internal Medicine IIIUlmGermany
| | - Martin Dreyling
- Department of Medicine IIILudwig‐Maximilians‐UniversityMunichGermany
| | - Andy Davies
- General Hospital, University Hospital NHS TrustSouthamptonUK
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6
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Kurosawa S, Yoshimura Y, Takada Y, Yokota T, Hibi M, Hirahara A, Yoshida T, Okubo S, Masuda M, So Y, Miyata N, Nakayama H, Sakurai A, Sato K, Ito C, Aisa Y, Nakazato T. A predictive model for HIV-related lymphoma. AIDS 2024; 38:1627-1637. [PMID: 38831732 PMCID: PMC11296280 DOI: 10.1097/qad.0000000000003949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/24/2024] [Accepted: 05/28/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVES To address the paucity of HIV-related lymphoma (HRL)-specific prognostic scores for the Japanese population by analyzing domestic cases of HRL and constructing a predictive model. DESIGN A single-center retrospective study coupled with a review of case reports of HRL. METHODS We reviewed all patients with HRL treated at our hospital between 2007 and 2023 and conducted a comprehensive search for case reports of HRL from Japan using public databases. A multivariate analysis for overall survival (OS) was performed using clinical parameters, leading to the formulation of the HIV-Japanese Prognostic Index (HIV-JPI). RESULTS A total of 19 patients with HRL were identified in our institution, whereas the literature review yielded 44 cases. In the HIV-JPI, a weighted score of 1 was assigned to the following factors: age at least 45 years, HIV-RNA at least 8.0×10 4 copies/ml, Epstein-Barr virus-encoded small RNA positivity, and Ann Arbor classification stage IV. The overall score ranged from 0 to 4. We defined the low-risk group as scores ranging from 0 to 2 and the high-risk group as scores ranging from 3 to 4. The 3-year OS probability of the high-risk group [30.8%; 95% confidence interval (CI): 9.5-55.4%) was significantly poorer than that of the low-risk group (76.8%; 95% CI: 52.8-89.7%; P < 0.01). CONCLUSION This retrospective analysis established pivotal prognostic factors for HRL in Japanese patients. The HIV-JPI, derived exclusively from Japanese patients, highlights the potential for stratified treatments and emphasizes the need for broader studies to further refine this clinical prediction model.
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Affiliation(s)
| | - Yukihiro Yoshimura
- Division of Infectious Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | | | | | | | | | | | | | | | - Yuna So
- Division of Infectious Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Nobuyuki Miyata
- Division of Infectious Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | | | | | - Kosuke Sato
- Division of Infectious Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
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7
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Rubinstein PG, Galvez C, Ambinder RF. Hematopoietic stem cell transplantation and cellular therapy in persons living with HIV. Curr Opin Infect Dis 2024; 37:254-263. [PMID: 38820072 DOI: 10.1097/qco.0000000000001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
PURPOSE OF REVIEW Summarize the latest research of both stem cell transplantation and cellular therapy and present the implications with respect to persons with HIV (PWH), hematologic malignancies, and HIV-1 cure. RECENT FINDINGS Allogeneic (alloSCT) and autologous (autoSCT) stem cell transplantation have been shown to be well tolerated and effective regardless of HIV-1 status. AlloSCT leads to a decrease in the HIV-1 latently infected reservoir orders of magnitude below that achieved with antiretroviral therapy (ART) alone. Utilization of CCR5Δ2/Δ32 donors in an alloSCT has resulted in HIV-1 cures. In the last 12 months, three cases of cure have been published, giving further insight into the conditions required for HIV-1 control. Other advances in the treatment of hematological cancers include chimeric antigen receptor T-cell (CART) therapy, which are active in PWH with lymphoma. SUMMARY Here we discuss the advances in SCT and cellular therapy in PWH and cancer. Additionally, we discuss how these technologies are being utilized to achieve HIV-1 cure.
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Affiliation(s)
- Paul G Rubinstein
- Section of Hematology/Oncology, Department of Medicine, University of Illinois
- Ruth M. Rothstein CORE Center
- Section of Hematology/Oncology, Department of Medicine, Cook County Health and Hospital Systems (Cook County Hospital), Chicago, Illinois
| | - Carlos Galvez
- Section of Hematology/Oncology, Department of Medicine, University of Illinois
| | - Richard F Ambinder
- Division of Hematologic Malignancies and Bone Marrow Transplantation, Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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8
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Mashriqi F, Keir G, Vijayashankar A, Glaser JE, Franceschi AM. FDG-PET in HIV-Positive Patient with Extranodal Diffuse Large B-Cell Lymphoma. World J Nucl Med 2024; 23:126-129. [PMID: 38933069 PMCID: PMC11199027 DOI: 10.1055/s-0044-1779751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024] Open
Abstract
Extranodal diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease process and an aggressive form of non-Hodgkin's lymphoma. We present a case of multiorgan involvement of DLBCL in a patient with documented risk factors, including [ 18 F] fluorodeoxyglucose positron emission tomography/magnetic resonance imaging findings highlighting striking perineural spread involving intracranial and extracranial segments of the bilateral trigeminal nerves.
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Affiliation(s)
- Faizullah Mashriqi
- Division of Neuroradiology, Department of Radiology, Northwell Health / Donald and Barbara Zucker School of Medicine, Lenox Hill Hospital, New York, New York, United States
| | - Graham Keir
- Division of Neuroradiology, Department of Radiology, Northwell Health / Donald and Barbara Zucker School of Medicine, Lenox Hill Hospital, New York, New York, United States
| | - Akarsh Vijayashankar
- Division of Neuroradiology, Department of Radiology, Northwell Health / Donald and Barbara Zucker School of Medicine, Lenox Hill Hospital, New York, New York, United States
| | - Joseph E. Glaser
- Division of Nuclear Medicine, Department of Radiology, Northwell Health / Donald and Barbara Zucker School of Medicine, Manhasset, New York, United States
| | - Ana M. Franceschi
- Division of Neuroradiology, Department of Radiology, Northwell Health / Donald and Barbara Zucker School of Medicine, Lenox Hill Hospital, New York, New York, United States
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9
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Ma WL, Liu WD, Sun HY, Sheng WH, Hsieh SM, Wu SJ, Hung CC. Complete response to front-line therapies is associated with long-term survival in HIV-related lymphomas in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2024:S1684-1182(24)00070-7. [PMID: 38632022 DOI: 10.1016/j.jmii.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/13/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND The prognosis for people living with HIV (PLWH) who develop lymphomas has been greatly improved by combination antiretroviral therapy (cART) and anti-CD20 monoclonal antibodies. However, real-world clinical data on this patient group in Asia are limited. METHODS Treatment outcomes were retrospectively examined for 104 PLWH with lymphomas between 2000 and 2019. The cohort comprised five PLWH with Hodgkin lymphoma (HL) and 99 with non-Hodgkin lymphomas, including 61 with diffuse large B-cell lymphoma (DLBCL), 19 with Burkitt lymphoma (BL), nine with primary central nervous system lymphoma (PCNSL) and ten with other subtypes. RESULTS The 5-year overall survival (OS) rates were as follows: HL (100%), PCNSL (76.2%), other subtypes (60.0%), BL (57.4%), and DLBCL (55.6%). Individuals who achieved complete response (CR) to front-line therapies had a significantly better 5-year OS rate than those without (96.2% vs. 17.8%, p < 0.001). PLWH who received cART for ≤6 months had significantly lower CD4+ T-cell counts at lymphoma diagnosis than those who received cART for longer periods (p = 0.048). Additionally, the 5-year OS rate was better for PLWH who received cART for ≤6 months before lymphomas diagnosis than those who received cART for longer periods (64.5% vs. 51.9%, p = 0.114). CONCLUSIONS PLWH with DLBCL or BL had OS rates compatible to patients without HIV infection. Better outcomes for patients achieving CR to front-line therapy and those with shorter cART duration before lymphoma diagnosis suggest an underlying biological distinction in the lymphomas and the involvement of immunity, which warrants further studies.
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Affiliation(s)
- Wei-Li Ma
- Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wang-Da Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Szu-Min Hsieh
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shang-Ju Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
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10
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Carbone A, Chadburn A, Gloghini A, Vaccher E, Bower M. Immune deficiency/dysregulation -associated lymphoproliferative disorders. Revised classification and management. Blood Rev 2024; 64:101167. [PMID: 38195294 DOI: 10.1016/j.blre.2023.101167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/13/2023] [Accepted: 12/30/2023] [Indexed: 01/11/2024]
Abstract
Significant advances in the field of lymphoma have resulted in two recent classification proposals, the International Consensus Classification (ICC) and the 5th edition WHO. A few entities are categorized differently in the ICC compared to the WHO. Nowhere is this more apparent than the immunodeficiency lymphoproliferative disorders. The three previous versions of the WHO classification (3rd, 4th and revised 4th editions) and the ICC focused on four clinical settings in which these lesions arise for primary categorization. In contrast the 2023 WHO 5th edition includes pathologic characteristics including morphology and viral status, in addition to clinical setting, as important information for lesion classification. In addition, the 2023 WHO recognizes a broader number of clinical scenarios in which these lesions arise, including not only traditional types of immune deficiency but also immune dysregulation. With this classification it is hoped that new treatment strategies will be developed leading to better patient outcomes.
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Affiliation(s)
- Antonino Carbone
- Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico, National Cancer Institute, Aviano, Italy.
| | - Amy Chadburn
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, United States of America.
| | - Annunziata Gloghini
- Department of Advanced Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Emanuela Vaccher
- Infectious Diseases and Tumors Unit, Department of Medical Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, National Cancer Institute, Aviano, Italy.
| | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London SW109NH, UK.
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11
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Bibas M. Plasmablastic Lymphoma. A State-of-the-Art Review: Part 2-Focus on Therapy. Mediterr J Hematol Infect Dis 2024; 16:e2024015. [PMID: 38468838 PMCID: PMC10927196 DOI: 10.4084/mjhid.2024.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/14/2024] [Indexed: 03/13/2024] Open
Abstract
The objective of this two-part review is to present a current and comprehensive understanding of the diagnosis and management of plasmablastic lymphoma. The first part, which was published previously, focused on the study of epidemiology, etiology, clinicopathological characteristics, differential diagnosis, prognostic variables, and the impact of plasmablastic lymphoma on specific populations. This second part addresses the difficult topic of the treatment of plasmablastic lymphoma, specifically examining both the conventional, consolidated approach and the novel therapeutic strategy.
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Affiliation(s)
- Michele Bibas
- Department of Clinical Research, Hematology. National Institute for Infectious Diseases "Lazzaro Spallanzani" I.R.C.S.S. Via Portuense 292 00148 Rome Italy
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12
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Ollila TA, Taher R, Moku P, Olszewski AJ. Immunochemotherapy or chemotherapy alone in primary central nervous system lymphoma: a National Cancer Database analysis. Blood Adv 2023; 7:5470-5479. [PMID: 37459209 PMCID: PMC10515309 DOI: 10.1182/bloodadvances.2023010352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/06/2023] [Indexed: 09/16/2023] Open
Abstract
Debate remains over the role of rituximab, a large molecule with reduced central nervous system (CNS) penetration, in therapy for primary CNS lymphoma (PCNSL). Since 2013, the National Cancer Database has distinguished between chemotherapy and immunotherapy for frontline treatment. In this setting, rituximab would be the only standard frontline immunotherapy. We examined factors associated with the receipt of immunotherapy using a multivariate regression model for relative risk, with a random intercept to account for the hospital-specific treatment selection process. Patients were matched using a 1:1 propensity score to limit possible confounders, and overall survival (OS) was compared in the matched cohort. We identified 4691 patients with PCNSL diagnosed between 2013 and 2018. The use of immunotherapy has increased from 45% in 2013 to 76% in 2018. Immunotherapy use was associated with sociodemographic variables and local (hospital level) preference rather than clinical factors. The main factors associated with reduced use of immunotherapy included male sex, Black race or Hispanic ethnicity (compared with White non-Hispanic), HIV+ status, treatment in a lower-volume hospital, and earlier year of diagnosis. We matched 2830 patients for the survival analysis. Receipt of immunotherapy was associated with a significantly better OS (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.67-0.83). There was heterogeneity according to age, because the advantage of immunotherapy was more pronounced for patients aged ≤75 years (HR, 0.71; 95% CI, 0.63-0.80) than for those older than 75 years (HR, 0.87; 95% CI, 0.70-1.08). Overall, our findings support the current trend toward rituximab use, although a nuanced approach should be adopted when treating older patients.
