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Zhang J, Xie Z, Cai S, Qin S, Ruan G, Lu A, Wu Y, Chen J, Peng J. Hypoalbuminemia predicts inferior outcome in patients with AIDS-related lymphoma. Infect Agent Cancer 2022; 17:33. [PMID: 35717275 PMCID: PMC9206320 DOI: 10.1186/s13027-022-00448-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/06/2022] [Indexed: 11/15/2022] Open
Abstract
Background The prognostic value of serum albumin in acquired immunodeficiency syndrome (AIDS)-related lymphoma (ARL) remains covered. Methods We retrospectively analyzed de novo ARL patients from 2013 to 2019 across three centers. Factors correlated with progression-free survival (PFS) and overall survival (OS) were evaluated in Kaplan–Meier, univariate and multivariate Cox proportional hazard models. Results A total of 86 ARL patients were enrolled with a median follow-up of 34 months. In the cohort, the OS and 2-year PFS rates were 37.5% and 35.4%, respectively. In multivariate models, older age (PFS, hazard ratios [HR] = 1.035, p = 0.037; OS, HR = 1.034, p = 0.041) and hypoalbuminemia (OS, HR = 0.910, p = 0.038) predicted inferior survival. ARL patients with hypoalbuminemia showed worse OS and 2-year PFS (p = 0.028 and p = 0.01, respectively), which was associated with poor Eastern Cooperative Oncology Group performance status (ECOG PS) and higher International Prognosis Index (IPI) score. Conclusion In conclusion, serum albumin at diagnosis is an independent prognostic factor for overall survival in AIDS-related lymphoma.
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Affiliation(s)
- Jinxin Zhang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue, Guangzhou, China.,Department of Respiratory Medicine, University of Chinese Academy of Sciences Shenzhen Hospital, Guangzhou, China
| | - Zhiman Xie
- Department of Infectious Diseases, the Fourth Hospital of Nanning, Nanning, China
| | - Shaohang Cai
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue, Guangzhou, China
| | - Shanfang Qin
- Guangxi AIDS Diagnosis and Treatment Quality Control Center, Longtan Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Guangjing Ruan
- Department of Infectious Diseases, the Fourth Hospital of Nanning, Nanning, China
| | - Aili Lu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue, Guangzhou, China
| | - Yihua Wu
- Department of Infectious Diseases, the Fourth Hospital of Nanning, Nanning, China
| | - Juanjuan Chen
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue, Guangzhou, China.
| | - Jie Peng
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue, Guangzhou, China.
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Sun Y, Luo J, Qian C, Luo L, Xu M, Min H, Cen Y. The Value of Nutritional Status in the Prognostic Analysis of Patients with AIDS-Related Lymphoma. Infect Drug Resist 2021; 14:1105-1113. [PMID: 33776456 PMCID: PMC7987257 DOI: 10.2147/idr.s295077] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/24/2021] [Indexed: 12/30/2022] Open
Abstract
Objective Many studies have suggested that indexes of nutritional status, such as body mass index (BMI), serum albumin (ALB), serum pre-albumin (PA), and hemoglobin, may be used as risk factors for the prognosis of HIV or lymphoma. Therefore, this study aimed to retrospectively analyze and explore the value of nutritional status in the prognostic assessment of patients with AIDS-related lymphoma (ARL). Methods In this retrospective study, the clinical data of 69 patients with ARL were collected. All patients had a definite diagnosis of non-Hodgkin lymphoma by pathological examination and met the requirements of the Hematopoietic and Lymphocytic Tissue Tumor Classification (2016) established by the World Health Organization. Patients who did not receive standard chemotherapy, those with incomplete medical records, and those with an unclear pathological diagnosis were excluded. The patients were divided into two groups (survival and death) according to the prognostic outcome, and their clinical characteristics and prognoses were discussed by relevant statistical methods. Results During the three-year follow-up period, 20 (28.99%) patients died, and 49 (71.01%) survived. The one-year cumulative survival rate was 78.26%. A univariate analysis found that the prognosis was associated with the International Prognostic Index (IPI) score, BMI, ALB, PA, and CD4 T lymphocyte count. The Cox risk proportional regression analysis showed that the IPI score, BMI, and PA were the independent risk factors for survival; their combination had a greater ability to forecast the clinical outcome (area under the curve = 0.874, P < 0.001). Conclusion In this study, at the time of the visit, the patients with ARL tended to be in the advanced stages of disease and, therefore, at high risk of mortality. Therefore, their nutritional status might be of great value to the prognostic assessment. The combination of BMI, PA, and IPI scores could be used for risk stratification and better screening of high-risk patients.
