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Mbai MM, Mduma E, Thuo S, Rugengamanzi E, Malichewe CV, Lugina EL. A comparison of clinical profile and treatment outcome of Hodgkin's Lymphoma in Tanzania according to HIV status during the HAART era. BMC Cancer 2024; 24:796. [PMID: 38961368 PMCID: PMC11220972 DOI: 10.1186/s12885-024-12569-z] [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] [Accepted: 06/26/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND The incidence of Hodgkin's lymphoma (HL) in people living with HIV (PLWHA) and on HAART is approximately 20-30 times higher than in HIV-negative individuals. Most patients with HIV-HL present at an advanced stage (III-IV) have 'B' symptoms and extranodal involvement. The natural history and risk stratification of HIV-HL has undergone a significant change as a result of HAART's rollout. This study investigated the differences in clinicopathological and survival patterns of HL among individuals with and without HIV disease in Tanzania during the HAART era. METHODOLOGY This hospital-based retrospective cohort study was conducted at the ORCI, Dar-Es-Salaam, Tanzania. Chi-square and Fisher's exact tests were used to compare proportions. The student t-test was used to compare means. To determine factors that predict survival, we used the log-rank test to analyze the variables in univariate analysis. A Cox regression model was used to analyze the significant factors from univariate analysis in multivariate analysis. RESULTS Eighty-three patients with HL were recruited, and the prevalence of HIV-positive status was 27.7%. Most of the patients with HIV-HL had an age of > 30 years (73.9%), while most of the non-HIV-HL patients had an age of ≤ 30 years (63.3%) (P = 0.02). The 2-year OS rate for HIV-HL was 34%, while that for non-HIV-HL was 67%. Among the HIV-HL patients, predictors of a poorer outcome were a CD4 count ≤ 200 cells/mm3 (P = 0.05), lack of HAART use (P = 0.00), and the use of HAART for ≤ 10 months (P = 0.00). CONCLUSION The prevalence of HIV-HL was 27.7% among HL patients. HIV positivity is still a poor prognostic factor in our setting, especially for patients not on HAART, on HAART for ≤ 10 months, or with a low CD4 count below 200 cells/mm3. Patients with HIV-HL were older and had higher LDH levels, whereas patients with non-HIV-HL were younger and had low LDH levels.
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Affiliation(s)
- Mercy M Mbai
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.
- Department of Oncology, Longisa County Referral Hospital, Bomet, Kenya.
| | - Emmanuel Mduma
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
- Department of Clinical Oncology, Rabininsia Memorial Hospital, Dar Es Salaam, Tanzania
| | - Samuel Thuo
- Department of Otolaryngology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Eulade Rugengamanzi
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
- Butaro Cancer Center of Excellence, Burera, Rwanda
- School of Medicine, University of Global Health Equity, Kigali, Rwanda
| | - Christina V Malichewe
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Emmanuel L Lugina
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
- Academic, Research and Consultancy Unit, Ocean Road Cancer Institute, Dar Es Salaam, Tanzania
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Hentrich M, Müller M, Wyen C, Pferschy A, Jurinovic V, Siehl J, Rockstroh JK, Schürmann D, Hoffmann C. Stage-adapted treatment of HIV-associated Hodgkin lymphoma: Long-term results of a prospective, multicenter study. Hemasphere 2024; 8:e68. [PMID: 38962576 PMCID: PMC11221608 DOI: 10.1002/hem3.68] [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: 01/26/2024] [Revised: 03/04/2024] [Accepted: 04/01/2024] [Indexed: 07/05/2024] Open
Abstract
Results of a prospective study of stage-adapted treatment of human immunodeficiency virus (HIV)-associated Hodgkin lymphoma (HIV-HL) showed a 2-year overall survival (OS) of 90.7% with no significant difference between early favorable (EF), early unfavorable (EU), and advanced HL. Patients with EF HIV-HL received two to four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) + 30 Gy involved field (IF) radiation, those with EU HIV-HL received four cycles of ABVD or BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) baseline + 30 Gy IF, and six to eight cycles of BEACOPP baseline were administered in advanced disease. The objective of the present analysis is to determine long-term outcomes of HIV-HL. Of 108 patients, 23 (21%) had EF HL, 14 (13%) had EU HL, and 71 (66%) had advanced-stage HL. After a median follow-up of 9.14 (range, 0-12.9) years, there were five primary refractory HL patients (5%) and 11 relapses (10%), of which seven were late relapses (>2 years). A second primary malignancy (SPM) occurred in 10 patients after a median of 7.3 years (range, 1.5-10.7) from HL diagnosis. The 10-year OS for patients with EF, EU, and advanced HL was 95.7%, 84.6%, and 76.1%, respectively. By multivariate analysis, Center for Disease Control and Prevention category C (hazard ratio [HR] 3.00, 95% confidence interval [CI]: 1.16-7.74, p = 0.023) and achievement of complete remission were significant for OS (HR 0.03, 95% CI: 0.01-0.08, p = 2.45 × 10-9). In conclusion, a stage-adapted treatment approach for HIV-HL is highly effective with long-term survival rates similar to those reported in HIV-uninfected HL. However, the risk for late relapse and SPM is significant.
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Affiliation(s)
- Marcus Hentrich
- Department of Hematology and Oncology, Red Cross HospitalLudwig‐Maximilian University of MunichMunichGermany
| | - Markus Müller
- Department of Infectious DiseasesSt. Joseph's HospitalBerlinGermany
| | - Christoph Wyen
- First Department of Internal MedicineUniversity Hospital CologneCologneGermany
| | - Anna Pferschy
- Department of Hematology and Oncology, Red Cross HospitalLudwig‐Maximilian University of MunichMunichGermany
| | - Vindi Jurinovic
- Department of Internal Medicine III, University HospitalLudwig‐Maximilian University of MunichMunichGermany
| | | | | | - Dirk Schürmann
- Department of Infectious Diseases and Pulmonary MedicineCharité—University Medicine BerlinBerlinGermany
| | - Christian Hoffmann
- ICH Study CenterHamburgGermany
- Department of Internal Medicine IIUniversity Hospital of Schleswig Holstein, Campus KielKielGermany
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Souza ATD, Andrade FRD, Sarmento AC, Villarim CC, Araújo-Filho I, Medeiros KSD. Clinical features in Hodgkin lymphoma patients living with human immunodeficiency virus: A meta-analysis in the antiretroviral therapy era. Int J STD AIDS 2024:9564624241259512. [PMID: 38905613 DOI: 10.1177/09564624241259512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Abstract
OBJECTIVE Evaluate the clinical features in people with Hodgkin's lymphoma living with HIV (HIV-HL) during the combination ART (cART) era. DESIGN Systematic review and meta-analysis. METHODS The study was conducted in accordance with the recommendations of 2020 PRISMA and MOOSE statements. The protocol was prospectively registered through the PROSPERO (CRD42021289520). Manuscripts published until July 2023 were systematically searched in the PubMed, EMBASE, Cochrane Library, and Web of Science databases, with no language and year of publication restriction. Meta-analysis was performed to estimate a pooled proportion of each outcome using a random-effect analysis. Quality assessment was performed by using New-Castle Ottawa scale. Certainty of evidence was graded using the GRADE. RESULTS Sixteen cohorts, representing 3.882 HIV-HL patients, were included in this review. Our findings indicate that HIV-HL patients showed a 2-year overall survival (OS) of 92% (95% CI 0.87, 0.95). However, the 5-year overall survival decreased to 79% (95% CI 0.74, 0.83), with a high certainty of evidence according to GRADE. Additionally, the 5-year progression-free survival declined to 79% and complete remission rate increased to 81%. Our meta-analysis indicates an increase for B symptoms (80%, 95% CI 0.75, 0.84) and extranodal involvement in bone marrow (43%, 95% CI 0.30, 0.47) among HIV-HL patients. CONCLUSION The HIV-HL patients showed a 2-year OS of 92%. However, the 5-year OS decreased to 79%. The reported main cause of mortality among HIV-HL patients was progression of HL. Our systematic review and meta-analysis suggest that cART is associated with improved short-term survival of HIV-HL patients.
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Affiliation(s)
- Amaxsell Tb de Souza
- Instituto de Ensino, Pesquisa e Inovação, Liga Contra o Câncer, Natal, Brazil
- Faculty of Pharmacy, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Fernanda Ra de Andrade
- Instituto de Ensino, Pesquisa e Inovação, Liga Contra o Câncer, Natal, Brazil
- Department of Medicine, Health School, Potiguar University, Natal, Brazil
| | - Ayane Ca Sarmento
- Instituto de Ensino, Pesquisa e Inovação, Liga Contra o Câncer, Natal, Brazil
- Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal, Brazil
- Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Irami Araújo-Filho
- Instituto de Ensino, Pesquisa e Inovação, Liga Contra o Câncer, Natal, Brazil
- Department of Medicine, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Kleyton S de Medeiros
- Instituto de Ensino, Pesquisa e Inovação, Liga Contra o Câncer, Natal, Brazil
- Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
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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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Mponda M, Kudowa E, Craven DM, Eastburg LC, Chikasema M, Kasonkanji E, Tomoka T, Roush SM, Simwinga L, Mumba N, Gopal S, Fedoriw Y, Painschab MS. Safety, efficacy, and affordability of ABVD for Hodgkin lymphoma in Malawi: a prospective cohort study. EClinicalMedicine 2024; 69:102480. [PMID: 38356728 PMCID: PMC10864874 DOI: 10.1016/j.eclinm.2024.102480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/22/2023] [Accepted: 01/25/2024] [Indexed: 02/16/2024] Open
Abstract
Background ABVD (doxorubicin, bleomycin, vinblastine, and dexamethasone) is a proven, curative regimen for Hodgkin lymphoma (HL). Prospective data describing HL treatment in sub-Saharan Africa are limited. We aimed to fill this knowledge gap, using data from Malawi. Methods We report a prospective observational cohort of HL (aged ≥ 15) from a single, tertiary referral centre in Malawi. We enrolled patients with pathologicially confirmed Hodgkin lymphoma between June 1, 2013, and Dec 31, 2021 with follow-up censored on May 31, 2022. Patients were treated with ABVD and concurrent antiretroviral therapy if HIV-positive and were followed up for 5 years. The primary outcome was overall survival; secondary outcomes included progression-free survival, response assessment, and adverse events. Microcosting of HL diagnosis, treatment, and follow-up was embedded. Findings We enrolled 38 patients with a median age of 27 years (interquartile range 19-46); eleven (28%) were HIV-positive. Of 35 patients treated with ABVD, 24 (71%) had stage III/IV, nine (26%) unfavourable limited stage, and two (6%) favourable limited stage. Among HIV-infected individuals, mean CD4 count at HL diagnosis was 179 cells/uL and ten (91%) had HIV RNA < 400 copies/mL. Grade 3/4 neutropenia occurred in 24 (68%) patients and caused treatment delay in 16 (46%). Of ten deaths, seven were due to HL, two possible treatment-related toxicity, and one uncertain. 2-year overall survival was 82% (95% CI 70-96%) and 2-year progression-free survival was 64% (95% CI 50-83%). PFS appeared better for HIV-positive patients (HR 0.23 (95% CI 0.05-1.02)) after controlling for stage and performance status (p = 0.05). We estimated $2708 (2022 USD) for HL diagnosis, treatment, and follow-up in our cohort. Interpretation Our findings suggest that treatment with ABVD is safe, efficacious, and affordable for HL in Malawi. Outcomes are worse than in high-income countries due to HL progression. Future studies are needed to understand outcome inequities and to assess efficacy of therapies for patients with relapsed or refractory HL in Malawi. Funding National Institutes of Health, Lineberger Comprehensive Cancer Center.