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Affiliation(s)
- Thomas A. Ollila
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI
- Division of Hematology and Oncology, Rhode Island Hospital, Providence, RI
| | - Rashida Taher
- Division of Hematology and Oncology, Rhode Island Hospital, Providence, RI
| | - Prashanth Moku
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI
| | - Adam J. Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI
- Division of Hematology and Oncology, Rhode Island Hospital, Providence, RI
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13
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Kaur S, Kollimuttathuillam S. Plasmablastic Lymphoma: Past, Present, and Future. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:e253-e259. [PMID: 37453866 DOI: 10.1016/j.clml.2023.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/21/2023] [Accepted: 05/25/2023] [Indexed: 07/18/2023]
Abstract
Plasmablastic Lymphoma is a rare large B-cell lymphoma with unique immunohistochemical and morphological features. It was most commonly associated with HIV infection; however, it's now seen in other immunosuppressed states like autoimmune conditions, post-transplant settings, and even in elderly immunocompetent individuals. Although rare, it is an aggressive lymphoma with unfavorable outcomes. The aim of this manuscript is to have an in-depth review of the current knowledge of epidemiology, pathophysiology, prognostic markers, and treatment approaches currently in use and in clinical trials for this challenging disease.
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Affiliation(s)
- Supreet Kaur
- University of Texas Health Science Center San Antonio, TX.
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14
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Silver S, Schmelz M. The AIDS and Cancer Specimen Resource (ACSR): HIV malignancy specimens and data available at no cost. AIDS Res Ther 2023; 20:61. [PMID: 37641153 PMCID: PMC10464020 DOI: 10.1186/s12981-023-00558-4] [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: 07/11/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023] Open
Abstract
The goal of the AIDS and Cancer Specimen Resource (ACSR) is to play a major role in the advancement of HIV/AIDS cancer-related research/treatment by providing richly annotated biospecimens and data to researchers at no cost. The ACSR acquires, stores, and equitably distributes these samples and associated clinical data to investigators conducting HIV/AIDS-related research, at no costs. Currently, it is the only biorepository of human biospecimens from people with HIV and cancer available to eligible researchers globally who are studying HIV associated malignancies.This review describes the history and organizational structure of the ACSR, its types of specimens in its inventory, and the process of requesting specimens. In addition, the review provides an overview of research that was performed over the last 5 years with its support and gives a summary of important new findings acquired by this research into the development of cancers in people with HIV, including both Aids-related and non-Aids-related malignancies.
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Affiliation(s)
- Sylvia Silver
- Department of Microbiology, Immunology and Tropical Medicine, George Washington University, Washington, DC, USA
| | - Monika Schmelz
- Department of Pathology, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ, 85724, USA.
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15
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Chan JY, Somasundaram N, Grigoropoulos N, Lim F, Poon ML, Jeyasekharan A, Yeoh KW, Tan D, Lenz G, Ong CK, Lim ST. Evolving therapeutic landscape of diffuse large B-cell lymphoma: challenges and aspirations. Discov Oncol 2023; 14:132. [PMID: 37466782 PMCID: PMC10361453 DOI: 10.1007/s12672-023-00754-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) represents the commonest subtype of non-Hodgkin lymphoma and encompasses a group of diverse disease entities, each harboring unique molecular and clinico-pathological features. The understanding of the molecular landscape of DLBCL has improved significantly over the past decade, highlighting unique genomic subtypes with implications on targeted therapy. At the same time, several new treatment modalities have been recently approved both in the frontline and relapsed settings, ending a dearth of negative clinical trials that plagued the past decade. Despite that, in the real-world setting, issues like drug accessibility, reimbursement policies, physician and patient preference, as well as questions regarding optimal sequencing of treatment options present difficulties and challenges in day-to-day oncology practice. Here, we review the recent advances in the therapeutic armamentarium of DLBCL and discuss implications on the practice landscape, with a particular emphasis on the context of the healthcare system in Singapore.
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Affiliation(s)
- Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, 30 Hospital Blvd, Singapore, 168583, Singapore.
- Cancer and Stem Cell Biology, Duke-NUS Medical School, National Cancer Centre Singapore, 8 College Road, Singapore, 169857, Singapore.
| | - Nagavalli Somasundaram
- Division of Medical Oncology, National Cancer Centre Singapore, 30 Hospital Blvd, Singapore, 168583, Singapore
- Cancer and Stem Cell Biology, Duke-NUS Medical School, National Cancer Centre Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Nicholas Grigoropoulos
- Cancer and Stem Cell Biology, Duke-NUS Medical School, National Cancer Centre Singapore, 8 College Road, Singapore, 169857, Singapore
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | - Francesca Lim
- Cancer and Stem Cell Biology, Duke-NUS Medical School, National Cancer Centre Singapore, 8 College Road, Singapore, 169857, Singapore
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | - Michelle Limei Poon
- Department of Haematology, National University Cancer Institute, Singapore, Singapore
| | - Anand Jeyasekharan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Kheng Wei Yeoh
- Cancer and Stem Cell Biology, Duke-NUS Medical School, National Cancer Centre Singapore, 8 College Road, Singapore, 169857, Singapore
- Division of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - Daryl Tan
- Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - Georg Lenz
- Department of Medicine A, Department of Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany
| | - Choon Kiat Ong
- Cancer and Stem Cell Biology, Duke-NUS Medical School, National Cancer Centre Singapore, 8 College Road, Singapore, 169857, Singapore.
- Lymphoma Genomic Translational Research Laboratory, Cellular and Molecular Research, National Cancer Centre Singapore, Singapore, Singapore.
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, 30 Hospital Blvd, Singapore, 168583, Singapore.
- Cancer and Stem Cell Biology, Duke-NUS Medical School, National Cancer Centre Singapore, 8 College Road, Singapore, 169857, Singapore.
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16
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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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17
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Matute Mizger V, Martínez Sánchez LM. Quimioterapia en linfoma y su estrecha relación con el virus de la inmunodeficiencia humana /síndrome de inmunodeficiencia adquirida. REPERTORIO DE MEDICINA Y CIRUGÍA 2023. [DOI: 10.31260/repertmedcir.01217372.1313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
El virus de la inmunodeficiencia humana (VIH) ha estado en nuestra sociedad durante muchos años y los casos han aumentado con el paso del tiempo. La inmunosupresión y el síndrome de inmunodeficiencia adquirida (SIA) predisponen en gran parte al desarrollo de diferentes enfermedades, como el linfoma. Objetivo: realizar una revisión acerca de la quimioterapia en el linfoma asociado con el virus de la inmunodeficiencia humana y el síndrome de inmunodeficiencia adquirida, y su predisposición a sufrir más enfermedades oportunistas. Métodos: se realizó una revisión de la literatura en las bases de datos PubMed y ScienceDirect, con los descriptores “infecciones”, “linfoma”, “neoplasias”, “quimioterapia”, “serodiagnóstico del SIDA”, en inglés y español, seleccionando 10 artículos relacionados. Conclusión: la inmunosupresión que genera este virus puede predisponer en gran medida al desarrollo de muchas neoplasias en especial el linfoma. A pesar de que la quimioterapia es el tratamiento más efectivo en este tipo de pacientes, exacerba la condición de base de las personas y los hace más susceptibles a padecer infecciones oportunistas, las cuales pueden empeorar su situación, considerando así la quimioterapia como un factor de riesgo.
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18
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Lim KJC, Di Ciaccio P, Polizzotto MN, Milliken S, Cochrane T, Goh Z, Shaw B, Perry E, Gilbertson M, Kermode W, Cheah CY, Latimer M, Hamad N, Ku M. Outcomes of human immunodeficiency virus-associated Burkitt lymphoma and diffuse large B-cell lymphoma treated in Australia: A report from the Australasian Lymphoma Alliance. Br J Haematol 2023; 201:865-873. [PMID: 36866733 DOI: 10.1111/bjh.18704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/24/2023] [Accepted: 02/07/2023] [Indexed: 03/04/2023]
Abstract
Antiretroviral therapy (ART) has improved outcomes for human immunodeficiency virus-associated non-Hodgkin lymphoma (HIV-NHL). This is an analysis of 44 patients with HIV with Burkitt lymphoma (HIV-BL) and diffuse large B-cell lymphoma (HIV-DLBCL) treated in Australia over a 10-year period (2009-2019) during the ART and rituximab era. At HIV-NHL diagnosis, the majority of presenting patients had adequate CD4 counts and undetectable HIV viral load <50 copies/mL. More than 80% of patients received chemotherapy with curative intent, rituximab, and concurrent ART with chemotherapy (immunotherapy). R-CODOX-M/IVAC or R-Hyper-CVAD (55%) were most commonly used in HIV-BL. CHOP (58%) was the most commonly used chemotherapy backbone for HIV-DLBCL, although 45% of patients received more intense chemotherapy regimens. Overall, 93% of patients who received curative therapy completed their intended course. The 2-year progression-free survival (PFS) and overall survival (OS) for the HIV-BL cohort was 67% and 67% respectively. The 2-year PFS and OS for the HIV-DLBCL cohort was 77% and 81% respectively. Treatment related mortality was 5%. In all, 83% of patients achieved a CD4 count of >0.2 ×109 /L 6 months after the end of treatment. Current Australian practice favours the treatment of HIV-BL and HIV-DLBCL similarly to the HIV-negative population with the use of concurrent ART, achieving outcomes comparable to the HIV-negative population.