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Affiliation(s)
- Yanbo Sun
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, People's Republic of China
| | - Jing Luo
- Department of Gastrointestinal Surgery, The First People's Hospital of Qujing, Qujing, 655000, People's Republic of China
| | - Chuan Qian
- The Second Department of Infection, Yunnan Provincial Infectious Disease Hospital, Kunming, 650301, People's Republic of China
| | - Lan Luo
- The Second Department of Infection, Yunnan Provincial Infectious Disease Hospital, Kunming, 650301, People's Republic of China
| | - Manqi Xu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, People's Republic of China
| | - Haiyan Min
- The Second Department of Infection, Yunnan Provincial Infectious Disease Hospital, Kunming, 650301, People's Republic of China
| | - Yunyun Cen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, People's Republic of China
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Liu Y, Xie S, Li L, Si Y, Zhang W, Liu X, Guo L, Liu B, Lu R. Clinical observations of bone marrow transfusion for promoting bone marrow reconstruction after chemotherapy for AIDS-related lymphoma. BMC Immunol 2021; 22:10. [PMID: 33509081 PMCID: PMC7845098 DOI: 10.1186/s12865-021-00399-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 01/19/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This study investigates the effect of autologous bone marrow transfusion (BMT) on the reconstruction of both bone marrow and the immune system in patients with AIDS-related lymphoma (ARL). METHODS A total of 32 patients with ARL participated in this study. Among them, 16 participants were treated with conventional surgery and chemotherapy (control group) and the remaining 16 patients were treated with chemotherapy followed by autologous bone marrow transfusion via a mesenteric vein (8 patients, ABM-MVI group) or a peripheral vein (8 patients, ABM-PI group). Subsequently, peripheral blood and lymphocyte data subsets were detected and documented in all patients. RESULTS Before chemotherapy, no significant difference in indicators was observed between three groups of ARL patients. Unexpectedly, 2 weeks after the end of 6 courses of chemotherapy, the ABM-MVI group, and the ABM-PI group yielded an increased level of CD8+T lymphocytes, white blood cells (WBC), and platelet (PLT) in peripheral blood in comparison to the control group. Notably, the number of CD4+T lymphocytes in the ABM-PI group was significantly higher than that in the other two groups. Additionally, no significant difference in haemoglobin levels was observed before and after chemotherapy in both the ABM-MVI and ABM-PI groups, while haemoglobin levels in the control group decreased significantly following chemotherapy. CONCLUSIONS Autologous bone marrow transfusion after chemotherapy can promote the reconstruction of both bone marrow and the immune system. There was no significant difference in bone marrow recovery and reconstruction between the mesenteric vein transfusion group and the peripheral vein transfusion group.