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Affiliation(s)
- Marriam Mponda
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi
| | - Evaristar Kudowa
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi
| | - Dalton M. Craven
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi
| | - Luke C. Eastburg
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maria Chikasema
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi
| | | | - Tamiwe Tomoka
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi
| | - Sophie Maharry Roush
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lusayo Simwinga
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi
| | - Noel Mumba
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Rockville, MD, USA
| | - Yuri Fedoriw
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matthew S. Painschab
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi
- Department of Medicine, 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
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6
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Xiao P, Chen X, Chen Y, Fan W, Dong Z, Huang J, Zhang Y. CD4 + T cell count in HIV/TB co-infection and co-occurrence with HL: Case report and literature review. Open Life Sci 2023; 18:20220744. [PMID: 37744454 PMCID: PMC10512445 DOI: 10.1515/biol-2022-0744] [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] [Received: 06/21/2023] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 09/26/2023] Open
Abstract
In the human immunodeficiency virus (HIV)-infected population, especially HIV with concomitant tuberculosis (TB) or Hodgkin's lymphoma (HL), numerous risk factors have been reported in recent years. Among them, the decreased CD4+ T cell count was recognized as the common risk factor. We report a case of a patient with HIV and TB and HL co-occurrence, in which patient's CD4+ T cell count was inconsistent with disease. A 58-year-old male presented with fever and shortness of breath that persisted for 2 months. The patient had a 4-year history of HIV infection and underwent antiretroviral therapy (ART) effectively. After blood test, computed tomography, bone biopsy, and lymphoma biopsy, the patient was diagnosed with skeletal TB and HL, underwent TB treatment and received ART, and underwent four cycles of chemotherapy. CD4+ T cell count was not decreased before diagnosed with TB/HL and increased in this case after the fourth cycle of chemotherapy. We collected and analyzed CD4+ T cell counts in our case and reviewed relevant literature. It is suggested that CD4+ T cell count may be insufficient to predict the risk of HIV-related disease, especially lymphoproliferative disorders.
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Affiliation(s)
- Pingping Xiao
- Department of Hematology and Rheumatology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P. R. China
| | - Xuyan Chen
- Department of Hematology and Rheumatology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P. R. China
| | - Yongquan Chen
- Department of Hematology and Rheumatology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P. R. China
| | - Wei Fan
- Department of Hematology and Rheumatology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P. R. China
| | - Zhigao Dong
- Department of Hematology and Rheumatology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P. R. China
| | - Jinmei Huang
- Department of Hematology and Rheumatology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P. R. China
| | - Yi Zhang
- Department of Hematology and Rheumatology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, P. R. China
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Hoffmann C, Hentrich M. Optimising treatment of HIV-associated Hodgkin lymphoma. Lancet Haematol 2023; 10:e563-e564. [PMID: 37532413 DOI: 10.1016/s2352-3026(23)00177-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Christian Hoffmann
- ICH Study Center, Hamburg 20146, Germany; University Hospital of Schleswig Holstein, Campus Kiel, Kiel, Germany.
| | - Marcus Hentrich
- Red Cross Hospital Munich, University of Munich, Munich, Germany
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Rubinstein PG, Moore PC, Bimali M, Lee JY, Rudek MA, Chadburn A, Ratner L, Henry DH, Cesarman E, DeMarco CE, Costagliola D, Taoufik Y, Ramos JC, Sharon E, Reid EG, Ambinder RF, Mitsuyasu R, Mounier N, Besson C, Noy A. Brentuximab vedotin with AVD for stage II-IV HIV-related Hodgkin lymphoma (AMC 085): phase 2 results from an open-label, single arm, multicentre phase 1/2 trial. Lancet Haematol 2023; 10:e624-e632. [PMID: 37532416 PMCID: PMC10859222 DOI: 10.1016/s2352-3026(23)00157-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/08/2023] [Accepted: 05/16/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Brentuximab vedotin in combination with doxorubicin, vinblastine, and dacarbazine (AVD) is approved in the upfront setting for advanced stage classical Hodgkin lymphoma (cHL). People living with HIV have been excluded from these studies. We aimed to understand the activity and safety of brentuximab vedotin-AVD in people living with HIV diagnosed with Hodgkin lymphoma, while focusing on HIV disease parameters and antiretroviral therapy (ART) interactions. METHODS We present the phase 2 portion of a multicentre phase 1/2 study. Eligible patients were 18 years or older, had untreated stage II-IV HIV-associated cHL (HIV-cHL), a Karnofsky performance status of more than 30%, a CD4+ T-cell count of 50 cells per μL or more, were required to take ART, and were not on strong CYP3A4 or P-glycoprotein inhibitors. Patients were treated intravenously with 1·2 mg/kg of brentuximab vedotin (recommended phase 2 dose) with standard doses of AVD for six cycles on days 1 and 15 of a 28-day cycle. The primary endpoint of the phase 2 portion was 2-year progression-free survival (PFS), assessed in all eligible participants who began treatment. Accrual has been completed. This trial is registered at ClinicalTrials.gov, NCT01771107. FINDINGS Between March 8, 2013, and March 7, 2019, 41 patients received study therapy with a median follow up of 29 months (IQR 16-38). 34 (83%) of 41 patients presented with stage III-IV and seven (17%) with stage II unfavourable HIV-cHL. 37 (90%) of 41 patients completed therapy, all 37 of whom achieved complete response. The 2-year PFS was 87% (95% CI 71-94) and the overall survival was 92% (78-97). The most common grade 3 or worse adverse events were peripheral sensory neuropathy (four [10%] of 41 patients), neutropenia (18 [44%]), and febrile neutropenia (five [12%]). One treatment-related death was reported, due to infection. INTERPRETATION Brentuximab vedotin-AVD was highly active and had a tolerable adverse event rate in HIV-cHL and is an important therapeutic option for people with HIV-cHL. The complete reponse rate is encouraging and is possibly related to a unique aspect of HIV-cHL biology. Upcoming 5-year data will evaluate the sustainability of the outcomes obtained. FUNDING National Institutes of Health and National Cancer Institute.
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Affiliation(s)
- Paul G Rubinstein
- John H Stroger Jr Hospital of Cook County (Cook County Hospital), Section of Hematology/Oncology, Department of Medicine, Chicago, IL, USA; Ruth M Rothstein CORE Center, Chicago, IL, USA; University of Illinois, Chicago, Section of Hematology/Oncology, Department of Medicine, Chicago, IL, USA.
| | - Page C Moore
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Milan Bimali
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeanette Y Lee
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Amy Chadburn
- Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Lee Ratner
- Washington University School of Medicine, St Louis, MO, USA
| | - David H Henry
- Abramson Cancer Center, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Ethel Cesarman
- Weill Cornell Medical College, Cornell University, New York, NY, USA
| | | | - Dominique Costagliola
- INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, UPMC Univ Paris 06, Sorbonne Universités, Paris, France
| | - Yassine Taoufik
- Faculté de médecine Paris Sud, Université Paris Sud, Le Kremlin-Bicétre, France; Service d'imunologie biologique, Hôpitaux Paris Sud, AP-HP, Le Kremlin-Bicétrse, France
| | - Juan Carlos Ramos
- University of Miami School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Elad Sharon
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Erin G Reid
- Moores Cancer Center, Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | | | - Ronald Mitsuyasu
- University of California Los Angeles, Center for Clinical AIDS Research and Education, Los Angeles, CA, USA
| | | | - Caroline Besson
- CH Versailles, Le Chesnay, France; Inserm U1018, CESP, UVSQ, University Paris-Saclay, Villejuif, France
| | - Ariela Noy
- Weill Cornell Medical College, Cornell University, New York, NY, USA; Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
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Liu Q, Yang T, Chen X, Liu Y. Clinical value of 18F-FDG PET/CT in the management of HIV-associated lymphoma. Front Oncol 2023; 13:1117064. [PMID: 36776334 PMCID: PMC9909962 DOI: 10.3389/fonc.2023.1117064] [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: 12/06/2022] [Accepted: 01/10/2023] [Indexed: 01/27/2023] Open
Abstract
HIV is still a major public health problem. At present, HIV-associated lymphoma remains the leading cause of deaths among people living with HIV, which should be paid more attention to. 18F-fluorodeoxglucose (FDG) PET/CT has been recommended in the initial staging, restaging, response assessment and prognostic prediction of lymphomas in general population. HIV-associated lymphoma is, however, a different entity from lymphoma in HIV-negative with a poorer prognosis. The ability to accurately risk-stratify HIV-infected patients with lymphoma will help guide treatment strategy and improve the prognosis. In the review, the current clinical applications of 18F-FDG PET/CT in HIV-associated lymphoma will be discussed, such as diagnosis, initial staging, response evaluation, prognostic prediction, PET-guided radiotherapy decision, and surveillance for recurrence. Moreover, future perspectives will also be presented.
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Affiliation(s)
- Qi Liu
- Department of Nuclear Medicine, Chongqing University Cancer Hospital, Chongqing, China
| | - Tao Yang
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Xiaoliang Chen
- Department of Nuclear Medicine, Chongqing University Cancer Hospital, Chongqing, China,*Correspondence: Xiaoliang Chen, ; Yao Liu,
| | - Yao Liu
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing, China,*Correspondence: Xiaoliang Chen, ; Yao Liu,
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10
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Fagundes RBC, Delgado de Mederios LG, Barros de Souza AT, Oliveira da Silva MI, Moreira MJB, Villarrim CC, Araújo-Filho I, Medeiros KS. Impact of the HIV infection in Hodgkin lymphoma individuals: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2022; 101:e30765. [PMID: 36181035 PMCID: PMC9524929 DOI: 10.1097/md.0000000000030765] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Hodgkin lymphoma (HL) is a rare lymphoproliferative disorder that occurs in about 10% of all cancer cases. Human immunodeficiency virus (HIV) is associated with an increased occurrence of a wide range of cancers, including HL due to progressive immunosuppression and co-infection with oncogenic viruses. However, the aim of this systematic review is to obtain evidence about the impact of the HIV infection in HL individuals. METHODS We will obtain studies through PubMed, Embase, CINAHL, LILACS, CENTRAL, Web of Science, Scopus, Cochrane Library, and Google Scholar databases. The inclusion criteria will be observational studies (sectional, cohort, and case-control) that describe the impact of the HIV infection in HL individuals. Outcomes of interest include mortality, prevalence, causes of hospitalization, time between HIV diagnosis and HL diagnosis in days, comorbidities (systemic hypertension, diabetes mellitus, metabolic syndrome, others), T CD4 + cells/mm3 at HIV diagnosis and at HL diagnosis, viral load (log10 copies/mL) at HL diagnosis, and history of treatment abandon. Two reviewers, independently, will extract the data from each included study. Meta-analysis will then be carried out using fixed-effects or random-effects model, using the mean difference for continuous outcomes and the relative risk for dichotomous outcomes. Risk of bias will be assessed using the Newcastle-Ottawa Scale. The quality of evidence for each outcome will be assessed using Grading of Recommendations Assessment, Development and Evaluation methodology. Review Manager V.5.3.5 will be used for synthesis and subgroup analysis. To assess heterogeneity, we will compute the I2 statistics. Additionally, a quantitative synthesis will be performed if the included studies are sufficiently homogenous. ETHICS AND DISSEMINATION This study will be a review of the published data, and thus it is not necessary to obtain ethical approval. The findings of this systematic review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42021289520.