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Affiliation(s)
- Kenneth J C Lim
- Department of Haematology, St Vincent's Hospital Melbourne, Sydney, Melbourne, Australia
| | - Pietro Di Ciaccio
- Department of Haematology, St Vincent's Hospital Sydney, Fitzroy, New South Wales, Australia.,College of Health and Medicine, Australian National University, Canberra, Australia
| | - Mark N Polizzotto
- College of Health and Medicine, Australian National University, Canberra, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Sam Milliken
- Department of Haematology, St Vincent's Hospital Sydney, Fitzroy, New South Wales, Australia
| | - Tara Cochrane
- Gold Coast University Hospital, Southport, Queensland, Australia.,Griffiths University, Nathan, Queensland, Australia
| | - Zhong Goh
- Gold Coast University Hospital, Southport, Queensland, Australia.,Griffiths University, Nathan, Queensland, Australia
| | - Briony Shaw
- Monash Hospital, Clayton, Victoria, Australia
| | - Evelyn Perry
- Department of Haematology, St Vincent's Hospital Melbourne, Sydney, Melbourne, Australia
| | | | - William Kermode
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Chan Y Cheah
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,University of Western Australia, Perth, Western Australia, Australia
| | - Maya Latimer
- Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital Sydney, Fitzroy, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew Ku
- Department of Haematology, St Vincent's Hospital Melbourne, Sydney, Melbourne, Australia.,University of Melbourne, Melbourne, Victoria, Australia
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19
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Sengar M, Jain H, Shet T, Sridhar E, Gota V, Rangarajan V, Laskar SS, Alahari A, Thorat J, Agarwal A, Sharma N, Gupta H, Kannan S, Kumar S, Nayak L, Menon H, Gujral S, Bagal B. Phase II trial of a novel chemotherapy regimen CVEP (cyclophosphamide, vinblastine, etoposide and prednisolone) for acquired immunodeficiency syndrome (AIDS)-associated lymphomas. Br J Haematol 2023; 200:429-439. [PMID: 36323643 DOI: 10.1111/bjh.18532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/08/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
Management of acquired immunodeficiency syndrome (AIDS)-related diffuse large B-cell (DLBCL) and plasmablastic lymphomas (PBL) poses significant challenges. The evidence supports use of dose-adjusted EPOCH (etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin) with or without rituximab as first-line therapy. The need for central venous access, growth factors and significant toxicities limits its use in resource-constrained settings. To address these challenges, we have developed a novel regimen, CVEP (cyclophosphamide, vinblastine, etoposide, and prednisolone) based on the pharmacodynamic principles of dose-adjusted EPOCH. This single-centre phase II study evaluated the efficacy and safety of CVEP regimen in patients with de novo systemic AIDS-related DLBCL and PBL. The primary objective was complete response (CR) rates as assessed by positron emission tomography-computed tomography. The secondary objectives were incidence of Grade 3/4 toxicities, toxicities requiring hospitalisation, and disease-free survival. From May 2011 to February 2017, 42 patients were enrolled. At the end of therapy the CR rates were 69% (29/42) in the intention-to-treat population and 80.5% (29/36) in evaluable patients. At a median follow-up of 69 months, the 5-year disease-free survival was 65.3%. Out of 217 cycles administered, febrile neutropenia occurred in 19.3% and hospitalisation was required in 18.3% of cycles. There were two treatment-related deaths. The CVEP regimen is an active and safe regimen for AIDS-related DLBCL and PBL.
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Affiliation(s)
- Manju Sengar
- Department of Medical Oncology, Tata Memorial Centre, A CI of Homi Bhabha National Institute, Mumbai, India
| | - Hasmukh Jain
- Department of Medical Oncology, Tata Memorial Centre, A CI of Homi Bhabha National Institute, Mumbai, India
| | - Tanuja Shet
- Department of Pathology, Tata Memorial Centre, A CI of Homi Bhabha National Institute, Mumbai, India
| | - Epari Sridhar
- Department of Pathology, Tata Memorial Centre, A CI of Homi Bhabha National Institute, Mumbai, India
| | - Vikram Gota
- Department of Clinical Pharmacology, ACTREC, Tata Memorial Centre, A CI of Homi Bhabha National Institute, Mumbai, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, A CI of Homi Bhabha National Institute, Mumbai, India
| | - Siddhartha S Laskar
- Department of Radiation Oncology, Tata Memorial Centre, A CI of Homi Bhabha National Institute, Mumbai, India
| | - Aruna Alahari
- Department of General Medicine, Tata Memorial Centre, A CI of Homi Bhabha National Institute, Mumbai, India
| | - Jayashree Thorat
- Department of Medical Oncology, Tata Memorial Centre, A CI of Homi Bhabha National Institute, Mumbai, India
| | - Archi Agarwal
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, A CI of Homi Bhabha National Institute, Mumbai, India
| | - Neha Sharma
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | | | - Sadhana Kannan
- Department of Biostatistics, Tata Memorial Centre, A CI of Homi Bhabha National Institute, Mumbai, India
| | - Shikhar Kumar
- Adult Hematolymphoid Unit, Tata Memorial Centre, A CI of Homi Bhabha National Institute, Mumbai, India
| | - Lingaraj Nayak
- Adult Hematolymphoid Unit, Tata Memorial Centre, A CI of Homi Bhabha National Institute, Mumbai, India
| | - Hari Menon
- Department of Haematology & Medical Oncology, St. Johns National Academy of Health Sciences, Bengaluru, India
| | - Sumeet Gujral
- Department of Pathology, Tata Memorial Centre, A CI of Homi Bhabha National Institute, Mumbai, India
| | - Bhausaheb Bagal
- Adult Hematolymphoid Unit, Tata Memorial Centre, A CI of Homi Bhabha National Institute, Mumbai, India
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20
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Bertinchamp R, Garzaro M, Boutboul D, Galicier L, Meignin V, Calvani J, Djerad MEH, Rozenbaum W, Simon P, Oksenhendler E, Gérard L. Mantle cell lymphoma in human immunodeficiency virus-infected patients. Br J Haematol 2022; 199:782-784. [PMID: 36223890 DOI: 10.1111/bjh.18493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/12/2022] [Accepted: 09/19/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Rémi Bertinchamp
- Service d'Immunopathologie Clinique, Hôpital Saint-Louis, APHP, Paris, France
| | - Margaux Garzaro
- Service d'Immunopathologie Clinique, Hôpital Saint-Louis, APHP, Paris, France
| | - David Boutboul
- Service d'Immunopathologie Clinique, Hôpital Saint-Louis, APHP, Paris, France.,Université de Paris Cité, Paris, France
| | - Lionel Galicier
- Service d'Immunopathologie Clinique, Hôpital Saint-Louis, APHP, Paris, France
| | | | - Julien Calvani
- Service de Pathologie Hôpital Saint-Louis, APHP, Paris, France
| | | | - Willy Rozenbaum
- Université de Paris Cité, Paris, France.,Service des Maladies Infectieuses, Hôpital Saint-Louis, APHP, Paris, France
| | - Philippe Simon
- Service de Maladies Infectieuses et Tropicales, Grand Hôpital de l'Est Francilien - site Marne la vallée, Jossigny, France
| | - Eric Oksenhendler
- Service d'Immunopathologie Clinique, Hôpital Saint-Louis, APHP, Paris, France.,Université de Paris Cité, Paris, France
| | - Laurence Gérard
- Service d'Immunopathologie Clinique, Hôpital Saint-Louis, APHP, Paris, France
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21
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Lurain K, Ramaswami R, Yarchoan R. The role of viruses in HIV-associated lymphomas. Semin Hematol 2022; 59:183-191. [PMID: 36805886 PMCID: PMC9971650 DOI: 10.1053/j.seminhematol.2022.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/15/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022]
Abstract
Lymphomas are among the most common cancers in people with HIV (PWH). The lymphoma subtypes and pathogenesis of lymphoma in PWH are different from the immunocompetent population. It is well-known that HIV causes severe CD4+ T cell lymphopenia in the absence of antiretroviral therapy (ART); however, the risk of developing certain subtypes of lymphoma remains elevated even in people receiving ART with preserved CD4+ T cells. HIV contributes to lymphomagenesis and causes decreased immune surveillance via T cell depletion and dysregulation, B cell dysregulation, and the potential contribution of HIV-encoded proteins. The oncogenic gammaherpesviruses, Epstein-Barr virus (EBV) and Kaposi sarcoma herpesvirus (KSHV, also known as human herpesvirus 8), are the causative agents in the majority of HIV-associated lymphomas. HIV-associated T cell depletion and dysregulation allows EBV and KSHV to proliferate in infected B cells. Specific EBV- and KSHV-encoded proteins participate in B cell activation, and proliferation leading to B cell transformation. Understanding the distinct pathogenesis of HIV-associated lymphomas affords opportunities to develop therapies that specifically target these unique aspects and improve lymphoma outcomes in PWH. Agents being studied that target the specific roles of HIV, EBV, and KSHV in lymphomagenesis include immunotherapies, targeted agents, and cellular therapies.
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Affiliation(s)
- Kathryn Lurain
- HIV & AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
| | - Ramya Ramaswami
- HIV & AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Robert Yarchoan
- HIV & AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
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22
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Wang C, Liu J, Lei H, Li Y, Wu J, Guo B, Hu R, Liu T, Wu J, Ding Y, Hu C, Liang S, Xiao C, Liang X, Huang D, Yang T, Zhang W, Yang Z, Li J, Nan Y, Li Q, Xiang Y, Li Z, Wu Y, Liu Y. Clinical characteristics and outcomes of newly diagnosed patients with
HIV
‐associated aggressive B‐cell
NHL
in China. J Cell Mol Med 2022; 26:5067-5077. [PMID: 36056692 PMCID: PMC9549495 DOI: 10.1111/jcmm.17534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/18/2022] [Accepted: 08/24/2022] [Indexed: 11/27/2022] Open
Abstract
Little is known about the incidence, clinical characteristics and prognostic factors in HIV associated lymphoma as these are less common than HIV‐negative lymphoma in China. Currently, there are no standard guidelines for treatment of these patients. Therefore, we performed a study to analyse the clinical characteristics and outcomes of newly diagnosed HIV‐associated aggressive B‐cell non‐Hodgkin's lymphoma (NHL) patients in Chongqing University Cancer Hospital (CUCH). Totally 86 newly diagnosed HIV‐associated aggressive B‐cell NHL patients in CUCH, southwest China, from July 2008 to August 2021, were analysed. In the entire cohort, median age was 48 years (range, 23–87 years), and more patients were male (87.2%). Most patients had elevated lactate dehydrogenase (LDH) (82.6%), advanced ann arbor stage (80.2%) and high IPI score (IPI score, 3–5) (62.7%) at diagnosis. Median CD4+ T‐cell count at diagnosis was 191/μl (range, 4–1022), 84 patients (97.7%) were on combination antiretroviral therapy (cART) at lymphoma diagnosis. In DLBCL patients, cox multivariate analysis showed that age ≥ 60 (HR = 2.251, 95%CI 1.122–4.516; p = 0.012), elevated LDH (HR = 4.452, 95%CI 1.027–19.297; p = 0.041) and received less than two cycles of chemotherapy (HR = 0.629, 95%CI 0.589–1.071; p = 0.012) were independent risk factors for adverse prognosis based on PFS. Age ≥ 60 (HR = 3.162, 95%CI 1.500–6.665; p = 0.002) and received less than two cycles of chemotherapy (HR = 0.524, 95%CI 0.347–0.791; p = 0.002) were also independent risk factor for adverse prognosis based on OS. In BL patients, cox multivariate analysis showed that elevated LDH and received less than two cycles of chemotherapy were independent risk factors for adverse prognosis. In the DLBCL group, median PFS times in the received rituximab and no received rituximab groups were not reached and 12 months, respectively (p = 0.006). Median OS times were not reached and 36 months, respectively (p = 0.021). In the BL group, median PFS times in the received rituximab and no received rituximab groups were not reached and 4.8 months, respectively (p = 0.046). Median OS times were not reached and 10.1 months, respectively (p = 0.035). Overall, these data indicated that standardized anti‐lymphoma therapy and rituximab administration were significantly associated with improved outcomes in patients with HIV‐associated DLBCL and BL.
