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Fan S, Zhou Q, Zhou Z, Wang D, Lin S, Bi H, Wang H, Min H. Acute myeloid leukemia following remission of AIDS-associated extra-nodal NK/T-cell lymphoma. Heliyon 2024; 10:e33622. [PMID: 39091951 PMCID: PMC11292489 DOI: 10.1016/j.heliyon.2024.e33622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 08/04/2024] Open
Abstract
Background AIDS-related NK/T-cell lymphoma is a rare subtype of AIDS-related lymphomas, characterized by a poor prognosis and lack of standardized treatment protocols. To date, there have been no reported cases of AIDS-associated NK/T-cell lymphoma in remission followed by treatment-related acute myeloid leukemia (t-AML), where both the lymphoma and AML achieved remission and long-term survival through chemotherapy alone. Case presentation We report a case of a patient diagnosed with AIDS-related extra-nodal NK/T-cell lymphoma (ENKTCL). The patient achieved complete remission after receiving six cycles of chemotherapy, local radiotherapy, and combination antiretroviral therapy (cART). Throughout the follow-up period, the patient continued cART treatment, maintaining an HIV-RNA level below the lower limit of detection. However, 70 months later, the patient developed new symptoms and was subsequently diagnosed with acute myeloid leukemia (AML) M4 subtype. Following the completion of 10 cycles of chemotherapy and ongoing cART, the patient achieved complete remission of AML, with an overall survival time exceeding 103 months from the initial ENKTCL diagnosis. Conclusions This case highlights the effectiveness of chemotherapy combined with cART in the treatment of AIDS-associated NK/T-cell lymphoma and secondary treatment-related leukemia. This approach may serve as a viable option for patients who are not candidates for bone marrow transplantation. Furthermore, this case underscores the importance of long-term follow-up in the management of AIDS-associated malignancies.
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Affiliation(s)
- Shanshan Fan
- Department of Infectious Diseases, Yunnan Provincial Infectious Diseases Hospital/Yunnan AIDS Care Center, Kunming, 650301, China
| | - Qiwen Zhou
- Department of Infectious Diseases, Yunnan Provincial Infectious Diseases Hospital/Yunnan AIDS Care Center, Kunming, 650301, China
| | - Zeping Zhou
- Department of Hematology, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650101, China
| | - Danqing Wang
- Department of Infectious Diseases, Yunnan Provincial Infectious Diseases Hospital/Yunnan AIDS Care Center, Kunming, 650301, China
| | - Sen Lin
- Department of Infectious Diseases, Yunnan Provincial Infectious Diseases Hospital/Yunnan AIDS Care Center, Kunming, 650301, China
| | - Hui Bi
- Department of Hematology, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650101, China
| | - Honghui Wang
- Department of Hematology, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650101, China
| | - Haiyan Min
- Department of Infectious Diseases, Yunnan Provincial Infectious Diseases Hospital/Yunnan AIDS Care Center, Kunming, 650301, China
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Forghieri F, Nasillo V, Bettelli F, Pioli V, Giusti D, Gilioli A, Mussini C, Tagliafico E, Trenti T, Cossarizza A, Maffei R, Barozzi P, Potenza L, Marasca R, Narni F, Luppi M. Acute Myeloid Leukemia in Patients Living with HIV Infection: Several Questions, Fewer Answers. Int J Mol Sci 2020; 21:E1081. [PMID: 32041199 PMCID: PMC7036847 DOI: 10.3390/ijms21031081] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/01/2020] [Accepted: 02/04/2020] [Indexed: 12/18/2022] Open
Abstract
Both human immunodeficiency virus (HIV) infection and acute myeloid leukemia (AML) may be considered relatively uncommon disorders in the general population, but the precise incidence of AML in people living with HIV infection (PLWH) is uncertain. However, life expectancy of newly infected HIV-positive patients receiving anti-retroviral therapy (ART) is gradually increasing, rivaling that of age-matched HIV-negative individuals, so that the occurrence of AML is also expected to progressively increase. Even if HIV is not reported to be directly mutagenic, several indirect leukemogenic mechanisms, mainly based on bone marrow microenvironment disruption, have been proposed. Despite a well-controlled HIV infection under ART should no longer be considered per se a contraindication to intensive chemotherapeutic approaches, including allogeneic hematopoietic stem cell transplantation, in selected fit patients with AML, survival outcomes are still generally unsatisfactory. We discussed several controversial issues about pathogenesis and clinical management of AML in PLWH, but few evidence-based answers may currently be provided, due to the limited number of cases reported in the literature, mainly as case reports or small retrospective case series. Prospective multicenter clinical trials are warranted to more precisely investigate epidemiology and cytogenetic/molecular features of AML in PLWH, but also to standardize and further improve its therapeutic management.