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Affiliation(s)
| | | | - Amaxsell Thiago Barros de Souza
- Instituto de Ensino, Pesquisa e Inovação, Liga Contra o Câncer, Natal, Brazil
- Department of Pharmacy, Health Sciences Center, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | | | | | | | - Irami Araújo-Filho
- Department of Medicine, Health Sciences Center, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
- Health Sciences Postgraduate Program, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Kleyton Santos Medeiros
- Instituto de Ensino, Pesquisa e Inovação, Liga Contra o Câncer, Natal, Brazil
- Health Sciences Postgraduate Program, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
- *Correspondence: Kleyton Santos Medeiros, Eliza Branco Pereira dos Santos St., 750, Parnamirim, RN 59158-160, Brazil (e-mail: )
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11
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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] [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)
- Chaoyu Wang
- Department of Hematology-Oncology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Jun Liu
- Department of Hematology-Oncology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - 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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12
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Louarn N, Galicier L, Bertinchamp R, Lussato D, Montravers F, Oksenhendler É, Merlet P, Gérard L, Vercellino L. First Extensive Analysis of 18F-Labeled Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in a Large Cohort of Patients With HIV-Associated Hodgkin Lymphoma: Baseline Total Metabolic Tumor Volume Affects Prognosis. J Clin Oncol 2022; 40:1346-1355. [PMID: 35073166 DOI: 10.1200/jco.21.01228] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE 18F-labeled fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG PET-CT) data in HIV-associated Hodgkin lymphoma (HIV-HL) are scarcely reported. In addition to the description of the characteristics of both baseline and interim 18F-FDG PET-CT examinations (PET1 and iPET, respectively), the aim of this study was to assess the prognostic value of PET1 and previously identified clinical parameters in this population. PATIENTS AND METHODS PET1 of 109 patients with HIV-HL, treated with doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy regimen since 2007, and 104 iPET were centrally reviewed. All the patients were enrolled in an ongoing prospective single-center cohort of HIV-associated lymphoma. RESULTS Most patients had a disseminated disease according to the Ann Arbor classification (30% stage III and 43% stage IV), with especially bone marrow and liver as extranodal localizations. After a median follow-up of 6.7 years, 12 patients relapsed (11%) and 13 died (12%). Five-year progression-free survival (PFS) was 75.1%, and 5-year overall survival was 86.1%. Median total metabolic tumor volume (TMTV) was 121.4 cm3. The optimal TMTV cutoff identified for prognostic analysis was 527 cm3, with a 2-year PFS of 71% in the 20 patients with TMTV > 527 cm3, compared with 91% in the 89 patients with TMTV ≤ 527 cm3 (P = .004). On multivariate analysis, a high TMTV was the only parameter independently associated with PFS. CONCLUSION In this large series of HIV-HL patients with a homogeneous management, high TMTV on PET1 examination was associated with a poor prognosis.
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Affiliation(s)
- Nicolas Louarn
- Service de Médecine Nucléaire, Hôpital Saint-Louis, APHP, Paris, France.,Service de Médecine Nucléaire, Hôpital Henri Mondor, APHP, Créteil, France.,Université Paris-Est Créteil, Créteil, France
| | - Lionel Galicier
- Service d'Immunopathologie Clinique, Hôpital Saint-Louis, APHP, Paris, France.,Service de Médecine Interne, Hôpital Saint-Joseph, Marseille, France
| | - Rémi Bertinchamp
- Service d'Immunopathologie Clinique, Hôpital Saint-Louis, APHP, Paris, France
| | - David Lussato
- Service de Médecine Nucléaire, Centre Cardiologique du Nord, Saint-Denis, France
| | - Françoise Montravers
- Service de Médecine Nucléaire, Hôpital Tenon, APHP, Paris, France.,Sorbonne Université, Paris, France
| | - Éric Oksenhendler
- Service d'Immunopathologie Clinique, Hôpital Saint-Louis, APHP, Paris, France.,Université de Paris, Paris, France
| | - Pascal Merlet
- Service de Médecine Nucléaire, Hôpital Saint-Louis, APHP, Paris, France.,Université de Paris, Paris, France
| | - Laurence Gérard
- Service d'Immunopathologie Clinique, Hôpital Saint-Louis, APHP, Paris, France
| | - Laetitia Vercellino
- Service de Médecine Nucléaire, Hôpital Saint-Louis, APHP, Paris, France.,Université de Paris, INSERM, UMR_S942 MASCOT, F-75006, Paris, France
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13
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Wang F, Xiang P, Zhao H, Gao G, Yang D, Xiao J, Han N, Wu L, Liang H, Ni L, Duan Y, Xu Q, Chen M, Zhang F. A retrospective study of distribution of HIV associated malignancies among inpatients from 2007 to 2020 in China. Sci Rep 2021; 11:24353. [PMID: 34934097 PMCID: PMC8692320 DOI: 10.1038/s41598-021-03672-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 12/06/2021] [Indexed: 01/15/2023] Open
Abstract
HIV-associated malignancies are responsible for morbidity and mortality increasingly in the era of potent antiretroviral therapy. This study aimed to investigate the distribution of HIV-associated malignancies among inpatients, the immunodeficiency and the effect of antiretroviral therapy (ART) on spectrum of HIV-associated malignancies. A total of 438 cases were enrolled from 2007 to 2020 in Beijing Ditan Hospital. Demographic, clinical and laboratory data, managements, and outcomes were collected and analyzed retrospectively. Of 438 cases, 433 were assigned to non-AIDS-defining cancers (NADCs) (n = 200, 45.7%) and AIDS-defining cancers (ADCs) (n = 233, 53.2%), 5 (1.1%) with lymphoma were not specified further. No significant change was observed in the proportion of NADCs and ADCs as time goes on. Of NADCs, lung cancer (n = 38, 19%) was the most common type, followed by thyroid cancer (n = 17, 8.5%). Patients with ADCs had lower CD4 counts(104.5/μL vs. 314/μL), less suppression of HIVRNA(OR 0.23, 95%CI 0.16–0.35) compared to those with NADCs. ART did not affect spectrum of NADCs, but affect that of ADCs (between patients with detectable and undetectable HIVRNA). ADCs remain frequent in China, and NADCs play an important role in morbidity and mortality of HIV positive population.
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Affiliation(s)
- Fang Wang
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Pan Xiang
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongxin Zhao
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Guiju Gao
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Di Yang
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jiang Xiao
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ning Han
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Liang Wu
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongyuan Liang
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Liang Ni
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yujiao Duan
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Qiuhua Xu
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Meiling Chen
- The Medical Statistic Department, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Fujie Zhang
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
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14
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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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15
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Hentrich MU, Bower M, Daugaard G, Dieing A, Bickel M, Berretta M, Lesmeister F, Jurinovic V, Stoehr A, Heinzelbecker J, Krznaric I, Dieckmann KP, Necchi A, Maroto Rey P, Rockstroh JK, Brito M, Pfister D, Hoffmann C. Outcomes of men with HIV and germ cell cancer: Results from an international collaborative study. Cancer 2021; 128:260-268. [PMID: 34592009 DOI: 10.1002/cncr.33928] [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: 06/06/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Previous studies have shown that men with HIV and germ cell cancer (HIV-GCC) have inferior overall survival (OS) in comparison with their HIV-negative counterparts. However, little information is available on treatments and outcomes of HIV-GCC in the era of combination antiretroviral therapy (cART). METHODS This study examined men living with HIV who were 18 years old or older and had a diagnosis of histologically proven germ cell cancer (GCC). The primary outcomes were OS and progression-free survival (PFS). RESULTS Data for 89 men with a total of 92 HIV-GCCs (2 synchronous GCCs and 1 metachronous bilateral GCC) were analyzed; among them were 64 seminomas (70%) and 28 nonseminomas (30%). The median age was 36 years, the median CD4 T-cell count at GCC diagnosis was 420 cells/µL, and 77% of the patients on cART had an HIV RNA load < 500 copies/mL. Stage I disease was found in 44 of 79 gonadal GCCs (56%). Among 45 cases with primary disseminated GCC, 78%, 18%, and 4% were assigned to the good-, intermediate-, and poor-prognosis groups, respectively, of the International Germ Cell Cancer Collaborative Group. Relapses occurred in 14 patients. Overall, 12 of 89 patients (13%) died. The causes of death were refractory GCC (n = 5), an AIDS-defining illness (n = 3), and other causes (n = 4). After a median follow-up of 6.5 years, the 5- and 10-year PFS rates were 81% and 73%, respectively, and the 5- and 10-year OS rates were 91% and 85%, respectively. CONCLUSIONS The 5- and 10-year PFS and OS rates of men with HIV-GCC were similar to those reported for men with HIV-negative GCC. Patients with HIV-GCC should be managed identically to HIV-negative patients. LAY SUMMARY Men living with HIV are at increased risk for germ cell cancer (GCC). Previous studies have shown that the survival of men with HIV-associated germ cell cancer (HIV-GCC) is poorer than the survival of their HIV-negative counterparts. This study examined the characteristics, treatments, and outcomes of 89 men with HIV-GCC in the era of effective combination antiretroviral therapies. The long-term outcomes of men with HIV-GCC were similar to those reported for men with HIV-negative GCC. Patients with HIV-GCC should be managed identically to HIV-negative patients.
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Affiliation(s)
- Marcus Ulrich Hentrich
- Department of Hematology and Oncology, Red Cross Hospital, University of Munich, Munich, Germany
| | - Mark Bower
- National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, United Kingdom
| | - Gedske Daugaard
- Department of Oncology, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Annette Dieing
- Department of Hematology and Oncology, Vivantes Klinikum am Urban, Berlin, Germany
| | | | - Massimiliano Berretta
- National Cancer Institute, Aviano, Italy.,Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Florian Lesmeister
- Department of Hematology and Oncology, Red Cross Hospital, University of Munich, Munich, Germany
| | - Vindi Jurinovic
- Institute of Biometrics and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany
| | | | - Julia Heinzelbecker
- Department of Urology and Pediatric Urology, Saarland University Medical Center and Saarland University, Homburg, Germany
| | | | | | - Andrea Necchi
- IRCCS San Raffaele Hospital and Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Pablo Maroto Rey
- Department of Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Margarida Brito
- Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal
| | - David Pfister
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Christian Hoffmann
- ICH Study Center, Hamburg, Germany.,University Hospital of Schleswig Holstein, Kiel, Germany
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16
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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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17
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Hodgkin Lymphoma in People Living with HIV. Cancers (Basel) 2021; 13:cancers13174366. [PMID: 34503176 PMCID: PMC8430611 DOI: 10.3390/cancers13174366] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 01/24/2023] Open
Abstract
Simple Summary Hodgkin lymphoma (HL) is a non-AIDS defining neoplasm, but people living with HIV (PLWH) have between a 5- and 26-fold higher risk of developing it than the general population. Epstein-Barr virus is present in almost all HIV-related HL cases, and plays an important role in its etiopathogenesis. Despite the aggressive characteristics, the prognosis of HL affecting PLWH is similar to that of the general population if patients are treated following the same recommendations. Administration of cART concomitantly with chemotherapy is highly recommended. However, this combination may be challenging due to drug–drug interactions and overlapping toxicity. Thus, interdisciplinary collaboration between hemato-oncologists and HIV specialists is crucial for the optimal treatment of both lymphoma and HIV infection. Abstract Despite widespread use of combined antiretroviral therapy (cART) and increased life expectancy in people living with HIV (PLWH), HIV-related lymphomas (HRL) remain a leading cause of cancer morbidity and mortality for PLWH, even in patients optimally treated with cART. While the incidence of aggressive forms of non-Hodgkin lymphoma decreased after the advent of cART, incidence of Hodgkin lymphoma (HL) has increased among PLWH in recent decades. The coinfection of Epstein–Barr virus plays a crucial role in the pathogenesis of HL in the HIV setting. Currently, PLWH with HRL, including HL, are treated similarly to HIV-negative patients and, importantly, the prognosis of HL in PLWH is approaching that of the general population. In this regard, effective cART during chemotherapy is strongly recommended since it has been shown to improve survival rates in all lymphoma subtypes, including HL. As a consequence, interdisciplinary collaboration between HIV specialists and hemato-oncologists for the management of potential drug–drug interactions and overlapping toxicities between antiretroviral and antineoplastic drugs is crucial for the optimal treatment of PLWH with HL. In this article the authors review and update the epidemiological, clinical and biological aspects of HL presenting in PLWH with special emphasis on advances in prognosis and the factors that have contributed to it.