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Affiliation(s)
- Chaoyu Wang
- Department of Hematology Oncology Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment Chongqing China
| | - Jun Liu
- Department of Hematology Oncology Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment Chongqing China
| | - Haike Lei
- Chongqing Cancer Research and Control Office Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment Chongqing China
| | - Yu Li
- Department of Pathology Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment Chongqing China
| | - Jian Wu
- Department of Head and Neck Cancer Center Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment Chongqing China
| | - Bingling Guo
- Department of Hematology Oncology Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment Chongqing China
| | - Renzhi Hu
- Department of Hematology Oncology Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment Chongqing China
| | - Tingting Liu
- Department of Hematology Oncology Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment Chongqing China
| | - Jing Wu
- Department of Hematology Oncology Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment Chongqing China
| | - Yao Ding
- Department of Hematology Oncology Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment Chongqing China
| | - Chongling Hu
- Department of Hematology Oncology Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment Chongqing China
| | - Shunsi Liang
- Department of Hematology Oncology Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment Chongqing China
| | - Chunyan Xiao
- Department of Hematology Oncology Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment Chongqing China
| | - Xiping Liang
- Department of Hematology Oncology Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment Chongqing China
| | - Dehong Huang
- Department of Hematology Oncology Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment Chongqing China
| | - Tao Yang
- Department of Hematology Oncology Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment Chongqing China
| | - Wenjun Zhang
- Department of Hematology Oncology Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment Chongqing China
| | - Zailin Yang
- Department of Hematology Oncology Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment Chongqing China
| | - Jieping Li
- Department of Hematology Oncology Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment Chongqing China
| | - Yingyu Nan
- Department of Hematology Oncology Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment Chongqing China
| | - Qiying Li
- Department of Hematology Oncology Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment Chongqing China
| | - Ying Xiang
- Department of Hematology Oncology Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment Chongqing China
| | - Zhenhua Li
- Department of Head and Neck Cancer Center Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment Chongqing China
| | - Yongzhong Wu
- Department of Radiation Oncology Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment Chongqing China
| | - Yao Liu
- Department of Hematology Oncology Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment Chongqing China
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Rapiti N, Abdelatif N, Rapiti A, Moosa MY. Patient characteristics and outcome of CD20-positive HIV-associated lymphoma: a single-center KwaZulu-Natal, South African hospital 12-year retrospective review. J Egypt Natl Canc Inst 2022; 34:32. [PMID: 35909189 DOI: 10.1186/s43046-022-00131-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 06/14/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Due to the high prevalence of HIV, HIV-associated lymphoma (HAL) is a common malignancy in South Africa. However, there is a paucity of literature on HAL from this region. The objective of this study was to profile the clinical characteristics and outcome of CD20-positive HAL treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), with or without rituximab (R), from a single center in KwaZulu -Natal, South Africa. METHODS Retrospective chart review of adult patients treated from 2006 to 2018 for HIV-associated CD20-positive lymphoma. The clinical characteristics, complete response (CR), and 2-year overall survival (OS) are described. RESULTS The analysis included 102 patients, 54% females, median age of 39 years, and median CD4 cell count of 196 cells/μL. Bone marrow involvement was noted in 5%. Eighty-six percent of the cohort received concomitant antiretroviral therapy and chemotherapy, 76% of the CHOP group, and 92% of the R-CHOP group. Overall, a CR was seen in 55% (95% CI 45%; 65%), with a 2-year OS of 59% (95% CI 50%, 69%). A CR was attained in 46% on CHOP and 64% on R-CHOP, with a 2-year disease-free survival (DFS) for CHOP of 42% and 50% for R-CHOP. CONCLUSION Although the clinical characteristics and laboratory findings are similar to other higher-income cohorts, there was a difference in gender and incidence of marrow involvement. The low incidence of marrow involvement has prompted more routine use of immunohistochemistry and flow cytometry in staging marrows of HAL locally. Further randomized studies are required for the establishment of locally validated, cost-effective treatment guidelines.
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Affiliation(s)
- Nadine Rapiti
- Department of Haematology, NHLS/University of KwaZulu Natal/King Edward VIII Hospital, Durban, South Africa.
| | - Nada Abdelatif
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Anand Rapiti
- Department of Neurosurgery, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Mahomed-Yunus Moosa
- Department of Infectious Diseases, University of KwaZulu-Natal, Durban, South Africa
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24
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Berhan A, Bayleyegn B, Getaneh Z. HIV/AIDS Associated Lymphoma: Review. Blood Lymphat Cancer 2022; 12:31-45. [PMID: 35517869 PMCID: PMC9063794 DOI: 10.2147/blctt.s361320] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/19/2022] [Indexed: 11/23/2022]
Abstract
Lymphoma is one of the hematologic malignancies that occur at a higher rate in human immunodeficiency virus-infected individuals. It is one of the most frequent neoplastic causes of death in those individuals. Non-Hodgkin's lymphoma and Hodgkin's lymphomas are acquired immunodeficiency syndrome defining lymphoma and non-acquired immunodeficiency syndrome defining lymphoma, respectively. Non-Hodgkin's lymphoma is the most common type of lymphoma in human immunodeficiency virus-positive people. The lymphoma that develops in patients infected with the human immunodeficiency virus/acquired immunodeficiency syndrome is heterogeneous in terms of morphology, pathogenesis pathways, and cellular derivation. A narrative review was conducted on the basis of relevant literature on the current topic to summarize the current epidemiology, pathogenesis, laboratory diagnosis, and treatment of lymphoma in human immunodeficiency virus-infected patients. The finding showed that although the incidence of non-Hodgkin's lymphoma has decreased after the advent of highly active antiretroviral therapy, it has remained higher in human immunodeficiency virus-infected people than in the general population. On the other hand, the incidence of Hodgkin's lymphoma has increased after the introduction of highly active antiretroviral therapy. Therefore, it is recommended that people living with human immunodeficiency virus/ acquired immunodeficiency syndrome be screened for the development of lymphoma to increase their survival time and quality of life, and further research is required regarding the pathogenesis, treatment, and laboratory diagnosis of human immunodeficiency virus/ acquired immunodeficiency syndrome-associated lymphoma.
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Affiliation(s)
- Ayenew Berhan
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Biruk Bayleyegn
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zegeye Getaneh
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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25
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Abu Khalaf S, Dandachi D, Granwehr BP, Rodriguez-Barradas MC. Cancer immunotherapy in adult patients with HIV. J Investig Med 2022; 70:883-891. [PMID: 35086858 DOI: 10.1136/jim-2021-002205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 11/03/2022]
Abstract
The availability of antiretroviral therapy (ART) has increased the life expectancy of people with HIV (PWH) and reduced the incidence of AIDS-associated malignancies, yet PWH have a significantly increased incidence of malignancy and less favorable outcomes of cancer treatment compared with the general population.Immunotherapy has revolutionized cancer therapy, becoming the standard of care for various malignancy treatments. However, PWH are an underserved population with limited access to clinical trials and cancer treatment.This review of the available evidence on different classes of cancer immunotherapy in PWH is mostly based on case reports, case series, but few prospective studies and clinical trials due to the exclusion of PWH from most oncologic clinical trials. The results of the available evidence support the safety of immunotherapy in PWH. Immunotherapy has similar effectiveness in PWH, an acceptable toxicity profile, and has no clinically significant impact on HIV viral load and CD4-T cell count. In addition, there is no reported change in the incidence of opportunistic infections and other complications for PWH with well-controlled viremia.This review aims to briefly summarize the current state of immunotherapy in cancer, guide clinicians in the management of immunotherapy in cancer PWH, and encourage the inclusion of PWH in clinical trials of cancer immunotherapy.
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Affiliation(s)
- Suha Abu Khalaf
- Department of Medicine, Division of Infectious Diseases, University of Missouri System, Columbia, Missouri, USA
| | - Dima Dandachi
- Department of Medicine, Division of Infectious Diseases, University of Missouri System, Columbia, Missouri, USA
| | - Bruno P Granwehr
- Department of Medicine, Division of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E DeBakey VAMC, Houston, Texas, USA.,Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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26
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Wang C, Liu J, Liu Y. Progress in the Treatment of HIV-Associated Lymphoma When Combined With the Antiretroviral Therapies. Front Oncol 2022; 11:798008. [PMID: 35096597 PMCID: PMC8792758 DOI: 10.3389/fonc.2021.798008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/23/2021] [Indexed: 01/11/2023] Open
Abstract
With the wide use of combination antiretroviral therapy (cART), the life expectancy of HIV-infected individuals drastically improved. However, HIV infection and HIV-associated cancers were the most common causes of death in the HIV-infected populations. The HIV-associated cancers are divided into acquired immune deficiency syndrome (AIDS)-defining and non-AIDS-defining cancers based on the incidence among the HIV-infected patients. Among HIV-associated cancers, acquired immune deficiency syndrome-related lymphoma (ARL) is still the most common condition and the leading cause of HIV/AIDS-related deaths. Diffuse large B-cell lymphoma (DLBCL) and Burkitt's lymphoma (BL) are the most common subtypes of the ARL. Although Hodgkin's lymphoma (HL) is not considered as an AIDS-defining cancer, incidence of HL in HIV-infected individuals is higher than the general population. The review summarizes the new progress in the treatment of HIV-associated lymphoma.
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Affiliation(s)
| | | | - Yao Liu
- Department of Hematology-Oncology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
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27
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Verdu-Bou M, Tapia G, Hernandez-Rodriguez A, Navarro JT. Clinical and Therapeutic Implications of Epstein-Barr Virus in HIV-Related Lymphomas. Cancers (Basel) 2021; 13:5534. [PMID: 34771697 PMCID: PMC8583310 DOI: 10.3390/cancers13215534] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 10/29/2021] [Indexed: 12/26/2022] Open
Abstract
The incidence of lymphomas is increased in people living with HIV (PLWH). Aggressive B-cell non-Hodgkin lymphomas (NHLs) are the most common and are considered an AIDS-defining cancer (ADC). Although Hodgkin lymphoma (HL) is not considered an ADC, its incidence is also increased in PLWH. Among all HIV-related lymphomas (HRL), the prevalence of Epstein-Barr virus (EBV) is high. It has been shown that EBV is involved in different lymphomagenic mechanisms mediated by some of its proteins, contributing to the development of different lymphoma subtypes. Additionally, cooperation between both HIV and EBV can lead to the proliferation of aberrant B-cells, thereby being an additional lymphomagenic mechanism in EBV-associated HRL. Despite the close relationship between EBV and HRL, the impact of EBV on clinical aspects has not been extensively studied. These lymphomas are treated with the same therapeutic regimens as the general population in combination with cART. Nevertheless, new therapeutic strategies targeting EBV are promising for these lymphomas. In this article, the different types of HRL are extensively reviewed, focusing on the influence of EBV on the epidemiology, pathogenesis, clinical presentation, and pathological characteristics of each lymphoma subtype. Moreover, novel therapies targeting EBV and future strategies to treat HRL harboring EBV are discussed.
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Affiliation(s)
- Miriam Verdu-Bou
- Lymphoid Neoplasms Group, Josep Carreras Leukaemia Research Institute, Can Ruti Campus, 08916 Badalona, Spain;
| | - Gustavo Tapia
- Department of Pathology, Germans Trias i Pujol Hospital, Universitat Autònoma de Barcelona, 08916 Badalona, Spain;
| | - Agueda Hernandez-Rodriguez
- Department of Microbiology, Germans Trias i Pujol Hospital, Universitat Autònoma de Barcelona, 08916 Badalona, Spain;
| | - Jose-Tomas Navarro
- Lymphoid Neoplasms Group, Josep Carreras Leukaemia Research Institute, Can Ruti Campus, 08916 Badalona, Spain;
- Department of Hematology, Institut Català d’Oncologia-Germans Trias i Pujol Hospital, 08916 Badalona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08916 Badalona, Spain
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Major A, Smith SM. DA-R-EPOCH vs R-CHOP in DLBCL: How do we choose? CLINICAL ADVANCES IN HEMATOLOGY & ONCOLOGY : H&O 2021; 19:698-709. [PMID: 34807015 PMCID: PMC9036549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The emerging molecular and prognostic characterization of diffuse large B-cell lymphoma (DLBCL) has challenged the rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) treatment paradigm in recent years, with the identification of several DLBCL subtypes associated with significantly inferior survival after standard R-CHOP therapy. Efforts to improve upon the R-CHOP backbone have included dose intensification as well as the addition of new agents; the infusional dose-adjusted rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-R-EPOCH) regimen has been identified as a potential replacement for R-CHOP in high-risk DLBCL. In this review, we provide a historical perspective on the R-CHOP and DA-R-EPOCH regimens and summarize the clinical trial literature regarding the efficacy of each regimen in various risk groups of DLBCL. Further, we propose clinical management scenarios in which DA-R-EPOCH may be preferred, including some for patient populations in which the use of R-CHOP vs DA-R-EPOCH is controversial.