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Affiliation(s)
- Yixuan Liu
- Department of Clinical Laboratory, Fudan University Shanghai Cancer Center, No.270, Dong'An Road, Xuhui District, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of surgery, Shanghai Public Health Clinical Center, Affiliated to Fudan University, Shanghai, China
| | - Suhong Xie
- Department of Clinical Laboratory, Fudan University Shanghai Cancer Center, No.270, Dong'An Road, Xuhui District, Shanghai, 200032, China
| | - Lei Li
- Department of surgery, Shanghai Public Health Clinical Center, Affiliated to Fudan University, Shanghai, China
| | - Yanhui Si
- Department of surgery, Shanghai Public Health Clinical Center, Affiliated to Fudan University, Shanghai, China
| | - Weiwei Zhang
- Department of surgery, Shanghai Public Health Clinical Center, Affiliated to Fudan University, Shanghai, China
| | - Xin Liu
- Department of surgery, Shanghai Public Health Clinical Center, Affiliated to Fudan University, Shanghai, China
| | - Lin Guo
- Department of Clinical Laboratory, Fudan University Shanghai Cancer Center, No.270, Dong'An Road, Xuhui District, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Baochi Liu
- Department of surgery, Shanghai Public Health Clinical Center, Affiliated to Fudan University, Shanghai, China
| | - Renquan Lu
- Department of Clinical Laboratory, Fudan University Shanghai Cancer Center, No.270, Dong'An Road, Xuhui District, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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Casimiro LC, Mauro GP, Medici CTM, Weltman E. Survival and consolidative radiotherapy in patients living with HIV and treated for diffuse large B-cell lymphoma. Rep Pract Oncol Radiother 2020; 25:956-960. [PMID: 33100911 DOI: 10.1016/j.rpor.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/28/2020] [Accepted: 09/16/2020] [Indexed: 11/19/2022] Open
Abstract
Objectives Current guidelines tend to treat HIV positive (HIV+) patients as their seronegative counterparts with diffuse large B-cell lymphoma (DLBCL) but little is known about their radiotherapy responses differences. Patients and Methods A retrospective cohort of all consecutive HIV+ DBCL patients treated with chemotherapy between 2004 and 2018 was assessed. All patients had biopsy-proven lymphomas. They were included if the proposed radical treatment was done without progression or death during chemotherapy and had at least 6 months of follow-up or were followed until death. Results Fifty-three (53) patients were selected, with a median age at diagnosis of 41.39 years (20-65 years). Median follow-up of 35.16 months (1.4-178.7 months). Male patients accounted for 54.7% and most had a good performance in the ECOG scale at diagnoses (81.1% are ECOG 0-1). Median overall survival was not reached. Mean OS was 41.5 months with 16 deaths. Age had an impact on OS, with patients older than 60 years at more risk (p = 0.044), as did longtime use of HAART, with those that started antiretroviral therapy within the diagnose of the lymphoma at greatest risk (p = 0.044). RT did not have an impact on OS (p = 0.384) or PFS (p = 0.420), although survival curves show better OS in the radiotherapy group. Toxicities were rare, since none of the patients had grade 3 or superior toxicity. Conclusion RT did not impact survival or progression in our limited sample, but a longer OS may occur after the first-year post RT. RT should be tested in prospective data in the HIV+ population with DLBCL.
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Affiliation(s)
- Lucas Coelho Casimiro
- Department of Radiation Oncology, Instituto do Câncer do Estado de São Paulo (ICESP), University of São Paulo Medical School, Brazil
| | - Geovanne Pedro Mauro
- Department of Radiology and Oncology, University of Sao Paulo Medical School, School of Medicine, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
- Department of Radiology and Oncology, University of Sao Paulo Medical School, Brazil
| | | | - Eduardo Weltman
- Department of Radiation Oncology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Department of Radiology and Oncology, University of Sao Paulo Medical School, Brazil
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Abstract
BACKGROUND. Plasmablastic lymphoma (PBL) is an aggressive B-cell lymphoma that is characterized by the expression of plasma cell antigens and loss of pan B-cell antigens. The neoplasm is extensively reported in the oral cavity and anorectal region but rarely in the gastrointestinal tract, where only isolated case reports and small case series have been reported. In the current study, morphologic, immunohistochemical, and molecular features of 17 cases of gastrointestinal tract PBL were reviewed. METHODS. Ten-year retrospective study that reappraised the histomorphological and immunophenotypical profiles of HIV-associated PBLs in the gastrointestinal tract. RESULTS. The mean age of the study patients was 41 years with a 3:1 ratio of males to females. The most common site of tumor origin was the small intestine (42%), followed by the stomach (29%) and the colon (29%). Majority of the cases showed a predominant diffuse (82%) growth pattern. Immunoblasts and plasmablasts were observed in all cases. Plasmacytic differentiation was seen in 5 (29%) cases. Additional observations not previously described or emphasized in literature includes pseudo-alveolar growth pattern, centroblast-predominance, multinucleated giant cells, and clear cell change. Immunohistochemistry revealed absence of pan B-cell antigens and expression of plasma cell antigens in all cases. Epstein-Barr virus-encoded RNA was expressed in 53% of the cases. CONCLUSIONS. This study highlights the spectrum of histopathological features seen in gastrointestinal tract PBLs. Awareness of this entity and its histopathological features in the gastrointestinal tract is essential for making a timely and accurate diagnosis and improving patient outcomes.