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18
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Carbone A, Gloghini A, Serraino D, Spina M, Tirelli U, Vaccher E. Immunodeficiency-associated Hodgkin lymphoma. Expert Rev Hematol 2021; 14:547-559. [PMID: 34044724 DOI: 10.1080/17474086.2021.1935851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Hodgkin lymphoma (HL) can occur in different host conditions, i.e. in the general population and immunocompromised individuals, either during HIV infection or solid organ/hematopoietic transplantation and immunosuppressive drug treatment.Areas covered: Areas covered include multidimensional characteristics of tumor cells and cellular composition of tumor microenvironment of HL. Current conventional treatments and new treatment strategies for HL in immunosuppressed patients, especially in persons living with HIV (PLWH), are also discussed.PubMed and MEDLINE were used for database searches to identify articles in English published from 1989 to 2020.Expert opinion: For people with post-transplant HL or for those with HIV/AIDS-associated HL, standard treatments mirror those in the general population. In the last decade, the combination of cART with anti-neoplastic treatments, alongside with current anti-rejection therapies, has increased long-term survival of people with HL and acquired immune deficiencies. High-dose chemotherapy and autologous stem cell transplantation have been favorably proven as salvage therapy in PLWH with relapsed and refractory HL. Immune checkpoint inhibitors emerged as an area of clinical investigation for relapsed and refractory HL in the general population. Pembrolizumab, an anti-programmed cell death protein 1 (PD-1) drug, resulted safe in PLWH indicating that PD-1 ligand assessment should be advisable in HIV-associated HL.
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Affiliation(s)
- Antonino Carbone
- Pathology, Centro di Riferimento Oncologico (CRO), IRCCS, National Cancer Institute, Aviano, Italy
| | - Annunziata Gloghini
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Diego Serraino
- Epidemiology, Centro di Riferimento Oncologico (CRO), IRCCS, National Cancer Institute, Aviano, Italy
| | - Michele Spina
- Medical Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, National Cancer Institute, Aviano, Italy
| | - Umberto Tirelli
- Medical Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, National Cancer Institute, Aviano, Italy
| | - Emanuela Vaccher
- Medical Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, National Cancer Institute, Aviano, Italy
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19
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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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20
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Hentrich M. [Diagnosis and treatment of HIV-associated lymphoma: Update 202]. Dtsch Med Wochenschr 2021; 146:724-727. [PMID: 34062586 DOI: 10.1055/a-1169-0848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The risk of malignant lymphomas is markedly increased in HIV-infected persons even in the era of effective combination antiretroviral therapy. Major risk factors are the depth of CD4-cell nadir and HIV viremia. R-CHOP remains treatment of choice for diffuse large B-cell lymphoma. In HIV-Burkitt lymphoma CODOX-M/IVAC proved superior to EPOCH in a large retrospective study. Standard treatment for plasmablastic or primary effusion lymphoma has not yet been defined. Favourable results have been reported with a stage adapted treatment for HIV-Hodgkin lymphoma. Patients with relapsed/refractory HIV-lymphoma should undergo autologous stem cell transplantation if indicated. Successful anti-CD19 CAR T-cell therapy was also reported in HIV-infected patients with refractory B-cell lymphoma.
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Affiliation(s)
- Marcus Hentrich
- Rotkreuzklinikum München, Abteilung für Innere Medizin III - Hämatologie/Onkologie, München
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21
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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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Geel JA, Eyal KC, Hendricks MG, Myezo KH, Stones DK, Omar F, Goga Y, van Zyl A, van Emmenes B, Vaithilingum M, Irusen S, Bandini RM, Wedi O, Rowe B, Ballot DE, Metzger ML. Prognostic factors affecting survival in children and adolescents with HIV and Hodgkin lymphoma in South Africa. Leuk Lymphoma 2020; 62:2854-2863. [PMID: 33284043 DOI: 10.1080/10428194.2020.1852472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
South African children with Hodgkin lymphoma (HL) and human immunodeficiency virus (HIV) have low 5-year overall survival (OS) rates. In this retrospective multicenter study, 271 South African pediatric patients with HL were studied to determine OS and prognostic factors in those with HIV and HL. Univariate risk factor analysis was performed to analyze prognostic factors. The 29 HIV-infected patients were younger (p = .021), more likely to present with wasting (0.0573), stunting (0.0332), and Stage IV disease (p = .000) than HIV-uninfected patients. The 5- and 10-year OS of HIV-infected patients of 49% and 45% versus 84% and 79%, respectively for HIV-uninfected patients (p = .0001) appeared to be associated with hypoalbuminemia (<20 g/dL) and CD4 percentage of <15%. Causes of death in the HIV-infected group included disease progression (6/14), infection (4/14), unknown (3/14), and second malignancy (1/14). HIV-infected pediatric patients with HL experience increased mortality due to post-therapy opportunistic and nosocomial infections.
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Affiliation(s)
- Jennifer Ann Geel
- Division of Paediatric Haematology/Oncology, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | | | - Marc Gerald Hendricks
- Division of Paediatric Haematology/Oncology, Faculty of Health Sciences, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Khumo Hope Myezo
- Division of Paediatric Haematology/Oncology, Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - David Kenneth Stones
- Division of Paediatric Haematology/Oncology, Faculty of Health Sciences, University of the Free State, Universitas Hospital, Bloemfontein, South Africa
| | - Fareed Omar
- Division of Paediatric Haematology/Oncology, Faculty of Health Sciences, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
| | - Yasmin Goga
- Division of Paediatric Haematology/Oncology, Faculty of Health Sciences, University of Kwazulu-Natal, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Anel van Zyl
- Division of Paediatric Haematology/Oncology, Faculty of Health Sciences, University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa
| | - Barry van Emmenes
- Division of Paediatric Haematology/Oncology, Walter Sisulu University, Frere Hospital, East London, South Africa
| | | | - Shaegan Irusen
- Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Rossella Marina Bandini
- Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Oloko Wedi
- Division of Paediatric Haematology/Oncology, University of Limpopo, Polokwane-Mankweng Hospital Complex, Polokwane, South Africa
| | - Biance Rowe
- Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Daynia Elizabeth Ballot
- Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Monika L Metzger
- St Jude Children's Research Hospital, University of Tennessee Health Sciences Center, Memphis, TN, USA
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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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Re A, Cattaneo C, Montoto S. Treatment management of haematological malignancies in people living with HIV. LANCET HAEMATOLOGY 2020; 7:e679-e689. [PMID: 32791044 DOI: 10.1016/s2352-3026(20)30115-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/15/2020] [Accepted: 04/06/2020] [Indexed: 01/10/2023]
Abstract
Although the incidence of HIV-associated lymphomas decreased after the introduction of effective combination antiretroviral therapy, they became the most common AIDS-related cancer in high-income countries. Moreover, as people living with HIV live longer, a wide range of non-AIDS-related cancer has emerged, including other haematological malignancies. Nonetheless, combination antiretroviral therapy has offered people with HIV the opportunity to receive the same therapies as those provided to the general population, and intensive curative therapies have become the standard. However, several population-based studies highlight a major health-care disparity between people with HIV and those without, with people who are HIV positive often excluded from using innovative therapies and participating in prospective trials. In addition, patients from low-income countries frequently receive inappropriate treatment. The hope is that with increased awareness of effective curative options these disparities will decrease, and people with HIV will be given the same therapeutic opportunities and enrolled in clinical trials alongside patients who are HIV negative.
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Affiliation(s)
- Alessandro Re
- Department of Hematology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy.
| | - Chiara Cattaneo
- Department of Hematology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Silvia Montoto
- Department of Haemato-Oncology, St Bartholomew's Hospital, London, UK
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Abstract
Cancer is the leading cause of death for HIV-infected persons in economically developed countries, even in the era of antiretroviral therapy (ART). Lymphomas remain a leading cause of cancer morbidity and mortality for HIV-infected patients and have increased incidence even in patients optimally treated with ART. Even limited interruptions of ART can lead to CD4 cell nadirs and HIV viremia, and increase the risk of lymphoma. The treatment of lymphoma is now similar for HIV-infected patients and the general population: patients with good HIV control can withstand intensive therapies appropriate to the lymphoma, including autologous and even allogeneic hematopoietic stem cell transplantation. Nonetheless, HIV-related lymphomas have unique aspects, including differences in lymphoma pathogenesis, driven by the presence of HIV, in addition to coinfection with oncogenic viruses. These differences might be exploited in the future to inform therapies. The relative incidences of lymphoma subtypes also differ in the HIV-infected population, and the propensity to advanced stage, aggressive presentation, and extranodal disease is higher. Other unique aspects include the need to avoid potential interactions between ART and chemotherapeutic agents, and the need for HIV-specific supportive care, such as infection prophylaxis. Despite these specific challenges for cancer treatment in the setting of HIV infection, 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- patients in cancer clinical trials when appropriate.
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Epstein-Barr virus biomarkers have no prognostic value in HIV-related Hodgkin lymphoma in the modern combined antiretroviral therapy era. AIDS 2019; 33:993-1000. [PMID: 30946153 DOI: 10.1097/qad.0000000000002129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Epstein-Barr virus (EBV) has been implicated in lymphomagenesis of HIV-related classical Hodgkin lymphoma (HIV-cHL). The utility of EBV molecular and serological biomarkers has scarcely been examined in HIV-cHL in the recent combined antiretroviral therapy (cART) era. DESIGN We evaluated EBV DNA load and a panel of EBV antibodies in HIV-cHL patients prospectively enrolled in the French ANRS-CO16 Lymphovir cohort between 2008 and 2015. METHODS Pretreatment whole blood, plasma EBV DNA load and serological profiles were analysed in 63 HIV-infected patients diagnosed with cHL. For the 42 patients with available material, comparisons were performed between values at diagnosis and 6 months after the initiation of chemotherapy. RESULTS Pretreatment whole blood and plasma EBV DNA loads were positive in 84 and 59% of HIV-cHL patients, respectively. Two-year progression-free survival estimates did not differ between the patients with pretreatment whole blood (n = 53) or plasma (n = 37) EBV DNA(+) and the patients with pretreatment whole blood (n = 10) or plasma (n = 26) EBV DNA(-) (92 vs. 80% or 89 vs. 92%, P = 0.36 and 0.47, respectively). At diagnosis, 47% of patients harboured an EBV reactivation serological profile. Following chemotherapy, whole blood and plasma EBV DNA levels significantly declined from medians of 1570 [interquartile range, 230-3760) and 73 (0-320) copies/ml to 690 (0-1830) and 0 (0-0) copies/ml, respectively (P = 0.02 and P < 0.0001, respectively]. Anti-EBV IgG antibody level significantly dropped at 6-month follow-up (P = 0.004). CONCLUSION Whole blood and plasma EBV DNA loads do not constitute prognostic markers in HIV-cHL patients in the modern cART era.