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Affiliation(s)
- Ajay Major
- Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois
| | - Sonali M Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois
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29
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Hematological cancers in individuals infected by HIV. Blood 2021; 139:995-1012. [PMID: 34469512 DOI: 10.1182/blood.2020005469] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/22/2020] [Indexed: 11/20/2022] Open
Abstract
HIV infection increases cancer risk and is linked to cancers associated to infectious agents classified as carcinogenic to humans by the International Agency for Research on Cancer. Lymphomas represent one of the most frequent malignancies among individuals infected by HIV. Diffuse large B-cell lymphoma remains a leading cancer after the introduction of combined antiretroviral therapy (cART). The incidence of other lymphomas including Burkitt lymphoma, primary effusion lymphomas, and plasmablastic lymphoma of the oral cavity remain stable, while the incidence of Hodgkin lymphoma and Kaposi sarcoma-associated herpesvirus (KSHV)-associated Multicentric Castleman Disease has increased. The heterogeneity of lymphomas in individuals infected by HIV likely depends on the complexity of involved pathogenetic mechanisms, i.e. HIV-induced immunosuppression, genetic abnormalities, cytokine dysregulation, co-infection with the gamma-herpesviruses, Epstein Barr virus and KSHV, and the dysregulation of the immune responses controlling these viruses. In the modern cART era, standard treatments for HIV-associated lymphoma including stem cell transplantation in relapsed/refractory disease, mirrors that of the general population. The combination of cART and anti neoplastic treatments has resulted in remarkable prolongation of long-term survival. However, oncolytic and immunotherapic strategies, and therapies targeting specific viral oncogenes will need to be developed primarily.
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30
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Benavente R, Peña C, Soto A, Valladares X, Puga B, Cabrera ME. Overall survival in Chilean patients with lymphoma and human immunodeficiency virus: A retrospective cohort study. Hematol Transfus Cell Ther 2021; 44:497-503. [PMID: 34489215 PMCID: PMC9605900 DOI: 10.1016/j.htct.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 05/04/2021] [Accepted: 06/13/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction People living with human immunodeficiency virus (PLWH) still face high morbidity and mortality resulting from lymphoma. Aim To describe a population of PLWH and lymphoma in a Chilean public hospital and compare the overall survival (OS) with a previously reported cohort from the same institution. Methods Retrospective single-center cohort study. All the patients diagnosed between 2010 and 2017 were included. Demographic and clinical variables were obtained from medical records. The overall survival (OS) was estimated in treated patients from diagnosis until death or October 2020. The OS was then compared with a cohort of patients diagnosed between 1992 and 2008. Main Results Eighty-four patients were included. The most common histological types were Burkitt´s lymphoma (BL), diffuse large B-cell lymphoma (DLBCL), Hodgkin´s lymphoma (HL) and plasmablastic lymphoma (PBL) at 31%, 27%, 21% and 14%, respectively. The three-year OS for the whole cohort of BL, DLBCL, HL and PBL was 58.9%, 65.2%, 47.4%, 76.4% and 50%, respectively. Compared to the cohort of 1992 to 2008, a global increase in the OS was found after excluding HL and adjusting for age and clinical stage (HR 0.38, p = 0.002). However, when the main types were analyzed individually, the increase in the OS was statistically significant only in DLBCL (HR 0.29, p = 0.007). Most patients with DLBCL received CHOP chemotherapy, as in the previous cohort. Conclusion The OS has improved in this population, despite no major changes in chemotherapy regimens, mainly due to the universal access to antiretroviral therapy.
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Affiliation(s)
- Rafael Benavente
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Hospital del Salvador, Santiago, Chile.
| | | | - Andrés Soto
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Hospital del Salvador, Santiago, Chile
| | | | - Bárbara Puga
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Hospital del Salvador, Santiago, Chile
| | - María Elena Cabrera
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Hospital del Salvador, Santiago, Chile
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Dzobo K. What to Do for Increasing Cancer Burden on the African Continent? Accelerating Public Health Diagnostics Innovation for Prevention and Early Intervention on Cancers. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2021; 25:567-579. [PMID: 34399067 DOI: 10.1089/omi.2021.0098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
No other place illustrates the increasing burden of cancer than in Africa and in particular, sub-Saharan Africa. Many of the individuals to be diagnosed with cancer will be in low-resource settings in the future due to, for example, an increase in populations and aging, and high co-morbidity with infections with viruses such as human immunodeficiency virus (HIV) and human papillomavirus (HPV), as well as the presence of infectious agents linked to cancer development. Due to lack of prevention and diagnostic innovation, patients present with advanced cancers, leading to poor survival and increased mortality. HIV infection-associated cancers such as B cell lymphomas, Kaposi's sarcoma, and HPV-associated cancers such as cervical cancer are particularly noteworthy in this context. Recent reports show that a host of other cancers are also associated with viral infection and these include lung, oral cavity, esophageal, and pharyngeal, hepatocellular carcinoma, and anal and vulvar cancers. This article examines the ways in which diagnostic innovation empowered by integrative biology and informed by public health priorities can improve cancer prevention or early intervention in Africa and beyond. In addition, I argue that because diagnostic biomarkers can often overlap with novel therapeutic targets, diagnostics research and development can have broader value for and impact on medical innovation.
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Affiliation(s)
- Kevin Dzobo
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town Component, Cape Town, South Africa.,Institute of Infectious Disease and Molecular Medicine, Division of Medical Biochemistry, Department of Integrative Biomedical Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Strother RM, Gopal S, Wirth M, Chadburn A, Noy A, Cesarman E, Lee JY, Remick SC, Busakhala N, Kaimila B, Mberi E, Ndlovu N, Omoding A, Krown SE. Challenges of HIV Lymphoma Clinical Trials in Africa: Lessons From the AIDS Malignancy Consortium 068 Study. JCO Glob Oncol 2021; 6:1034-1040. [PMID: 32634068 PMCID: PMC7392773 DOI: 10.1200/go.20.00152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The purpose of this article is to describe lessons from the first lymphoma clinical trial conducted by the AIDS Malignancy Consortium (AMC) in sub-Saharan Africa (SSA). AMC-068 was a randomized phase II comparison of intravenous versus oral chemotherapy for HIV-positive diffuse large B-cell lymphoma. Opening in 2016, AMC-068 planned to enroll 90 patients (45 per arm) in Kenya, Malawi, Uganda, and Zimbabwe over 24 months and follow patients for 24 months to assess overall survival. In 2018, the study closed after screening 42 patients but enrolling only 7. Challenges occurred during protocol development, pre-activation, and postactivation. During protocol development (2011-2012), major obstacles were limited baseline data to inform study design; lack of consensus among investigators and approving bodies regarding appropriateness of the oral regimen and need for randomized comparison with cyclophosphamide, doxorubicin, vincristine, and prednisone; and heterogeneity across sites in local standards for diagnosis, staging, and treatment. During pre-activation (2012-2016), challenges included unexpected length and layers of regulatory approval across multiple countries, need to upgrade pathology capacity at sites, need to augment existing chemotherapy infusion capacity at sites, and procurement issues for drugs and supplies. Finally, during postactivation (2016-2018), challenges included long delays between symptom onset and screening entry for many patients, leading to compromised performance status and organ function; other patient characteristics that frequently led to exclusion, including high tumor proliferative index or other pathologic features that were disallowed; and costs of routine diagnostic procedures often being borne by patients, which also contributed to pre-enrollment delays. Lessons from AMC-068 are being applied to the design and conduct of new AMC lymphoma trials in SSA, and the study has contributed to a strong operational foundation that will support innovative clinical trials in the future.
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Affiliation(s)
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Rockville, MD
| | | | | | - Ariela Noy
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Jeannette Y Lee
- University of Arkansas for Medical Sciences, Little Rock, AR
| | - Scot C Remick
- Maine Medical Center, Portland, ME, and Tufts University, Boston, MA
| | | | - Bongani Kaimila
- University of North Carolina Project-Malawi, Lilongwe, Malawi
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Tazi I, Lahlimi FZ. [Human immunodeficiency virus and lymphoma]. Bull Cancer 2021; 108:953-962. [PMID: 34246454 DOI: 10.1016/j.bulcan.2021.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/13/2021] [Accepted: 03/20/2021] [Indexed: 12/14/2022]
Abstract
Lymphomas remain a leading cause of morbidity and mortality for HIV-positive patients. The most common lymphomas include diffuse large B-cell lymphoma, Burkitt lymphoma, primary effusion lymphoma, plasmablastic lymphoma and Hodgkin lymphoma. Appropriate approach is determined by lymphoma stage, performans status, comorbidities, histological subtype, status of the HIV disease and immunosuppression. Treatment outcomes have improved due to chemotherapy modalities and effective antiretroviral therapy. This review summarizes epidemiology, pathogenesis, pathology, and current treatment landscape in HIV associated lymphoma.
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Affiliation(s)
- Illias Tazi
- CHU Mohamed VI, Université Cadi Ayyad, Faculté de Médecine, Service d'Hématologie Clinique, Marrakech, Maroc.
| | - Fatima Zahra Lahlimi
- CHU Mohamed VI, Université Cadi Ayyad, Faculté de Médecine, Service d'Hématologie Clinique, Marrakech, Maroc
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Kimani S, Painschab MS, Kaimila B, Kasonkanji E, Zuze T, Tomoka T, Mulenga M, Nyasosela R, Chikasema M, Mtangwanika A, Chawinga M, Mhango W, Nicholas S, Chimzimu F, Kampani C, Krysiak R, Lilly A, Randall C, Seguin R, Westmoreland KD, Montgomery ND, Fedoriw Y, Gopal S. Safety and efficacy of rituximab in patients with diffuse large B-cell lymphoma in Malawi: a prospective, single-arm, non-randomised phase 1/2 clinical trial. Lancet Glob Health 2021; 9:e1008-e1016. [PMID: 34022150 PMCID: PMC9338824 DOI: 10.1016/s2214-109x(21)00181-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/12/2021] [Accepted: 03/30/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND There are no clinical trials involving patients with diffuse large B-cell lymphoma (DLBCL) in sub-Saharan Africa since antiretroviral therapy (ART) for HIV became widely available in this region. We aimed to establish the safety and efficacy of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in patients with DLBCL in Malawi. METHODS This prospective, single-arm, non-randomised phase 1/2 clinical trial was done at Kamuzu Central Hospital Cancer Clinic (Lilongwe, Malawi). Eligible patients were adults (aged 18-60 years) with newly diagnosed DLBCL, an Eastern Cooperative Oncology Group performance status of 0-2, a CD4 count of 100 cells per μL or higher (if HIV-positive), measurable disease by physical examination, an absolute neutrophil count of 1000 × 109 cells per L or higher, a platelet count of 100 × 109 platelets per L or higher, a serum creatinine concentration of 132·60 μmol/L or less, a total bilirubin concentration of 34·21 μmol/L or less, a negative urine pregnancy test in women of childbearing potential, and no previous cytotoxic therapy. Pregnant or breastfeeding women, and individuals with CNS involvement from DLBCL, chronic hepatitis B infection (unless they were receiving tenofovir plus lamivudine), or any other comorbidities that would compromise the protocol objectives were excluded. Eligible patients received intravenous rituximab 375 mg/m2, cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2, and vincristine 1·4 mg/m2 (maximum 2 mg/m2), and oral prednisone 100 mg or an equivalent drug every 21 days for up to six cycles. HIV-positive patients received concurrent ART. The primary outcome was the proportion of patients with National Cancer Institute Common Terminology Criteria for Adverse Events grade 3 or 4 non-haematological toxic effects or treatment-related deaths after six cycles of treatment. Secondary efficacy outcomes included the proportion of patients with a complete response after six cycles of treatment, and progression-free survival and overall survival at 12 months and 24 months. This trial is registered with ClinicalTrials.gov, NCT02660710. FINDINGS Between Aug 1, 2016, and July 31, 2019, 76 patients were screened, of whom 37 were eligible for the study and received R-CHOP. The median age of patients was 44 years (IQR 39-49) and 16 (43%) were women. Of all 37 patients, 20 (54%) had stage III or IV DLBCL, and the age-adjusted international prognostic index was 2 or higher in 25 (68%) patients. 27 (73%) patients were HIV-positive, with a median CD4 count of 208 cells per μL (IQR 144-422), and 21 (78%) patients were receiving ART at enrolment. Patients completed a median of six cycles (IQR 4-6). Grade 3 or 4 non-haematological toxic effects were reported in 12 (32% [95% CI 19-49]) patients, the most common of which was infection (nine [24%] patients). Of 16 (43%) deaths, ten were due to progression of DLBCL, four were due to treatment-related complications, and two were due to other causes, yielding a treatment-related mortality of 11% (95% CI 4-26%). Grade 3 or 4 neutropenia was observed in 26 (70%) patients, and grade 3 or 4 anaemia was observed in 11 (29%) patients. A total of 22 (59%) patients had a complete response. Overall survival was 68% (95% CI 50-80) at 12 months and 55% (37-70) at 24 months, and progression-free survival was 59% (42-73) at 12 months and 53% (35-68) at 24 months. INTERPRETATION R-CHOP could be feasible, safe, and efficacious in patients with DLBCL in Malawi. This is the first completed clinical trial on DLBCL focused on sub-Saharan African populations. Given the paucity of data on treatment of DLBCL from this region, these results could inform emerging cancer treatment programmes in sub-Saharan Africa. FUNDING The University of North Carolina Lineberger Comprehensive Cancer Center.