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Affiliation(s)
- Absalom Mwazha
- University of KwaZulu-Natal, Durban, South Africa.,National Health Laboratory Services, Durban, South Africa
| | | | - Pedzisai Mazengenya
- University of the Witwatersrand, Johannesburg, South Africa.,Ajman University, Ajman, United Arab Emirates
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Silva WFD, Garibaldi PMM, Rosa LID, Bellesso M, Clé DV, Delamain MT, Rego EM, Pereira J, Rocha V. Outcomes of HIV-associated Burkitt Lymphoma in Brazil: High treatment toxicity and refractoriness rates - A multicenter cohort study. Leuk Res 2019; 89:106287. [PMID: 31864677 DOI: 10.1016/j.leukres.2019.106287] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/30/2019] [Accepted: 12/09/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Although the increased use of combined antiretroviral therapy (cART) has decreased the incidence of lymphomas HIV-associated, Burkitt lymphoma (BL) incidence remains stable. Reported outcomes on HIV-associated BL from developed countries seem to corroborate that the regimens do not need to be tailored to the HIV-positive population. MATERIALS AND METHODS This is a retrospective multicenter cohort study from Brazil, including HIV-positive patients aged 15 years and above diagnosed with BL. RESULTS A total of 54 patients were included. Median age was 39 years (range, 15-64). At diagnosis, advanced disease was found in 86% and 52% had a CD4+ count lower than 200 cells/mm3. Five patients died before starting any regimen. Among the remaining 49 patients, most were treated with Hyper-CVAD (53%) and CODOX-M IVAC (18%). Rituximab was used in frontline in only 16% of the patients. Primary refractory disease was found in 14%. A treatment-related mortality of 38.7% and a complete response rate of 44.9% were found. At 4 years, estimated overall survival (OS) was 39.8%. All relapsed and primary refractory patients eventually died. Remaining patients died from infections (24/34), despite antimicrobial prophylaxis and associated cART. CONCLUSION Early mortality and toxicity were higher in our cohort than in developed countries. A faster diagnosis, better understanding of the biology of the disease, establishment of low toxicity regimens, inclusion of rituximab and improvement of supportive care may decrease the mortality of HIV-associated BL in developing countries.
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Affiliation(s)
- Wellington F da Silva
- Instituto do Cancer de Sao Paulo (ICESP), Universidade de São Paulo, Av. Dr. Arnaldo, 251 - Cerqueira César, São Paulo, SP, 01246-000, Brazil.