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Hiv and Lymphoma: from Epidemiology to Clinical Management. Mediterr J Hematol Infect Dis 2019; 11:e2019004. [PMID: 30671210 PMCID: PMC6328036 DOI: 10.4084/mjhid.2019.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/23/2018] [Indexed: 01/19/2023] Open
Abstract
Patients infected with human immunodeficiency virus (HIV) are at increased risk for developing both non-Hodgkin’s lymphoma (NHL) and Hodgkin’s lymphoma (HL). Even if this risk has decreased for NHL after the introduction of combination antiretroviral therapy (cART), they remain the most common acquired immune deficiency syndrome (AIDS)-related cancer in the developed world. They are almost always of B-cell origin, and some specific lymphoma types are more common than others. Some of these lymphoma types can occur in both HIV-uninfected and infected patients, while others preferentially develop in the context of AIDS. HIV-associated lymphoma differs from lymphoma in the HIV negative population in that they more often present with advanced disease, systemic symptoms, and extranodal involvement and are frequently associated with oncogenic viruses (Epstein-Barr virus and/or human herpesvirus-8). Before the introduction of cART, most of these patients could not tolerate the treatment strategies routinely employed in the HIV-negative population. The widespread use of cART has allowed for the delivery of full-dose and dose-intensive chemotherapy regimens with improved outcomes that nowadays can be compared to those seen in non-HIV infected patients. However, a great deal of attention should be paid to opportunistic infections and other infectious complications, cART-chemotherapy interactions, and potential cumulative toxicity. In the context of relatively sparse prospective and randomized trials, the optimal treatment of AIDS-related lymphomas remains a challenge, particularly in patients with severe immunosuppression. This paper will address epidemiology, pathogenesis, and therapeutic strategies in HIV-associated NHL and HL.
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Hodgkin lymphoma at Groote Schuur Hospital, South Africa: the effect of HIV and bone marrow infiltration. Ann Hematol 2018; 98:381-389. [PMID: 30397846 DOI: 10.1007/s00277-018-3533-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/19/2018] [Indexed: 12/14/2022]
Abstract
Human immunodeficiency virus (HIV) is associated with an increased risk of developing Hodgkin lymphoma (HL). South Africa (SA) has the highest HIV prevalence rate in the world. There is currently no outcome-based data for HIV-associated HL from SA. A bone marrow database was compiled of all bone marrow biopsies (BMB) reported at National Health Laboratory Service (NHLS) Groote Schuur Hospital (GSH) between January 2005 and December 2012. Patients who had a BMB performed for staging of HL or where HL was diagnosed on the BMB were included for further analysis. Clinical and laboratory data was extracted from medical and laboratory records. Primary outcome measures included histological subtype, bone marrow infiltration (BMI) by HL, CD4 count, HIV-viral load (HIV-VL), tuberculosis (TB) data, treatment with chemotherapy and 5-year overall survival (OS). The database included 6569 BMB and 219 patients of these had HL and were included for analysis. The median age at presentation (32 years) was similar in the HIV+ and HIV- populations. While males predominated in the HIV- group, females predominated in the HIV+ group (male:female ratio of 1.5:1 vs 0.7:1, respectively). The majority of patients (71%) were HIV negative (HIV-) and 29% were HIV positive (HIV+). The diagnosis of HL was made on BMB in 17% of cases. BMI was seen in 37% (82/219) overall, and was found in more HIV+ patients (61%; 39/64) than HIV- patients (28%; 43/155; p = 0.03). The histological subtype varied according to HIV status with nodular sclerosis classical Hodgkin lymphoma (NSCHL) being most frequent in the HIV- group and classical Hodgkin lymphoma (CHL)-unclassifiable the most frequent in the HIV+ group. HIV+ patients had a median CD4 count of 149 × 106/L and 39% were anti-retroviral therapy (cART) naive at HL diagnosis. HIV+ patients had received anti-TB therapy more frequently than HIV- patients (72% vs 17%; p = 0.007). More HIV+ patients did not receive chemotherapy than HIV- patients (31% vs 3%; p = 0.001). The 5-year OS was 56%. HIV+ patients with BMI had a 5-year OS of 18%. BMI, HIV status, low CD4 count, histological subtype and TB therapy had a statistical significant impact on 5-year OS (p < 0.01). The 5-year OS was 56%, with both BMI and HIV+ status being associated with poor survival. BMB provided the diagnosis of HL in 17% of cases, confirming its diagnostic utility in our setting. Our cohort showed similar survival outcomes to other countries in Africa, Asia and Central America with comparable socio-economic constraints to SA.
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18F-FDG-PET metabolic metrics and International Prognostic Score for risk assessment in HIV-infected patients with Hodgkin lymphoma. Nucl Med Commun 2018; 39:1005-1012. [DOI: 10.1097/mnm.0000000000000905] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Lupo J, Germi R, Costagliola D, Morand P, Besson C. Utility of Epstein-Barr Virus Biomarkers in Human Immunodeficiency Virus–related Lymphomas in the Modern Combined Antiretroviral Therapy Era. Clin Infect Dis 2018; 68:891-892. [DOI: 10.1093/cid/ciy786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Julien Lupo
- Institut de Biologie Structurale, Commissariat à l’Énergie Atomique, Centre National de la Recherche Scientifique, Université Grenoble-Alpes, and Laboratoire de Virologie, Centre hospitalier Universitaire Grenoble-Alpes
| | - Raphaële Germi
- Institut de Biologie Structurale, Commissariat à l’Énergie Atomique, Centre National de la Recherche Scientifique, Université Grenoble-Alpes, and Laboratoire de Virologie, Centre hospitalier Universitaire Grenoble-Alpes
| | - Dominique Costagliola
- Institut national de la santé et de la recherche médicale (INSERM), Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris
| | - Patrice Morand
- Institut de Biologie Structurale, Commissariat à l’Énergie Atomique, Centre National de la Recherche Scientifique, Université Grenoble-Alpes, and Laboratoire de Virologie, Centre hospitalier Universitaire Grenoble-Alpes
| | - Caroline Besson
- Unité d’Hémato-Oncologie, Centre Hospitalier de Versailles, Le Chesnay
- Université Versailles Saint Quentin en Yvelines, Université Paris-Saclay
- Centre for Research in Epidemiology and Population Health, INSERM Unit 1018, Villejuif, France
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Meister A, Hentrich M, Wyen C, Hübel K. Malignant lymphoma in the HIV-positive patient. Eur J Haematol 2018; 101:119-126. [PMID: 29663523 DOI: 10.1111/ejh.13082] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2018] [Indexed: 12/27/2022]
Abstract
The introduction of combination antiretroviral therapy (cART) drastically improved performance status, immune function, and life expectancy of HIV-infected individuals. In addition, incidence of opportunistic infections and of AIDS-defining malignancies declined. Nevertheless, aggressive non-Hodgkin's lymphoma still remains the leading cause of AIDS-related deaths. The availability of cART, however, significantly improved the therapeutic options for HIV-positive patients with lymphomas. Diffuse large B-cell lymphoma, Burkitt's lymphoma, or Hodgkin lymphoma has increasingly become curable diseases. In light of these favorable developments in the treatment of HIV and HIV-associated lymphomas, reduction in treatment-associated toxicities and further improvement of outcome of patients with advanced immune suppression are major requirements for future clinical trials. This review summarizes the current treatment landscape and gives an overview on future needs in HIV-positive patients with lymphoma.
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Affiliation(s)
- Anne Meister
- Department of Medicine I, University Hospital of Cologne, Cologne, Germany
| | - Marcus Hentrich
- Department of Medicine III, Red Cross Hospital Munich, Munich, Germany
| | - Christoph Wyen
- Department of Medicine I, University Hospital of Cologne, Cologne, Germany.,Praxis am Ebertplatz, Cologne, Germany
| | - Kai Hübel
- Department of Medicine I, University Hospital of Cologne, Cologne, Germany
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Brentuximab vedotin with AVD shows safety, in the absence of strong CYP3A4 inhibitors, in newly diagnosed HIV-associated Hodgkin lymphoma. AIDS 2018; 32:605-611. [PMID: 29280762 DOI: 10.1097/qad.0000000000001729] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Brentuximab vedotin is a Food and Drug Administration approved anti-CD30 antibody drug conjugate potently active in Hodgkin lymphoma. Trials of brentuximab vedotin with doxorubicin, vinblastine, and dacarbazine (AVD-BV) excluded patients with HIV. We studied the safety of AVD-BV in newly diagnosed HIV-associated classical Hodgkin lymphoma . DESIGN AND METHODS Patients diagnosed with stage II-IV HIV-associated classical Hodgkin lymphoma received AVD-BV on days 1 and 15 every 28 days for six cycles. Anti-HIV medications with strong CYP3A4 inhibition were excluded. This phase 1 trial followed a 3+3 dose de-escalation design started with brentuximab vedotin at 1.2 mg/kg with standard dosing of AVD. Dose-limiting toxicities were defined in cycle one. RESULTS Seven patients were enrolled with six being evaluable: five of six stage III/IV, three with an international prognostic score at least 4. With no dose-limiting toxicities identified, all six were treated at the 1.2 mg/kg dose. Only five grade (G) three nonhematological adverse events were noted in three patients: pulmonary infection, diarrhea, and peripheral neuropathy. No G4/5 adverse events occurred. PET/computer tomography was negative in five of six after cycle 2 and six of six post therapy. Progression-free survival was 100% at 25 months with all patients in remission. One patient was deemed ineligible for taking ritonavir, a strong CYP3A4 inhibitor, but developed G3/4 adverse events including febrile neutropenia, and pancreatitis and though consented was excluded from all evaluation. CONCLUSION AVD-BV was well tolerated at recommended phase 2 dose of 1.2 mg/kg. Concurrent strong CYP3A4 inhibitors should be avoided. A phase 2 study of AVD-BV is currently enrolling (NCT01771107).
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Miralles P, Navarro JT, Berenguer J, Gómez Codina J, Kwon M, Serrano D, Díez-Martín JL, Villà S, Rubio R, Menárguez J, Ribera Santasusana JM. GESIDA/PETHEMA recommendations on the diagnosis and treatment of lymphomas in patients infected by the human immunodeficiency virus. Med Clin (Barc) 2018; 151:39.e1-39.e17. [PMID: 29357988 DOI: 10.1016/j.medcli.2017.11.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/21/2017] [Accepted: 11/02/2017] [Indexed: 01/20/2023]
Abstract
The incidence of non-Hodgkin's lymphoma and Hodgkin's lymphoma is higher in patients with HIV infection than in the general population. Following the introduction of combination antiretroviral therapy (cART), the prognostic significance of HIV-related variables has decreased, and lymphoma-related factors have become more pronounced. Currently, treatments for lymphomas in HIV-infected patients do not differ from those used in the general population. However, differentiating characteristics of seropositive patients, such as the need for cART and specific prophylaxis and treatment of certain opportunistic infections, should be considered. This document updates recommendations on the diagnosis and treatment of lymphomas in HIV infected patients published by GESIDA/PETHEMA in 2008.