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Affiliation(s)
- Stephen Kimani
- Department of Medicine, Division of Hematology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Matthew S Painschab
- Department of Medicine, Division of Hematology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Bongani Kaimila
- University of North Carolina Project-Malawi, Lilongwe, Malawi; University of Malawi, College of Medicine, Lilongwe Campus, Lilongwe, Malawi
| | | | - Takondwa Zuze
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Tamiwe Tomoka
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; University of North Carolina Project-Malawi, Lilongwe, Malawi; University of Malawi, College of Medicine, Lilongwe Campus, Lilongwe, Malawi
| | - Maurice Mulenga
- Kamuzu Central Hospital, Malawi Ministry of Health, Lilongwe, Malawi
| | - Richard Nyasosela
- Kamuzu Central Hospital, Malawi Ministry of Health, Lilongwe, Malawi
| | - Maria Chikasema
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | | | - Mena Chawinga
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | | | - Simon Nicholas
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Fred Chimzimu
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | | | - Robert Krysiak
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Amy Lilly
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cara Randall
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown, WV, USA
| | - Ryan Seguin
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Katherine D Westmoreland
- Department of Medicine, Division of Hematology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Nathan D Montgomery
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Yuri Fedoriw
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Rockville, MD, USA.
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Wang Z, Zhang R, Liu L, Shen Y, Chen J, Qi T, Song W, Tang Y, Sun J, Lin Y, Xu S, Yang J, Lu H. Incidence and spectrum of infections among HIV/AIDS patients with lymphoma during chemotherapy. J Infect Chemother 2021; 27:1459-1464. [PMID: 34158238 DOI: 10.1016/j.jiac.2021.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/30/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
Introduction Lymphoma is the most common cancer in HIV/AIDS patients. Chemotherapy regiments recommended for lymphomas in HIV-negative patients are also used for lymphomas in HIV/AIDS patients. Little is known about the infections among HIV/AIDS patients with lymphoma undergoing chemotherapy. Methods This retrospective study investigated the incidence, spectrum of and risk factors for infections during chemotherapy in 164 HIV/AIDS patients with lymphoma admitted to Shanghai Public Health Clinical Center from July 2013 to December 2020. Results The median age of the patients was 43 years old; 90.9% (149/164) were male. A total of 112 (68.3%) patients had a CD4 count < 200 cells/μL at lymphoma diagnosis. Diffuse large B-cell lymphoma (56%, 91/164) and Burkitt lymphoma (28%, 46/164) were the two most common subtypes of lymphoma. Among the 137 patients who underwent chemotherapy (total cycles = 749), 58.4% (80/137) of patients experienced a total of 153 episodes of infection, with an incidence rate of 20.4% (153/749). The most commonly seen infections were lung infection (29.2%, 40/137) and febrile neutropenia (27.0%, 37/137). Multivariate analysis showed that grade 4 neutropenia during chemotherapy (OR = 7.128, 95% CI 3.051-16.654, p < 0.001) and duration of antiretroviral treatment at lymphoma diagnosis <6 months (OR = 3.520, 95% CI 1.432-8.653, p = 0.006) were independent risk factors for infection during chemotherapy. Conclusions A large proportion of HIV/AIDS patients with lymphoma may be at risk of infection during chemotherapy. Effective measures should be taken for patients with high risk factors to prevent the occurrence of infection.
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Affiliation(s)
- Zhenyan Wang
- Fudan University (Shanghai Public Health Clinical Center), 130 Dongan Road, Xuhui District, Shanghai 200032, China; Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai 201508, China.
| | - Renfang Zhang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai 201508, China
| | - Li Liu
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai 201508, China
| | - Yinzhong Shen
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai 201508, China; Department of Medical Administration, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai 201508, China
| | - Jun Chen
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai 201508, China
| | - Tangkai Qi
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai 201508, China
| | - Wei Song
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai 201508, China
| | - Yang Tang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai 201508, China
| | - Jianjun Sun
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai 201508, China
| | - Yixiao Lin
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai 201508, China
| | - Shuibao Xu
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai 201508, China
| | - Junyang Yang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai 201508, China
| | - Hongzhou Lu
- Fudan University (Shanghai Public Health Clinical Center), 130 Dongan Road, Xuhui District, Shanghai 200032, China; Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai 201508, China.
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Zeng J, Zhang X, Jia L, Wu Y, Tian Y, Zhang Y. Pretreatment lymphocyte-to-monocyte ratios predict AIDS-related diffuse large B-cell lymphoma overall survival. J Med Virol 2021; 93:3907-3914. [PMID: 33155687 DOI: 10.1002/jmv.26655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/30/2020] [Accepted: 11/01/2020] [Indexed: 12/14/2022]
Abstract
The lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte ratio (PLR) have been reported to be useful for predicting the prognosis of various malignancies, including diffuse large B-cell lymphoma (DLBCL). However, little is known about the role of LMR and PLR in the prognosis of DLBCL patients with human immunodeficiency virus (HIV) infection. We retrospectively evaluated the prognostic value of the LMR and PLR in patients with newly diagnosed AIDS-related diffuse large B-cell lymphoma (AR-DLBCL) who were treated with CHOP-like chemotherapy at a single institution. In 33 AR-DLBCL patients, the median follow-up period was 32 months (range: 7-85 months), with an estimated 2-year overall survival (OS) rate of 79.9%. The univariate analysis confirmed the LMR ≤ 2.74 (p = .015), PLR ≥ 337.7 (p = .019), and moderate anemia (p = .045) were associated with inferior survival. The independent significant association between low LMR and poor OS in the multivariate analysis was identified (HR: 0.033, 95% CI: 0.001-0.853, p = .040). However, PLR (p = .459) and moderate anemia (p = .102) did not retain an independent significance in the multivariate analysis. Moreover, compared with the high-LMR group, patients with low-LMR more frequently had B symptoms (p = .010) and lower CD4+T cell count (p < .001). The pretreatment LMR may be an effective prognostic factor for predicting OS in patients with AR-DLBCL.
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Affiliation(s)
- Jing Zeng
- Department of Infectious Diseases, Beijing You An Hospital, Beijing Institute of Hepatology, Capital Medical University, Beijing, China
| | - Xiuqun Zhang
- Department of Hematology, Nanjing Medical University Affiliated Nanjing First Hospital, Nanjing, Jiangsu, China
| | - Lin Jia
- Department of Infectious Diseases, Beijing You An Hospital, Beijing Institute of Hepatology, Capital Medical University, Beijing, China
| | - Yongfeng Wu
- Department of Infectious Diseases, Beijing You An Hospital, Beijing Institute of Hepatology, Capital Medical University, Beijing, China
| | - Yakun Tian
- Department of Infectious Diseases, Beijing You An Hospital, Beijing Institute of Hepatology, Capital Medical University, Beijing, China
| | - Yulin Zhang
- Department of Infectious Diseases, Beijing You An Hospital, Beijing Institute of Hepatology, Capital Medical University, Beijing, China
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Jariwal R, Raza N, Bhandohal J, Cobos E. Non-Hodgkin's Plasmablastic Lymphoma as Initial Presentation of Human Immunodeficiency Virus. J Investig Med High Impact Case Rep 2021; 9:23247096211014689. [PMID: 33980062 PMCID: PMC8127741 DOI: 10.1177/23247096211014689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Plasmablastic lymphoma (PBL) is a subtype of non-Hodgkin’s lymphoma that manifests in patients with the diagnosis of human immunodeficiency virus (HIV), more prominently in the head, neck, and oral mucosal region. The diagnosis of this rare lymphoma serves as a concomitant diagnosis of acquired immunodeficiency syndrome. The case is of a 33-year-old previously healthy male, with an unknown diagnosis of HIV with a painful right mandibular mass. He was subsequently diagnosed with PBL and HIV. This case of PBL illustrates the importance of linking a rare and potentially life-threatening diagnosis as a possible first manifestation of HIV.
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Affiliation(s)
| | - Nadia Raza
- UCLA at Kern Medical Center, Bakersfield, CA, USA
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Abstract
Despite widely available antiretroviral therapy, lymphoma remains the leading cause of death for human immunodeficiency virus (HIV)-infected persons in economically developed countries. Even a few months of drug interruptions can lead to drops in the CD4 cell count, HIV viremia, and an increased risk of lymphoma. Currently, good HIV control facilitates intensive therapies appropriate to the lymphoma, including autologous and even allogeneic hematopoietic stem cell transplantation. Nonetheless, HIV-related lymphomas have unique aspects, including pathogenetic differences driven by the presence of HIV and often coinfection with oncogenic viruses. Future therapies might exploit these differences. Lymphoma subtypes also differ in the HIV-infected population, and the disease has a higher propensity for advanced-stage, aggressive presentation and extranodal disease. Other unique aspects include the need to avoid potential interactions between antiretroviral therapy and chemotherapeutic agents and the need for HIV-specific supportive care such as infection prophylaxis. Overall, the care of these patients has progressed sufficiently that recent guidelines from the American Society of Clinical Oncology advocate the inclusion of HIV-infected patients alongside HIV-negative patients in cancer clinical trials when appropriate. This article examines HIV lymphoma and includes Burkitt lymphoma in the general population.