| | - Pedro Manoel Marques Garibaldi
- Hospital das Clínicas da Faculdade de Medicina de Ribeirao Preto (HCRP), Av. Bandeirantes, 3900 - Vila Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Lidiane Inês da Rosa
- Instituto do Cancer de Sao Paulo (ICESP), Universidade de São Paulo, Av. Dr. Arnaldo, 251 - Cerqueira César, São Paulo, SP, 01246-000, Brazil; HEMOMED - Instituto de Oncologia e Hematologia, Av. Arnolfo Azevedo, 121 - Pacaembu, São Paulo, SP, 01236-030, Brazil
| | - Marcelo Bellesso
- Instituto do Cancer de Sao Paulo (ICESP), Universidade de São Paulo, Av. Dr. Arnaldo, 251 - Cerqueira César, São Paulo, SP, 01246-000, Brazil; HEMOMED - Instituto de Oncologia e Hematologia, Av. Arnolfo Azevedo, 121 - Pacaembu, São Paulo, SP, 01236-030, Brazil
| | - Diego Villa Clé
- Hospital das Clínicas da Faculdade de Medicina de Ribeirao Preto (HCRP), Av. Bandeirantes, 3900 - Vila Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Márcia Torresan Delamain
- Hospital de Clínicas da Universidade Estadual de Campinas (Unicamp), R. Vital Brasil, 251 - Cidade Universitária, Campinas, SP, 13083-888, Campinas, Brazil
| | - Eduardo Magalhães Rego
- Instituto do Cancer de Sao Paulo (ICESP), Universidade de São Paulo, Av. Dr. Arnaldo, 251 - Cerqueira César, São Paulo, SP, 01246-000, Brazil; Laboratory of Medical Investigation on Pathogenesis and Targeted Therapy in Onco-immuno-hematology (LIM-31), Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 155 - Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Juliana Pereira
- Instituto do Cancer de Sao Paulo (ICESP), Universidade de São Paulo, Av. Dr. Arnaldo, 251 - Cerqueira César, São Paulo, SP, 01246-000, Brazil; Laboratory of Medical Investigation on Pathogenesis and Targeted Therapy in Onco-immuno-hematology (LIM-31), Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 155 - Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Vanderson Rocha
- Instituto do Cancer de Sao Paulo (ICESP), Universidade de São Paulo, Av. Dr. Arnaldo, 251 - Cerqueira César, São Paulo, SP, 01246-000, Brazil; Laboratory of Medical Investigation on Pathogenesis and Targeted Therapy in Onco-immuno-hematology (LIM-31), Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 155 - Cerqueira César, São Paulo, SP, 05403-000, Brazil
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Rudresha AH, Khandare PA, Lokanatha D, Linu AJ, Suresh Babu MC, Lokesh KN, Rajeev LK, Smitha CS, Amale VB, Premalata CS, Nikita M. HIV/ AIDS-related lymphoma: perspective from a regional cancer center in India. Blood Res 2019; 54:181-188. [PMID: 31730692 PMCID: PMC6779940 DOI: 10.5045/br.2019.54.3.181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/18/2019] [Accepted: 05/29/2019] [Indexed: 11/17/2022] Open
Abstract
Background India has the third largest population of people living with HIV/AIDS (PLHA). Lymphoma is the second most common malignancy among PLHA. However, data are lacking regarding HIV/AIDS-related lymphoma (ARL) in India. This study evaluated the epidemiology and clinical outcomes of ARL from a regional cancer center in India. Methods This retrospective analysis included cases of ARL between March 2011 and September 2017. Data were obtained from patient record files for the assessment of epidemiology and clinical outcomes. Statistical analysis was performed using GraphPad Prism 6. Comparisons of subtype-specific survivals were performed using log-rank tests. Results Of 1,226 lymphoma cases, 80 (6.5%) were ARL. Details were available for 70 patients. The median age at diagnosis was 40.5 (9–74) years with a male:female ratio of 2:1. AIDS-defining lymphomas (ADL) constituted 78.6% of cases, while 21.4% had non-AIDS defining lymphoma (NADL). The mean CD4 counts were 193.15±92.85 and 301.93±107.95 cells/µL, respectively (t-test; P=0.0002). Extranodal involvement was present in 55.7%, B symptoms were reported in 60%, and lactate dehydrogenase (LDH) was elevated in 64.3% of patients. The median overall survival times were 6 months for plasmablastic lymphoma (PBL), 23 months for diffuse large B-cell lymphoma (DLBCL), and was not reached for Hodgkin's lymphoma (log-rank test; P=0.0011). Other histological subtype cases were too few to draw meaningful survival outcomes. Conclusion ARL is a heterogeneous disease. Histologic subtype is a major determinant of the clinical outcome. ADL has significantly lower CD4 counts than those of NADL. There is an urgent and unmet need for uniform management guidelines for improving outcomes in this under-represented patient population.