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Affiliation(s)
- Fabio Forghieri
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy; (V.N.); (F.B.); (V.P.); (D.G.); (A.G.); (R.M.); (P.B.); (L.P.); (R.M.); (F.N.); (M.L.)
| | - Vincenzo Nasillo
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy; (V.N.); (F.B.); (V.P.); (D.G.); (A.G.); (R.M.); (P.B.); (L.P.); (R.M.); (F.N.); (M.L.)
| | - Francesca Bettelli
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy; (V.N.); (F.B.); (V.P.); (D.G.); (A.G.); (R.M.); (P.B.); (L.P.); (R.M.); (F.N.); (M.L.)
| | - Valeria Pioli
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy; (V.N.); (F.B.); (V.P.); (D.G.); (A.G.); (R.M.); (P.B.); (L.P.); (R.M.); (F.N.); (M.L.)
| | - Davide Giusti
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy; (V.N.); (F.B.); (V.P.); (D.G.); (A.G.); (R.M.); (P.B.); (L.P.); (R.M.); (F.N.); (M.L.)
| | - Andrea Gilioli
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy; (V.N.); (F.B.); (V.P.); (D.G.); (A.G.); (R.M.); (P.B.); (L.P.); (R.M.); (F.N.); (M.L.)
| | - Cristina Mussini
- Section of Infectious Diseases, Department of Surgical, Medical, Dental and Morphological Sciences. University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy;
| | - Enrico Tagliafico
- Center for Genome Research, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, 41124 Modena, Italy;
| | - Tommaso Trenti
- Department of Laboratory Medicine and Pathology, Unità Sanitaria Locale, 41124 Modena, Italy;
| | - Andrea Cossarizza
- Section of Immunology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Rossana Maffei
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy; (V.N.); (F.B.); (V.P.); (D.G.); (A.G.); (R.M.); (P.B.); (L.P.); (R.M.); (F.N.); (M.L.)
| | - Patrizia Barozzi
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy; (V.N.); (F.B.); (V.P.); (D.G.); (A.G.); (R.M.); (P.B.); (L.P.); (R.M.); (F.N.); (M.L.)
| | - Leonardo Potenza
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy; (V.N.); (F.B.); (V.P.); (D.G.); (A.G.); (R.M.); (P.B.); (L.P.); (R.M.); (F.N.); (M.L.)
| | - Roberto Marasca
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy; (V.N.); (F.B.); (V.P.); (D.G.); (A.G.); (R.M.); (P.B.); (L.P.); (R.M.); (F.N.); (M.L.)
| | - Franco Narni
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy; (V.N.); (F.B.); (V.P.); (D.G.); (A.G.); (R.M.); (P.B.); (L.P.); (R.M.); (F.N.); (M.L.)
| | - Mario Luppi
- Section of Hematology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Policlinico, 41124 Modena, Italy; (V.N.); (F.B.); (V.P.); (D.G.); (A.G.); (R.M.); (P.B.); (L.P.); (R.M.); (F.N.); (M.L.)
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Vishnu P, Aboulafia DM. AIDS-Related Non-Hodgkin's Lymphoma in the Era of Highly Active Antiretroviral Therapy. Adv Hematol 2012; 2012:485943. [PMID: 22400030 PMCID: PMC3287061 DOI: 10.1155/2012/485943] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 11/24/2011] [Indexed: 01/30/2023] Open
Abstract
In economically developed countries, AIDS-related lymphoma (ARL) accounts for a large proportion of malignances in HIV-infected individuals. Since the introduction of highly active anti-retroviral therapy (HAART) in 1996, epidemiology and prognosis of ARL have changed. While there is a slight increase in the incidence of Hodgkin's lymphoma in HIV-infected individuals, use of HAART has contributed to a decline in the incidence of non-Hodgkin's lymphoma (NHL) and also a decrease in the overall incidence of ARL. Strategies that employ HAART, improved supportive care, and the use of Rituximab with multi-agent chemotherapy have contributed to improved rates of complete remission and survival of patients with ARL that rival those seen in stage and histology matched HIV negative NHL patients. Most recent clinical trials demonstrate better outcomes with the use of rituximab in ARL. Tumor histogenesis (germinal center vs. non-germinal center origin) is associated with lymphoma-specific outcomes in the setting of AIDS-related diffuse-large B cell lymphoma. High-dose chemotherapy (HDCT) and autologous stem cell rescue (ASCT) can be effective for a subset of patients with relapsed ARL. HIV sero-status alone should not preclude consideration of ASCT in the setting of ARL relapse. Clinical trials investigating the role of allogeneic hematopoietic stem cell transplant in ARL are currently underway.
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Affiliation(s)
- Prakash Vishnu
- Floyd & Delores Jones Cancer Institute, Virginia Mason Medical Center, Seattle, WA 98101, USA
| | - David M. Aboulafia
- Floyd & Delores Jones Cancer Institute, Virginia Mason Medical Center, Seattle, WA 98101, USA
- Division of Hematology-Oncology, University of Washington, Seattle, WA 98195, USA
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Abstract
PURPOSE OF REVIEW HIV-infected individuals remain at an increased risk for developing malignancies despite the use of combined antiretroviral therapy. Lymphomas comprise a large proportion of the malignancies that affect the HIV-infected population in developed countries. This review summarizes the recent progress made in HIV lymphoma research published in 2009 through January 2010. RECENT FINDINGS The majority of investigation in this field has been in diffuse large B-cell lymphoma, with infusional therapy remaining promising. Rituximab likely improves complete response and possibly overall survival, but may be associated with increased infections in a subset of patients with very low CD4 cell counts. Risk factors associated with the development of lymphoma include low CD4 cell count and likely cumulative HIV viremia. Biologic insights have been realized regarding pathogenesis. SUMMARY Overall, the outcome for HIV lymphoma continues to improve as insights into the pathophysiology and treatment advance.
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