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Affiliation(s)
- Pilar Miralles
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España.
| | - José Tomás Navarro
- Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autónoma de Barcelona, Badalona, Barcelona, España
| | - Juan Berenguer
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | | | - Mi Kwon
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - David Serrano
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - José Luis Díez-Martín
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - Salvador Villà
- Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autónoma de Barcelona, Badalona, Barcelona, España
| | | | - Javier Menárguez
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España
| | - José-María Ribera Santasusana
- Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autónoma de Barcelona, Badalona, Barcelona, España
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Hoffmann C. [In Process Citation]. MMW Fortschr Med 2018; 157 Suppl 2:23-6. [PMID: 26048116 DOI: 10.1007/s15006-015-3162-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Christian Hoffmann
- Infektionsmedizinisches Centrum Hamburg, Glockengiesserwall 1, D-20095, Hamburg, Deutschland,
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Oishi N, Bagán JV, Javier K, Zapater E. Head and Neck Lymphomas in HIV Patients: a Clinical Perspective. Int Arch Otorhinolaryngol 2017; 21:399-407. [PMID: 29018505 PMCID: PMC5629092 DOI: 10.1055/s-0036-1597825] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 10/31/2016] [Indexed: 12/13/2022] Open
Abstract
Introduction Because of the many HIV-related malignancies, the diagnosis and treatment of lymphoma in patients infected with human immunodeficiency virus are challenging. Objective Here, we review current knowledge of the pathogenesis, epidemiology, symptomatology, diagnosis, and treatment of head and neck lymphomas in HIV patients from a clinical perspective. Data Synthesis Although Hodgkin's lymphoma is not an AIDS-defining neoplasm, its prevalence is ten times higher in HIV patients than in the general population. NHL is the second most common malignancy in HIV patients, after Kaposi's sarcoma. In this group of patients, NHL is characterized by rapid progression, frequent extranodal involvement, and a poor outcome. HIV-related salivary gland disease is a benign condition that shares some features with lymphomas and is considered in their differential diagnosis. Conclusion The otolaryngologist may be the first clinician to diagnose head and neck lymphomas. The increasing survival of HIV patients implies clinical and epidemiological changes in the behavior of this disease. Early diagnosis is important to improve the prognosis and avoid the propagation of HIV infection.
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Affiliation(s)
- Natsuki Oishi
- ENT Department, Consorci Hospital General Universitari de Valencia, Valencia, Spain
- ENT Department, Universitat de Valencia Facultat de Medicina i Odontologia, Valencia, Comunitat Valenciana, Spain
| | - José Vicente Bagán
- Department of Stomatology, Consorci Hospital General Universitari de Valencia, Valencia, Comunitat Valenciana, Spain
| | - Karla Javier
- Department of Haematology, Consorci Hospital General Universitari de Valencia, Valencia, Comunitat Valenciana, Spain
| | - Enrique Zapater
- ENT Department, Consorci Hospital General Universitari de Valencia, Valencia, Spain
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Vogt SL, Patel M, Omar T, Pather S, Martinson N, Ambinder R. Molecular Diagnostics for AIDS Lymphoma Diagnosis in South Africa and the Potential for Other Low- and Middle-Income Countries. J Glob Oncol 2017; 4:1-6. [PMID: 30241211 PMCID: PMC6180762 DOI: 10.1200/jgo.17.00043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Samantha L Vogt
- Samantha L. Vogt and Richard Ambinder, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Moosa Patel, Tanvier Omar, and Sugeshnee Pather, University of the Witwatersrand, Johannesburg; and Neil Martinson, Perinatal HIV Research Unit, Soweto, South Africa
| | - Moosa Patel
- Samantha L. Vogt and Richard Ambinder, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Moosa Patel, Tanvier Omar, and Sugeshnee Pather, University of the Witwatersrand, Johannesburg; and Neil Martinson, Perinatal HIV Research Unit, Soweto, South Africa
| | - Tanvier Omar
- Samantha L. Vogt and Richard Ambinder, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Moosa Patel, Tanvier Omar, and Sugeshnee Pather, University of the Witwatersrand, Johannesburg; and Neil Martinson, Perinatal HIV Research Unit, Soweto, South Africa
| | - Sugeshnee Pather
- Samantha L. Vogt and Richard Ambinder, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Moosa Patel, Tanvier Omar, and Sugeshnee Pather, University of the Witwatersrand, Johannesburg; and Neil Martinson, Perinatal HIV Research Unit, Soweto, South Africa
| | - Neil Martinson
- Samantha L. Vogt and Richard Ambinder, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Moosa Patel, Tanvier Omar, and Sugeshnee Pather, University of the Witwatersrand, Johannesburg; and Neil Martinson, Perinatal HIV Research Unit, Soweto, South Africa
| | - Richard Ambinder
- Samantha L. Vogt and Richard Ambinder, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Moosa Patel, Tanvier Omar, and Sugeshnee Pather, University of the Witwatersrand, Johannesburg; and Neil Martinson, Perinatal HIV Research Unit, Soweto, South Africa
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The role of F-18 FDG PET/CT in evaluating the impact of HIV infection on tumor burden and therapy outcome in patients with Hodgkin lymphoma. Eur J Nucl Med Mol Imaging 2017; 44:2025-2033. [PMID: 28660348 DOI: 10.1007/s00259-017-3766-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/21/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND To evaluate the impact of HIV infection on tumor burden and therapy outcome following treatment with chemotherapy in patients with Hodgkin lymphoma. METHODS A total of 136 patients with classical Hodgkin lymphoma were studied (mean age ± SD = 32.31 ± 1.39 years, male = 86, female = 50). Advanced disease (stage III and IV) was present in 64% of patients. HIV infection was present in 57 patients while 79 patients were HIV-negative. Baseline F-18 FDG PET/CT was obtained in all patients. SUVmax, MTV and TLG were determined on the baseline scan to evaluate for tumor burden. All patients completed a standard regimen of adriamycin, bleomycin, vinblastine and dacarbazine (ABVD). After a median period of 8 weeks (range = 6 to 17 weeks), a repeat F-18 FDG PET/CT scan was obtained to evaluate response to therapy using Deauville 5-point scoring system. RESULTS The HIV-positive and HIV-negative groups were similar with regards to age and disease stage. The groups were heterogeneous with respect to gender (p = 0.029). The SUVmax, MTV and TLG of lesions were not significant different between the two groups. Complete response was seen in 72.8% of the study population. Presence of HIV infection was associated with higher rate of treatment failure with 40.4% of the HIV-positive patients having treatment failure while only 17.7% of the HIV-negative patients had treatment failure (p = 0.0034). HIV infection was a significant predictor of response to chemotherapy. Effects of SUVmax, MTV, TLG and Ann Arbor stage of the disease were not statistically significant as predictors of therapy outcome. In a multiple logistic regression, presence of HIV infection still remained an independent predictor of therapy outcome in the presence of other factors such as SUVmax, MTV, TLG and the Ann Arbor stage of the disease. CONCLUSIONS HIV infection is not associated with a higher tumor burden in patients with Hodgkin lymphoma. HIV infection is, however, a strong predictor of poor therapy outcome in patients treated with standard regimen of ABVD.
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Abstract
OBJECTIVE Classical Hodgkin lymphoma (cHL) is a non-AIDS-defining cancer with a good response to chemotherapy in the combined antiretroviral therapy (cART) era. The aim of the present study was to compare the characteristics, the response to treatment and the survival of advanced-stage cHL treated with adriamycin, bleomycin, vinblastine and dacarbazine (ABVD) between cART-treated HIV-positive and HIV-negative patients. DESIGN AND METHODS We retrospectively analyzed advanced-stage cHL patients from a single institution, uniformly treated with ABVD. All HIV-positive patients received cART concomitantly with ABVD. RESULTS A total of 69 patients were included in the study: 21 were HIV-positive and 48 were HIV-negative. HIV-positive patients had more aggressive features at cHL diagnosis, such as worse performance status, more frequent bone marrow involvement and mixed cellularity histologic subtype. There were no differences in complete response rate (89% in HIV-positive vs. 91% in HIV-negative), P = 1; disease-free survival (DFS) [10-year DFS probability (95% CI) 70% (41-99%) vs. 74% (57-91%)], P = 0.907 and overall survival (OS) [10-year OS probability (95% CI) 73% (52-94%) vs. 68% (51-85%)], P = 0.904. On multivariate analysis, HIV infection did not correlate with worse OS. CONCLUSION Although HIV-positive patients with cHL had more aggressive baseline features in this series, there were no differences in response rate or survival between HIV-positive and HIV-negative patients.
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Westmoreland KD, Stanley CC, Montgomery ND, Kaimila B, Kasonkanji E, El-Mallawany NK, Wasswa P, Mtete I, Butia M, Itimu S, Chasela M, Mtunda M, Chikasema M, Makwakwa V, Kampani C, Dhungel BM, Sanders MK, Krysiak R, Tomoka T, Liomba NG, Dittmer DP, Fedoriw Y, Gopal S. Hodgkin lymphoma, HIV, and Epstein-Barr virus in Malawi: Longitudinal results from the Kamuzu Central Hospital Lymphoma study. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26302. [PMID: 27781380 PMCID: PMC5529120 DOI: 10.1002/pbc.26302] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/07/2016] [Accepted: 09/19/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Contemporary descriptions of classical Hodgkin lymphoma (cHL) are lacking from sub-Saharan Africa where human immunodeficiency virus (HIV) and Epstein-Barr virus (EBV) are prevalent. METHODS We describe a prospective cHL cohort in Malawi enrolled from 2013 to 2015. Patients received standardized treatment and evaluation, including HIV status and EBV testing of tumors and plasma. RESULTS Among 31 patients with confirmed cHL, the median age was 19 years (range, 2-51 years) and 22 (71%) were male. Sixteen patients (52%) had stage III/IV, 25 (81%) B symptoms, and 16 (52%) performance status impairment. Twenty-three patients (74%) had symptoms >6 months, and 11 of 29 (38%) had received empiric antituberculosis treatment. Anemia was common with median hemoglobin 8.2 g/dL (range, 3.1-17.1 g/dL), which improved during treatment. No children and 5 of 15 adults (33%) were HIV+. All HIV+ patients were on antiretroviral therapy for a median 15 months (range, 2-137 months), with median CD4 count 138 cells/μL (range, 23-329 cells/μL) and four (80%) having undetectable HIV. EBV was present in 18 of 24 (75%) tumor specimens, including 14 of 20 (70%) HIV- and 4 of 4 (100%) HIV+. Baseline plasma EBV DNA was detected in 25 of 28 (89%) patients, with median viral load 4.7 (range, 2.0-6.7) log10 copies/mL, and subsequently declined in most patients. At 12 months, overall survival was 75% (95% confidence interval [CI], 55%-88%) and progression-free survival 65% (95% CI, 42%-81%). Baseline plasma EBV DNA and persistent viremia during treatment were associated with poorer outcomes. CONCLUSION cHL in Malawi is characterized by delayed diagnosis and advanced disease. Most cases were EBV associated and one-third of adults were HIV+. Despite resource limitations, 12-month outcomes were good.