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Prospective evaluation of blood Epstein-Barr virus DNA load and antibody profile in HIV-related non-Hodgkin lymphomas. AIDS 2021; 35:861-868. [PMID: 33749224 DOI: 10.1097/qad.0000000000002839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The value of Epstein-Barr virus (EBV) biomarkers on the prognosis of HIV-related non-Hodgkin's lymphoma (NHL) has been poorly explored in the combined antiretroviral therapy (cART) era. DESIGN We evaluated EBV DNA load and EBV antibodies in HIV-NHL patients enrolled in the French ANRS-CO16 Lymphovir Cohort between 2008 and 2015. METHODS Whole blood and plasma EBV DNA load and serological profiles were analyzed in 76 HIV-infected patients at diagnosis of NHL and 6 months after the initiation of chemotherapy. RESULTS Prechemotherapy whole blood (WB) and plasma EBV DNA loads were positive for 80 and 45% of HIV-NHL patients, respectively. Pretreatment WB EBV DNA positivity was associated with a positive plasma HIV-1 RNA load (relative risk (RR), 4.42 [1.33; 14.72]) and plasma EBV DNA positivity with EBV in situ detection (RR 10.62 [2.38; 47.49]). Following chemotherapy, the proportions of patients with positive WB or plasma EBV DNA declined from 81 to 23% (P < 0.0001) and from 43 to 8% (P < 0.0001), respectively. Estimated 2-year progression-free survival did not differ according to prechemotherapy WB positivity (82% versus 67%, P = 0.15) or plasma EBV DNA positivity (76% versus 81%, P = 0.52). CONCLUSIONS The plasma EBV DNA load correlates with in situ EBV detection. The WB EBV DNA load correlates with HIV load. WB and plasma EBV DNA loads at NHL diagnosis do not constitute prognostic markers for HIV-NHL patients in the modern cART era.
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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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Abstract
Primary effusion lymphoma (PEL) is defined as a HHV-8-associated large B-cell lymphoma, which favors HIV-infected young adults, typically presenting as a serous (pleural, pericardial, or peritoneal) effusion with no identifiable tumor mass. Uncommon instances of lymphoid proliferations with the same morphology, immunophenotype, and molecular features as PEL, but occurring as a solid tumor mass without serous cavities involvement, have been termed extracavitary (or solid) variant of PEL. We hereby report the exceptional case of a HIV-associated extracavitary PEL primarily localized to the skin and exhibiting a panniculitis-like presentation. Primary cutaneous presentation of extracavitary PEL is exceedingly uncommon, with only 6 cases previously described in the literature. In light of its atypical immunophenotype, the differential diagnosis in case of skin involvement by extracavitary PEL is challenging: demonstration of HHV-8 infection in neoplastic cells is of pivotal importance. Our case is further atypical in that the lymphoid proliferation underwent complete and protracted regression solely by establishment of highly active antiretroviral therapy.
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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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Sparano JA, Lee JY, Kaplan LD, Ramos JC, Ambinder RF, Wachsman W, Aboulafia D, Noy A, Henry DH, Ratner L, Cesarman E, Chadburn A, Mitsuyasu R. Response-adapted therapy with infusional EPOCH chemotherapy plus rituximab in HIV-associated, B-cell non-Hodgkin's lymphoma. Haematologica 2021; 106:730-735. [PMID: 32107337 PMCID: PMC7927888 DOI: 10.3324/haematol.2019.243386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Indexed: 12/20/2022] Open
Abstract
Four cycles of rituximab plus CHOP chemotherapy is as effective as 6 cycles in low-risk diffuse large B-cell lymphoma (DLBCL). Here we report a post-hoc analysis of a prospective clinical trial in patients with HIV-associated DLBCL and high-grade lymphoma treated with 4-6 cycles of EPOCH plus rituximab based a response-adapted treatment strategy. 106 evaluable patients with HIV-associated DLBCL or high-grade CD20-positive non-Hodgkin's lymphoma were randomized to receive rituximab (375 mg/m2) given either concurrently prior to each infusional EPOCH cycle, or sequentially (weekly for 6 weeks) following completion of EPOCH. EPOCH consisted of a 96-hour IV infusion of etoposide, doxorubicin, and vincristine plus oral prednisone followed by IV bolus cyclophosphamide every 21 days for 4 to 6 cycles. Patients received 2 additional cycles of therapy after documentation of a complete response (CR) by computerized tomography after cycles 2 and 4. 64 of 106 evaluable patients (60%, 95% CI 50%, 70%) had a CR in both treatment arms. The 2-year event-free survival (EFS) rates were similar in the 24 patients with CR who received 4 or fewer EPOCH cycles (78%, 95% confidence intervals [55%, 90%]) due to achieving a CR after 2 cycles, compared with those who received 5-6 cycles of EPOCH (85%, 95% CI 70%, 93%) because a CR was first documented after cycle 4. A response-adapted strategy may permit a shorter treatment duration without compromising therapeutic efficacy in patients with HIV-associated lymphoma treated with EPOCH plus rituximab, which merits further evaluation in additional prospective trials. Clinical Trials.gov identifier NCT00049036.
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Affiliation(s)
- Joseph A Sparano
- Montefiore-Einstein Cancer Center, Montefiore Medical Center, Bronx, NY, USA
| | - Jeannette Y Lee
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Juan Carlos Ramos
- University of Miami, Sylvester Comprehensive Cancer Center, Miami, USA
| | | | - William Wachsman
- Moores University of California, San Diego Cancer Center, La Jolla, CA, USA
| | | | - Ariela Noy
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
| | - David H Henry
- University of Pennsylvania, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Lee Ratner
- Washington University, St. Louis, MO, USA
| | - Ethel Cesarman
- Weill Medical College of Cornell University, New York, NY, USA
| | - Amy Chadburn
- Weill Cornell Medical College, New York, NY, USA
| | - Ronald Mitsuyasu
- University of California, Los Angeles Medical Center, Los Angeles, CA, USA
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Wang Z, Zhang R, Gong Z, Liu L, Shen Y, Chen J, Qi T, Song W, Tang Y, Sun J, Lin Y, Xu S, Yang J, Lu H. Real-world outcomes of AIDS-related Burkitt lymphoma: a retrospective study of 78 cases over a 10-year period. Int J Hematol 2021; 113:903-909. [PMID: 33594656 DOI: 10.1007/s12185-021-03101-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 01/12/2023]
Abstract
We investigated the clinical characteristics and outcomes of acquired immunodeficiency syndrome-related Burkitt lymphoma (AIDS-BL). A single-center retrospective study was performed of 78 cases over a 10-year period. The baseline characteristics of enrolled patients included the following: median age, 46 years; median CD4+ T lymphocyte count, 156 cells/μL; advanced stage, 74.3%; > 1 extranodal site, 55.1%; international prognostic index (IPI) > 1, 85.9%; and elevated serum lactate dehydrogenase, 82.1%. The 1-year and 2-year overall survival (OS) rates were 52.2 ± 5.9% and 42.7 ± 6.2%, respectively. A prognostic analysis of 65 patients who had undergone chemotherapy showed that B symptoms (with vs. without fever, night sweat or weight loss), number of extranodal sites (0, 1 vs. > 1), level of serum albumin (≥ 35 g/L vs. < 35 g/L), hemoglobin (≥ 110 g/L vs. < 110 g/L), and IPI score (≤ 2 vs. > 1) were all associated with OS. However, only B symptoms (HR = 4.036, 95% CI 1.821-8.948, p = 0.001), serum albumin level < 35 g/L (HR = 2.131, 95% CI 1.013-4.483, p = 0.046), and chemotherapy without rituximab (HR = 2.286, 95% CI 1.108-4.714, p = 0.025) were independent predictors of OS after multivariate adjustment. Patients with AIDS-BL were likely to present with high-risk features, and their clinical outcomes were relatively poor, especially those with B symptoms and lower serum albumin levels.
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Affiliation(s)
- Zhenyan Wang
- Fudan University (Shanghai Public Health Clinical Center), 130 Dongan Road, Xuhui District, Shanghai, 200032, China
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Renfang Zhang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Zhangyun Gong
- School of Clinical Medicine, Jiamusi University, Jiamusi, China
| | - Li Liu
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Yinzhong Shen
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
- Department of Medical Administration, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Jun Chen
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Tangkai Qi
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Wei Song
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Yang Tang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Jianjun Sun
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Yixiao Lin
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Shuibao Xu
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Junyang Yang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Hongzhou Lu
- Fudan University (Shanghai Public Health Clinical Center), 130 Dongan Road, Xuhui District, Shanghai, 200032, China.
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China.
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Sun JJ, Liu L, Wang JR, Shen YZ, Qi TK, Wang ZY, Tang Y, Song W, Chen J, Zhang RF. Clinical outcomes of people living with human immunodeficiency virus (HIV) with diffuse large B-cell lymphoma (DLBCL) in Shanghai, China. Chin Med J (Engl) 2020; 133:2796-2802. [PMID: 33273327 PMCID: PMC7717822 DOI: 10.1097/cm9.0000000000001180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Numerous studies have focused on lymphoma among patients infected with human immunodeficiency virus (HIV). However, little is known about the treatment options and survival rate of lymphoma in the Chinese people living with HIV (PLHIV). Our study aimed to investigate the prognosis and compare outcome of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (DA-EPOCH-R) with standard cyclophosphamide, doxorubicin, vincristine, prednisone and rituximab(R-CHOP) as front line therapy for PLHIV with diffuse large B-cell lymphoma (DLBCL) receiving modern combined antiretroviral therapy (cART). METHODS A retrospective analysis evaluating PLHIV with DLBCL was performed in Shanghai Public Health Clinical Center from July 2012 to September 2019. The demographic and clinical data were collected, and overall survival (OS) and progression-free survival (PFS) analyses of patients receiving R-CHOP or DA-EPOCH-R therapy were performed by Kaplan-Meier analysis. Additionally, a Cox multiple regression model was constructed to identify related factors for OS. RESULTS A total of 54 eligible patients were included in the final analysis with a median follow-up of 14 months (interquartile range [IQR]: 8-29 months). The proportion of high international prognostic index (IPI) patients was much larger in the DA-EPOCH-R group (n = 29) than that in the R-CHOP group (n = 25). The CD4 cell counts and HIV RNA levels were not significantly different between the two groups. The 2-year OS for all patients was 73%. However, OS was not significantly different between the two groups, with a 2-year OS rate of 78% for the DA-EPOCH-R group and 66% for the R-CHOP group. Only an IPI greater than 3 was associated with a decrease in OS, with a hazard ratio of 5.0. The occurrence of grade 3 and 4 adverse events of chemotherapy was not significantly different between the two groups. CONCLUSIONS Outcomes of R-CHOP therapy do not differ from those of DA-EPOCH-R therapy. No HIV-related factors were found to be associated with the OS of PLHIV in the modern cART era.
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Affiliation(s)
- Jian-Jun Sun
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
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Manyau MCP, Mudzviti T, Rusakaniko S, Mberi ET, Maponga CC, Morse GD. Survival of HIV-infected patients with high-grade non-Hodgkin's lymphomas: A retrospective study of experiences in Zimbabwe. PLoS One 2020; 15:e0239344. [PMID: 32941540 PMCID: PMC7498086 DOI: 10.1371/journal.pone.0239344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/04/2020] [Indexed: 12/24/2022] Open
Abstract
Background Rituximab in combination with chemotherapy is now widely accepted as standard of care for AIDS-related lymphomas (ARLs) of B-cell origin. However, the clinical impact of rituximab in resource limited settings remains unknown. Different settings and patient heterogeneity may affect the effect of any given treatment. The study objectives were to determine if rituximab use was associated with improved 18-month overall survival (OS) of patients with ARLs and to identify correlates of 18-month OS. Methods A retrospective review of medical records of adult HIV infected patients treated for high-grade large cell non-Hodgkin’s lymphoma with chemotherapy +/- rituximab between 2015–2017 was conducted. Vital status and disease progression/relapse at 18 months were determined. Survival functions were estimated using Kaplan-Meier methodology. Equality of survival functions were assessed using Log-rank tests and Cox regression analysis to identify risk factors for mortality. Results One hundred and twenty-four eligible medical records were identified. This was a cohort of black Africans with a median age of 42 (IQR: 33–47) and a 57% male gender distribution. Overall survival at 6, 12 and 18 months for the population was 75.9%, 44.0% and 30.6% respectively. Over the study period, 72.6% of patients were diagnosed with disease progression/ relapse. There was a higher rate of rituximab use in patients who were treated at a private institution and those with medical insurance. Rituximab use was not associated with a reduction in 18-month mortality [adjusted hazard ratio (aHR)1.28, (95% CI 0.63–2.60)]. Risk factors for 18-month mortality were male gender [aHR 1.89, (95% CI 1.04–3.43)], age 40+ years [aHR 2.49, (1.33–4.67)], receipt of <3 chemotherapy cycles [aHR 2.48, (95% CI 1.33–4.60)] and low socioeconomic status [aHR 2.44, (95% CI 1.28–4.67)]. Conclusions Predictors of mortality were male gender, older age, low socioeconomic status and receipt of a less than half of the recommended number of chemotherapy cycles. Rituximab use was not associated with an improvement in 18-month OS in Zimbabwean patients with ARLs.