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Affiliation(s)
- Katherine D. Westmoreland
- UNC Project-Malawi, Lilongwe, Malawi
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | | | - Nathan D. Montgomery
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina
| | | | | | | | - Peter Wasswa
- Section of Hematology/Oncology, Texas Children’s Hospital, Houston, Texas
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Idah Mtete
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Mercy Butia
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | | | - Mary Chasela
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Mary Mtunda
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | | | | | | | | | - Marcia K. Sanders
- Department of Microbiology & Immunology, University of North Carolina, Chapel Hill, North Carolina
| | | | | | | | - Dirk P. Dittmer
- UNC Project-Malawi, Lilongwe, Malawi
- Department of Microbiology & Immunology, University of North Carolina, Chapel Hill, North Carolina
| | - Yuri Fedoriw
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Satish Gopal
- UNC Project-Malawi, Lilongwe, Malawi
- Department of Medicine, University of Malawi College of Medicine, Blantyre, Malawi
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
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Danilov AV, Li H, Press OW, Shapira I, Swinnen LJ, Noy A, Reid E, Smith SM, Friedberg JW. Feasibility of interim positron emission tomography (PET)-adapted therapy in HIV-positive patients with advanced Hodgkin lymphoma (HL): a sub-analysis of SWOG S0816 Phase 2 trial. Leuk Lymphoma 2017; 58:461-465. [PMID: 27386786 PMCID: PMC5130311 DOI: 10.1080/10428194.2016.1201573] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 05/31/2016] [Accepted: 06/05/2016] [Indexed: 01/20/2023]
Affiliation(s)
| | - Hongli Li
- SWOG Statistical Center, Seattle, WA
| | | | - Ilan Shapira
- Mount Sinai Beth Israel Medical Center, New York, NY
| | | | - Ariela Noy
- Memorial Sloan Kettering Cancer Center and Weill-Cornell Medical College, New York, NY
| | - Erin Reid
- University of California at San Diego Moores Cancer Center, La Jolla, CA
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Malignancies in HIV-Infected and AIDS Patients. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1018:167-179. [PMID: 29052137 DOI: 10.1007/978-981-10-5765-6_10] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Currently, HIV infection and AIDS are still one of the most important epidemic diseases around the world. As early in the initial stage of HIV epidemic, the high incidence of ADCs including Kaposi sarcoma and non-Hodgkin's lymphoma was the substantial amount of disease burden of HIV infection and AIDS. With the increasing accessibility of HAART and improving medical care for HIV infection and AIDS, AIDS-related illness including ADCs has dramatically decreased. Meanwhile, the incidence of NADCs rises in PLWH. Compared with the general population, most of cancers are more likely to attack PLWH, and NADCs in PLWH were characterized as earlier onset and more aggressive. However, the understanding for cancer development in PLWH is still dimness. Herein, we reviewed the current knowledge of epidemiology and pathogenesis for malignancies in PLWH summarized from recent studies. On the basis of that, we discussed the special considerations for cancer treatment in PLWH. As those malignancies could be the major issue for HIV infection or AIDS in the future, we expect enhanced investigations, surveillances, and clinical trial for improving the understanding and management for cancers developed in PLWH.
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Hoffmann C. Neoplastic Disease. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00097-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Berretta M, Di Francia R, Stanzione B, Facchini G, LLeshi A, De Paoli P, Spina M, Tirelli U. New treatment strategies for HIV-positive cancer patients undergoing antiblastic chemotherapy. Expert Opin Pharmacother 2016; 17:2391-2403. [PMID: 27771974 DOI: 10.1080/14656566.2016.1252332] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The introduction of Highly Active Antiretroviral Therapy (HAART) into clinical practice has dramatically changed the outcome of HIV-infected patients by prolonging their survival. The increase in life expectancy has led to an increased risk of non-AIDS-related mortality and morbidity, including cardiovascular diseases, neurocognitive diseases, neuroendocrine dysfunctions and cancer. Areas covered: The GICAT (Italian Cooperation Group on AIDS and Tumors) has demonstrated that patients who receive a multidisciplinary approach with the combination of anticancer agents (AC) and HAART can achieve better responses and survival rates than patients who receive AC alone. The first obstacle for the oncologist to plan treatment for cancer HIV-patients is the preliminary evaluation of drug-drug interactions between AC and HAART. Recent progress in pharmacogenomics could provide a new approach for personalized treatments. The rationale of this review is to summarize the existing data on the impact of HAART on the clinical management of cancer patients with HIV/AIDS and DDIs between antiretrovirals and AC. In addition, to maximize the efficacy of both concomitant therapy and to minimize the risk of DDIs, a currently useful list of pharmacogenomic markers of key metabolic enzymes is provided. Expert opinion: In this scenario, the importance of cooperation between oncologists and other health specialists (i.e., infectivologists, pharmacists, genetics and lab specialists) must not be underestimated in the management of these patients with the aim of planning an individual treatment strategy.
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Affiliation(s)
| | - Raffaele Di Francia
- b Hematology-Oncology and Stem Cell Transplantation Unit , National Cancer Institute, Fondazione 'G. Pascale' IRCCS , Naples , Italy
| | - Brigida Stanzione
- a Department of Medical Oncology , National Cancer Institute , Aviano , Italy
| | - Gaetano Facchini
- c Division of Medical Oncology, Department of Uro-Gynecological Oncology , Istituto Nazionale Tumori 'Fondazione G. Pascale' - IRCCS , Naples , Italy
| | - Arben LLeshi
- a Department of Medical Oncology , National Cancer Institute , Aviano , Italy
| | - Paolo De Paoli
- d Scientific Directorate , National Cancer Institute , Aviano , Italy
| | - Michele Spina
- a Department of Medical Oncology , National Cancer Institute , Aviano , Italy
| | - Umberto Tirelli
- a Department of Medical Oncology , National Cancer Institute , Aviano , Italy
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Han X, Jemal A, Hulland E, Simard EP, Nastoupil L, Ward E, Flowers CR. HIV Infection and Survival of Lymphoma Patients in the Era of Highly Active Antiretroviral Therapy. Cancer Epidemiol Biomarkers Prev 2016; 26:303-311. [PMID: 27756777 DOI: 10.1158/1055-9965.epi-16-0595] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/29/2016] [Accepted: 10/12/2016] [Indexed: 11/16/2022] Open
Abstract
Background: Highly active antiretroviral therapy (HAART) has extended the life expectancy of patients with HIV/AIDS to approach that of the general population. However, it remains unclear whether HIV infection affects the survival of patients with lymphoma in the HAART era.Methods: Patients diagnosed with Hodgkin lymphoma, diffuse large B-cell lymphoma (DLBCL), Burkitt lymphoma, peripheral T-cell lymphoma (PTCL), or follicular lymphoma during 2004-2011 were identified from the National Cancer Database. Survival analyses were conducted, where each HIV-infected patient was propensity score matched to a HIV-uninfected patient on the basis of demographic factors, clinical features, and treatment characteristics.Results: Among 179,520 patients, the prevalence of HIV-infection ranged from 1.0% for follicular lymphoma, 3.3% for PTCL, 4.7% for Hodgkin lymphoma, 5.4% for DLBCL, to 29% for Burkitt lymphoma. HIV infection was significantly associated with inferior overall survival for patients with each lymphoma subtype: Hodgkin lymphoma [HR, 1.47; 95% confidence interval (CI), 1.25-1.74], DLBCL (HR, 1.95; 95% CI, 1.80-2.11), Burkitt lymphoma (HR, 1.46; 95% CI, 1.24-1.73), PTCL (HR, 1.43; 95% CI, 1.14-1.79), and follicular lymphoma (HR, 1.44; 95% CI, 1.04-2.00).Conclusions: HIV/AIDS continues to be independently associated with increased risk of death among patients with lymphoma in the HAART era in the United States, and the association varies by lymphoma histologic subtype.Impact: Examination of effective management strategies for patients with HIV/AIDS-associated lymphoma and enrollment of patients in prospective clinical trials are needed to improve patient outcomes. Cancer Epidemiol Biomarkers Prev; 26(3); 303-11. ©2016 AACR.
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Affiliation(s)
- Xuesong Han
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia.
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Erin Hulland
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia.,Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Edgar P Simard
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Loretta Nastoupil
- Winship Cancer Institute, Emory University, Atlanta, Georgia.,University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth Ward
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
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Serrano-Villar S, Gutiérrez F, Miralles C, Berenguer J, Rivero A, Martínez E, Moreno S. Human Immunodeficiency Virus as a Chronic Disease: Evaluation and Management of Nonacquired Immune Deficiency Syndrome-Defining Conditions. Open Forum Infect Dis 2016; 3:ofw097. [PMID: 27419169 PMCID: PMC4943534 DOI: 10.1093/ofid/ofw097] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/29/2016] [Indexed: 12/17/2022] Open
Abstract
In the modern antiretroviral therapy (ART) era, motivated people living with human immunodeficiency virus (HIV) who have access to therapy are expected to maintain viral suppression indefinitely and to receive treatment for decades. Hence, the current clinical scenario has dramatically shifted since the early 1980s, from treatment and prevention of opportunistic infections and palliative care to a new scenario in which most HIV specialists focus on HIV primary care, ie, the follow up of stable patients, surveillance of long-term toxicities, and screening and prevention of age-related conditions. The median age of HIV-infected adults on ART is progressively increasing. By 2030, 3 of every 4 patients are expected to be aged 50 years or older in many countries, more than 80% will have at least 1 age-related disease, and approximately one third will have at least 3 age-related diseases. Contemporary care of HIV-infected patients is evolving, and questions about how we might monitor and perhaps even treat HIV-infected adults have emerged. Through key published works, this review briefly describes the most prevalent comorbidities and age-associated conditions and highlights the differential features in the HIV-infected population. We also discuss the most critical aspects to be considered in the care of patients with HIV for the management and prevention of age-associated disease.
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Affiliation(s)
- Sergio Serrano-Villar
- Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria and Universidad de Alcalá , Madrid
| | - Félix Gutiérrez
- Hospital Universitario de Elche and Universidad Miguel Hernández , Alicante
| | | | - Juan Berenguer
- Juan Berenguer , Hospital Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón , Madrid
| | - Antonio Rivero
- Unidad de Gestión Clínica Enfermedades Infecciosas , Hospital Universitario Reina Sofía and Instituto Maimónides de Investigación Biomédica de Córdoba
| | - Esteban Martínez
- Hospital Clínic and Instituto de Investigaciones Biomédicas August Pi i Sunyer, University of Barcelona , Spain
| | - Santiago Moreno
- Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria and Universidad de Alcalá , Madrid
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Abstract
HIV is associated with an excess risk for lymphoid malignancies. Although the risk of lymphoma has decreased in HIV-infected individuals in the era of effective combination antiretroviral therapy, it remains high. Treatment outcomes have improved due to improvements in HIV and cancer therapeutics for the common HIV-associated lymphomas. R-CHOP/R-EPOCH are the standard of care for HIV-associated diffuse large B-cell lymphoma. HIV-infected patients with Burkitt lymphoma and good performance status should receive dose-intensive regimens. HIV-infected patients with primary central nervous system lymphoma can respond favorably to high-dose methotrexate-based therapy. In many cases, treatment and expected outcomes for HIV-infected patients with either Hodgkin or non-Hodgkin's lymphomas are very similar to HIV-negative patients. There is currently no standard treatment for HIV-associated multicentric Castleman disease or primary effusion lymphoma. For those hematologic cancers in which transplantation is part of standard care, this modality should be considered an option in those with well-controlled HIV infection.
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Affiliation(s)
- Chia-Ching J Wang
- a Division of Hematology/Oncology , San Francisco General Hospital , San Francisco , CA , USA
| | - Lawrence D Kaplan
- b Division of Hematology/Oncology, Helen Diller Comprehensive Cancer Center , University of California , San Francisco , CA , USA
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CD4+ and CD8+ T-cell kinetics in aviremic HIV-infected patients developing Hodgkin or non-Hodgkin lymphoma. AIDS 2016; 30:753-60. [PMID: 26605513 DOI: 10.1097/qad.0000000000000980] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The risk of non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) is increased in HIV-infected individuals. We studied the kinetics of lymphocyte subsets in patients who subsequently developed HL or NHL while on virologically suppressive antiretroviral therapy (ART). DESIGN Using a nested case-control design, cases of HIV+ HL or NHL were selected from two prospective clinical studies. Aviremia was defined as less than 200 HIV-RNA copies/ml for at least 6 months prior to lymphoma diagnosis. Each case was matched to three aviremic HIV+ controls without lymphoma. RESULTS In the 81 cases (50 HL and 31 NHL), prediagnostic CD4 T cells and CD8 T cells displayed discordant kinetics compared with controls. Within the last and within the next-to-last year preceding HL diagnosis, mean CD4 T cells decreased by -168 and by -2 cells/μl, compared with an increase of +44 and +73 cells/μl in the controls, respectively. Mean CD8 T cells decreased by -352 and -115 cells/μl, compared with nonsignificant changes of -29 and ±0 cells/μl in the controls, respectively. T-cell kinetics demonstrated a marked inter-individual variability. Kinetics of CD4 and CD8 T cells were also discordant between NHL cases and controls. CONCLUSION This study on a large number of aviremic patients developing HL and NHL who were carefully matched with controls, gives insights to prediagnostic kinetics of immune parameters. The discordant kinetics of both CD4 and CD8 T cells are already seen 1-2 years prior to lymphoma diagnosis, are more pronounced during the last year and in patients developing HL but are also seen in NHL.
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Abstract
OBJECTIVES Clinical series suggest favorable outcomes of HIV-associated Hodgkin lymphoma, in conflict with population-based statistics. Our objective was to investigate the proportion of Americans who received curative chemotherapy for this disease, and compare their survival with HIV-negative cases using population data. METHODS We selected cases of HIV-associated Hodgkin lymphoma diagnosed in 2004-2012 from the National Cancer Data Base. Factors associated with receipt of chemotherapy were analyzed by logistic regression. Overall survival was compared in proportional hazard models adjusting for available confounding factors. RESULTS Among 2090 HIV-positive patients, 81% received chemotherapy, but 16% received no treatment. Advanced age, male sex, nonwhite race, poor socioeconomic status, and undetermined histologic subtype were associated with higher risk of nontreatment. In 2012, 49% of HIV-positive patients were black, and 15% were Hispanic. Unadjusted 5-year overall survival was significantly lower for HIV-positive (66%) than for HIV-negative (80%) populations. However, among patients who received chemotherapy, HIV-positive status was not significantly associated with higher mortality in classical histologic subtypes, including nodular sclerosis (hazard ratio, HR, 1.08; 95% confidence interval, CI, 0.88-1.33) and mixed cellularity (HR, 1.06; 95% CI, 0.80-1.40). In contrast, prognosis remained significantly worse for cases with undetermined histology (HR, 1.56; 95% CI, 1.31-1.85), suggesting a more aggressive biology or other high-risk characteristics in this subgroup. CONCLUSION Worse survival statistics for HIV-associated Hodgkin lymphoma are driven by lower rates of chemotherapy administration. The disparity in treatment delivery needs attention because a majority of HIV-positive Americans with Hodgkin lymphoma are now black or Hispanic, and this proportion is increasing.
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Gopal S, Fedoriw Y, Kaimila B, Montgomery ND, Kasonkanji E, Moses A, Nyasosela R, Mzumara S, Varela C, Chikasema M, Makwakwa V, Itimu S, Tomoka T, Kamiza S, Dhungel BM, Chimzimu F, Kampani C, Krysiak R, Richards KL, Shea TC, Liomba NG. CHOP Chemotherapy for Aggressive Non-Hodgkin Lymphoma with and without HIV in the Antiretroviral Therapy Era in Malawi. PLoS One 2016; 11:e0150445. [PMID: 26934054 PMCID: PMC4775030 DOI: 10.1371/journal.pone.0150445] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 02/15/2016] [Indexed: 11/23/2022] Open
Abstract
There are no prospective studies of aggressive non-Hodgkin lymphoma (NHL) treated with CHOP in sub-Saharan Africa. We enrolled adults with aggressive NHL in Malawi between June 2013 and May 2015. Chemotherapy and supportive care were standardized, and HIV+ patients received antiretroviral therapy (ART). Thirty-seven of 58 patients (64%) were HIV+. Median age was 47 years (IQR 39–56), and 35 (60%) were male. Thirty-five patients (60%) had stage III/IV, 43 (74%) B symptoms, and 28 (48%) performance status ≥2. B-cell NHL predominated among HIV+ patients, and all T-cell NHL occurred among HIV- individuals. Thirty-one HIV+ patients (84%) were on ART for a median 9.9 months (IQR 1.1–31.7) before NHL diagnosis, median CD4 was 121 cells/μL (IQR 61–244), and 43% had suppressed HIV RNA. HIV+ patients received a similar number of CHOP cycles compared to HIV- patients, but more frequently developed grade 3/4 neutropenia (84% vs 31%, p = 0.001), resulting in modestly lower cyclophosphamide and doxorubicin doses with longer intervals between cycles. Twelve-month overall survival (OS) was 45% (95% CI 31–57%). T-cell NHL (HR 3.90, p = 0.017), hemoglobin (HR 0.82 per g/dL, p = 0.017), albumin (HR 0.57 per g/dL, p = 0.019), and IPI (HR 2.02 per unit, p<0.001) were associated with mortality. HIV was not associated with mortality, and findings were similar among patients with diffuse large B-cell lymphoma. Twenty-three deaths were from NHL (12 HIV+, 11 HIV-), and 12 from CHOP (9 HIV+, 3 HIV-). CHOP can be safe, effective, and feasible for aggressive NHL in Malawi with and without HIV.
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Affiliation(s)
- Satish Gopal
- UNC Project-Malawi, Lilongwe, Malawi
- Lineberger Comprehensive Cancer Center, Chapel Hill, United States of America
- University of Malawi College of Medicine, Blantyre, Malawi
- * E-mail:
| | - Yuri Fedoriw
- Lineberger Comprehensive Cancer Center, Chapel Hill, United States of America
- University of North Carolina Department of Pathology and Laboratory Medicine, Chapel Hill, United States of America
| | | | - Nathan D. Montgomery
- University of North Carolina Department of Pathology and Laboratory Medicine, Chapel Hill, United States of America
| | | | - Agnes Moses
- UNC Project-Malawi, Lilongwe, Malawi
- University of Malawi College of Medicine, Blantyre, Malawi
| | | | - Suzgo Mzumara
- University of Malawi College of Medicine, Blantyre, Malawi
- Kamuzu Central Hospital, Lilongwe, Malawi
| | - Carlos Varela
- University of Malawi College of Medicine, Blantyre, Malawi
- Kamuzu Central Hospital, Lilongwe, Malawi
| | | | | | | | - Tamiwe Tomoka
- University of Malawi College of Medicine, Blantyre, Malawi
| | - Steve Kamiza
- University of Malawi College of Medicine, Blantyre, Malawi
| | | | | | | | | | | | - Thomas C. Shea
- Lineberger Comprehensive Cancer Center, Chapel Hill, United States of America
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Spano JP, Poizot-Martin I, Costagliola D, Boué F, Rosmorduc O, Lavolé A, Choquet S, Heudel PE, Leblond V, Gabarre J, Valantin MA, Solas C, Guihot A, Carcelain G, Autran B, Katlama C, Quéro L. Non-AIDS-related malignancies: expert consensus review and practical applications from the multidisciplinary CANCERVIH Working Group. Ann Oncol 2015; 27:397-408. [PMID: 26681686 DOI: 10.1093/annonc/mdv606] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 12/01/2015] [Indexed: 01/01/2023] Open
Abstract
Malignancies represent a major cause of morbidity and mortality in human immunodeficiency virus (HIV)-infected patients. The introduction of combined antiretroviral therapy has modified the spectrum of malignancies in HIV infection with a decreased incidence of acquired immunodeficiency syndrome (AIDS) malignancies such as Kaposi's sarcoma and non-Hodgkin's lymphoma due to partial immune recovery and an increase in non-AIDS-defining malignancies due to prolonged survival. Management of HIV-infected patients with cancer requires a multidisciplinary approach, involving both oncologists and HIV physicians to optimally manage both diseases and drug interactions between anticancer and anti-HIV drugs. The French CANCERVIH group presents here a review and an experience of managing non-AIDS malignancies in HIV-infected individuals.
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Affiliation(s)
- J-P Spano
- Department of Medical Oncology, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, AP-HP, Paris INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé publique, Paris Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC Université Paris 06, Paris
| | - I Poizot-Martin
- Clinical Immunohaematology Service, Université Aix-Marseille, AP-HM Sainte-Marguerite, Marseille INSERM, U912 (SESSTIM), Marseille
| | - D Costagliola
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé publique, Paris Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC Université Paris 06, Paris
| | - F Boué
- Department of Internal Medicine and Immunology, Hôpital Antoine Béclère, Clamart Faculty of Medicine, Université Paris-Sud, Le Kremlin-Bicêtre
| | - O Rosmorduc
- Faculty of Medicine, Sorbonne Universités, UMPC Université Paris 06, Paris Hepatology Service, Hôpital Saint-Antoine, Paris
| | - A Lavolé
- Pneumology Service, Hôpital Tenon, Paris
| | - S Choquet
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé publique, Paris Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC Université Paris 06, Paris Department of Hematology, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Paris
| | - P-E Heudel
- Medical Oncology Service, Centre Léon Bérard, Lyon
| | - V Leblond
- Faculty of Medicine, Sorbonne Universités, UMPC Université Paris 06, Paris Department of Hematology, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Paris Centre for Research in Immunology and Infectious Diseases, Sorbonne Universités, UPMC Université Paris 06, Paris
| | - J Gabarre
- Department of Hematology, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Paris
| | - M-A Valantin
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé publique, Paris Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC Université Paris 06, Paris Department of Infectious Diseases, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Paris
| | - C Solas
- Laboratory of Pharmacokinetics and Toxicology, Hôpital de La Timone, Marseille
| | - A Guihot
- Faculty of Medicine, Sorbonne Universités, UMPC Université Paris 06, Paris Department of Immunology, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Paris
| | - G Carcelain
- Faculty of Medicine, Sorbonne Universités, UMPC Université Paris 06, Paris Centre for Research in Immunology and Infectious Diseases, Sorbonne Universités, UPMC Université Paris 06, Paris
| | - B Autran
- Faculty of Medicine, Sorbonne Universités, UMPC Université Paris 06, Paris Centre for Research in Immunology and Infectious Diseases, Sorbonne Universités, UPMC Université Paris 06, Paris
| | - C Katlama
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé publique, Paris Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC Université Paris 06, Paris Department of Infectious Diseases, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Paris
| | - L Quéro
- Department of Oncology and Radiotherapy, Hôpital Saint Louis, Paris INSERM UMR_S 965, Université Paris Denis Diderot, Paris, France
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