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Affiliation(s)
- Maudy C. P. Manyau
- School of Pharmacy, College of Health Sciences, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe
- * E-mail:
| | - Tinashe Mudzviti
- School of Pharmacy, College of Health Sciences, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe
- Newlands Clinic, Highlands, Harare, Zimbabwe
| | - Simbarashe Rusakaniko
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe
| | - Elson T. Mberi
- Department of Hematology, College of Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe
| | - Charles C. Maponga
- School of Pharmacy, College of Health Sciences, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe
- Center for Integrated Global Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
- Translational Pharmacology Research Core, University at Buffalo, Buffalo, New York, United States of America
| | - Gene D. Morse
- Center for Integrated Global Biomedical Sciences, University at Buffalo, Buffalo, New York, United States of America
- Translational Pharmacology Research Core, University at Buffalo, Buffalo, New York, United States of America
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Ramos JC, Sparano JA, Chadburn A, Reid EG, Ambinder RF, Siegel ER, Moore PC, Rubinstein PG, Durand CM, Cesarman E, Aboulafia D, Baiocchi R, Ratner L, Kaplan L, Capoferri AA, Lee JY, Mitsuyasu R, Noy A. Impact of Myc in HIV-associated non-Hodgkin lymphomas treated with EPOCH and outcomes with vorinostat (AMC-075 trial). Blood 2020; 136:1284-1297. [PMID: 32430507 PMCID: PMC7483436 DOI: 10.1182/blood.2019003959] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/14/2020] [Indexed: 12/11/2022] Open
Abstract
EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) is a preferred regimen for HIV-non-Hodgkin lymphomas (HIV-NHLs), which are frequently Epstein-Barr virus (EBV) positive or human herpesvirus type-8 (HHV-8) positive. The histone deacetylase (HDAC) inhibitor vorinostat disrupts EBV/HHV-8 latency, enhances chemotherapy-induced cell death, and may clear HIV reservoirs. We performed a randomized phase 2 study in 90 patients (45 per study arm) with aggressive HIV-NHLs, using dose-adjusted EPOCH (plus rituximab if CD20+), alone or with 300 mg vorinostat, administered on days 1 to 5 of each cycle. Up to 1 prior cycle of systemic chemotherapy was allowed. The primary end point was complete response (CR). In 86 evaluable patients with diffuse large B-cell lymphoma (DLBCL; n = 61), plasmablastic lymphoma (n = 15), primary effusion lymphoma (n = 7), unclassifiable B-cell NHL (n = 2), and Burkitt lymphoma (n = 1), CR rates were 74% vs 68% for EPOCH vs EPOCH-vorinostat (P = .72). Patients with a CD4+ count <200 cells/mm3 had a lower CR rate. EPOCH-vorinostat did not eliminate HIV reservoirs, resulted in more frequent grade 4 neutropenia and thrombocytopenia, and did not affect survival. Overall, patients with Myc+ DLBCL had a significantly lower EFS. A low diagnosis-to-treatment interval (DTI) was also associated with inferior outcomes, whereas preprotocol therapy had no negative impact. In summary, EPOCH had broad efficacy against highly aggressive HIV-NHLs, whereas vorinostat had no benefit; patients with Myc-driven DLBCL, low CD4, and low DTI had less favorable outcomes. Permitting preprotocol therapy facilitated accruals without compromising outcomes. This trial was registered at www.clinicaltrials.gov as #NCT0119384.
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MESH Headings
- Adult
- Aged
- Anti-HIV Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- CD4 Lymphocyte Count
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/adverse effects
- DNA, Viral/blood
- Doxorubicin/administration & dosage
- Doxorubicin/adverse effects
- Drug Administration Schedule
- Etoposide/administration & dosage
- Etoposide/adverse effects
- Female
- Genes, myc
- HIV Infections/drug therapy
- HIV-1/drug effects
- Herpesviridae Infections/complications
- Herpesviridae Infections/virology
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/isolation & purification
- Herpesvirus 8, Human/genetics
- Herpesvirus 8, Human/isolation & purification
- Histone Deacetylase Inhibitors/administration & dosage
- Histone Deacetylase Inhibitors/adverse effects
- Humans
- Kaplan-Meier Estimate
- Lymphoma, AIDS-Related/complications
- Lymphoma, AIDS-Related/drug therapy
- Lymphoma, AIDS-Related/genetics
- Lymphoma, AIDS-Related/virology
- Lymphoma, Non-Hodgkin/complications
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/genetics
- Lymphoma, Non-Hodgkin/virology
- Male
- Middle Aged
- Neutropenia/chemically induced
- Prednisone/administration & dosage
- Prednisone/adverse effects
- Progression-Free Survival
- Prospective Studies
- Rituximab/administration & dosage
- Rituximab/adverse effects
- Thrombocytopenia/chemically induced
- Treatment Outcome
- Vincristine/administration & dosage
- Vincristine/adverse effects
- Viral Load/drug effects
- Vorinostat/administration & dosage
- Vorinostat/adverse effects
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Affiliation(s)
- Juan C Ramos
- Department of Medicine, University of Miami School of Medicine, Miami, FL
| | - Joseph A Sparano
- Department of Oncology, Albert Einstein Comprehensive Cancer Center, Bronx, NY
| | - Amy Chadburn
- Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York, NY
| | - Erin G Reid
- Department of Medicine, University of California, San Diego, San Diego, CA
| | | | - Eric R Siegel
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Page C Moore
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Paul G Rubinstein
- Section of Hematology/Oncology, John H. Stroger Jr Hospital of Cook County, Chicago, IL
| | | | - Ethel Cesarman
- Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York, NY
| | - David Aboulafia
- Division of Hematology and Oncology, Virginia Mason Medical Center, Seattle, WA
| | - Robert Baiocchi
- Department of Internal Medicine, Ohio State University, Columbus, OH
| | - Lee Ratner
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Lawrence Kaplan
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | | | - Jeannette Y Lee
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Ronald Mitsuyasu
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Ariela Noy
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; and
- Department of Medicine, Weill Medical College of Cornell University, New York, NY
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Abstract
Purpose of Review Cancer remains a major cause of morbidity and mortality in HIV-infected individuals, with aggressive non-Hodgkin’s lymphoma as the most frequent one. However, the introduction of modern antiretroviral therapy (ART) drastically improved treatment options and prognosis in HIV-associated lymphomas. This review summarized the current treatment landscape and future challenges in HIV-positive patients with non-Hodgkin’s and Hodgkin’s lymphoma. Recent Findings Selecting the appropriate therapy for the individual patient, diffuse-large B cell lymphoma, Burkitt’s lymphoma, and Hodgkin’s disease may be curable diseases. In contrast, the prognosis of plasmablastic lymphoma and primary effusion lymphoma remain poor. New treatment approaches, as targeted therapies or CAR T cell therapy, may broaden the therapeutic armamentarium. Summary The continuous application of ART is mandatory for successful treatment. The choice of lymphoma therapy may follow the recommendations for HIV-negative patients, but prospective trials in HIV-lymphoma are needed.
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Habbous S, Guo H, Beca J, Dai WF, Isaranuwatchai W, Cheung M, Chan KKW. The effectiveness of rituximab and HIV on the survival of Ontario patients with diffuse large B-cell lymphoma. Cancer Med 2020; 9:7072-7082. [PMID: 32794362 PMCID: PMC7541135 DOI: 10.1002/cam4.3362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/18/2020] [Accepted: 07/19/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction For patients with diffuse large B‐cell lymphoma (DLBCL), standard‐care is rituximab administered with CHOP or CHOP‐like chemotherapy (R‐CHOP). However, the effectiveness and safety of R‐CHOP among DLBCL patients with human immunodeficiency virus (HIV) infection is less clear, as HIV+ patients were omitted from most clinical trials and population‐level data from unselected patients are limited. R‐CHOP was funded for HIV‐associated DLBCL patients with CD4 >50/mm3 in Ontario in February 2015. Methods Patients with a new diagnosis of DLBCL were identified from the Ontario Cancer Registry between April 2010 and March 2018. HIV diagnosis and chemotherapy regimen were ascertained using administrative databases at Ontario Health. The effect of rituximab and HIV on overall survival was assessed in the HIV+ subgroup (R‐CHOP vs CHOP) and in the R‐CHOP subgroup (HIV+ vs HIV−). Results Among HIV+ patients, receipt of R‐CHOP was associated with a fivefold improvement in overall survival (hazard ratio [HR] 0.29 (0.13‐0.66) compared with CHOP), after adjustment. Among patients who received R‐CHOP (n = 6106), older age, male sex, lower neighborhood income, and higher comorbidity were associated with worse overall survival, after adjustment (P < .001 for all), but HIV positivity was not prognostic (HR 1.12 (0.60‐2.10)). Within 1‐year after diagnosis, HIV+ patients receiving R‐CHOP had a similar proportion of patients who visited the emergency department (67% vs 66% P = .43) or admitted to hospital (58% vs 52%, P = .43) and as HIV− patients receiving R‐CHOP. Conclusion HIV status did not affect prognosis for patients with DLBCL receiving R‐CHOP in an unselected general population when rituximab was used according to funding criteria. R‐CHOP was safe and effective for DLBCL treatment, regardless of HIV status.
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Affiliation(s)
- Steven Habbous
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Helen Guo
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Jaclyn Beca
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Wei Fang Dai
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Wanrudee Isaranuwatchai
- Centre for Excellence in Economic Analysis Research, St. Michael's Hospital, Toronto, ON, Canada.,Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Toronto, ON, Canada
| | - Matthew Cheung
- Hematology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kelvin K W Chan
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada.,Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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50
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Rust BJ, Kiem HP, Uldrick TS. CAR T-cell therapy for cancer and HIV through novel approaches to HIV-associated haematological malignancies. LANCET HAEMATOLOGY 2020; 7:e690-e696. [PMID: 32791043 DOI: 10.1016/s2352-3026(20)30142-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/05/2020] [Accepted: 04/28/2020] [Indexed: 12/15/2022]
Abstract
People living with HIV are a global population with increased cancer risk but their access to modern immunotherapies for cancer treatment has been limited by socioeconomic factors and inadequate research to support safety and efficacy in this population. These immunotherapies include immune checkpoint inhibitors and advances in cellular immunotherapy, particularly chimeric antigen receptor (CAR) T-cell therapy. Despite the field of cancer immunotherapy rapidly expanding with ongoing clinical trials, people with HIV are often excluded from such trials. In 2019, post-approval evaluation of anti-CD19 CAR T-cell therapy in people with HIV and aggressive B-cell lymphoma showed the feasibility of CAR T-cell therapy for cancer in this excluded group. Along with expanded treatment options for people with HIV is the ability to assess the effects of immunotherapy on the latent HIV reservoir, with certain immunotherapies showing the ability to alleviate this burden. This Series paper addresses the increased cancer burden in people with HIV, the increasing evidence for the safety and efficacy of immunotherapies in the context of HIV and cancer, and opportunities for novel applications of CAR-T therapy for the treatment of both haematological malignancies and HIV.
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Affiliation(s)
- Blake J Rust
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Hans-Peter Kiem
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA
| | - Thomas S Uldrick
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA.
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