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Affiliation(s)
- A H Rudresha
- Department of Medical Oncology, Kidwai Cancer Institute, Bengaluru, India
| | | | - D Lokanatha
- Department of Medical Oncology, Kidwai Cancer Institute, Bengaluru, India
| | - Abraham Jacob Linu
- Department of Medical Oncology, Kidwai Cancer Institute, Bengaluru, India
| | - M C Suresh Babu
- Department of Medical Oncology, Kidwai Cancer Institute, Bengaluru, India
| | - K N Lokesh
- Department of Medical Oncology, Kidwai Cancer Institute, Bengaluru, India
| | - L K Rajeev
- Department of Medical Oncology, Kidwai Cancer Institute, Bengaluru, India
| | | | | | - C S Premalata
- Department of Pathology, Kidwai Cancer Institute, Bengaluru, India
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Mazzuca P, Marsico S, Schulze K, Mitola S, Pils MC, Giagulli C, Guzman CA, Caruso A, Caccuri F. Role of Autophagy in HIV-1 Matrix Protein p17-Driven Lymphangiogenesis. J Virol 2017; 91:e00801-17. [PMID: 28592537 DOI: 10.1128/JVI.00801-17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 05/29/2017] [Indexed: 12/18/2022] Open
Abstract
AIDS-related lymphomas (ARLs) are expected to increase in the future since combined antiretroviral therapy (cART) enhances the life expectancy of HIV-1-infected (HIV+) patients but does not affect the occurrence of ARLs to the same extent as that of other tumors. Lymphangiogenesis is essential in supporting growth and metastatic spreading of ARLs. HIV-1 does not infect the neoplastic B cells, but HIV-1 proteins have been hypothesized to play a key role in sustaining a prolymphangiogenic microenvironment in lymphoid organs. The HIV-1 matrix protein p17 is detected in blood and accumulates in the germinal centers of lymph nodes of HIV+ patients under successful cART. The viral protein displays potent lymphangiogenic activity in vitro and in vivo This is, at least in part, mediated by the secretion of the lymphangiogenic factor endothelin-1, suggesting that activation of a secretory pathway sustains the lymphangiogenic activity of p17. Here, we show that the p17 lymphangiogenic activity occurs on human lymph node-derived lymphatic endothelial cells (LN-LECs) under stress conditions only and relies entirely on activation of an autophagy-based pathway. In fact, induction of autophagy by p17 promotes lymphangiogenesis, whereas pharmacological and genetic inhibition of autophagy inhibits p17-triggered lymphangiogenesis. Similarly, the vasculogenic activity of p17 was totally inhibited in autophagy-incompetent mice. Our findings reveal a previously unrecognized role of autophagy in lymphangiogenesis and open the way to identify novel treatment strategies aimed at inhibiting aberrant tumor-driven lymphangiogenesis in HIV+ patients.IMPORTANCE AIDS-related lymphomas (ARLs) are the most common malignancies in HIV-1-infected (HIV+) patients after the introduction of combined antiretroviral therapy (cART). Lymphangiogenesis is of critical importance in sustaining growth and metastasis of ARLs. Indeed, enhanced lymphangiogenesis occurs in the lymph nodes of HIV+ patients under successful cART. The HIV-1 matrix protein p17 is detected in blood and accumulates in the lymph node germinal centers even in the absence of virus replication. Several findings suggest a key role for p17 as a microenvironmental factor capable of promoting lymphangiogenesis. Here, we show that p17 promotes lymphangiogenesis of human lymph node-derived lymphatic endothelial cells (LN-LECs). The lymphangiogenic activity of p17 is sustained by an autophagy-based pathway that enables LN-LECs to release prolymphangiogenic factors into the extracellular microenvironment. Our findings indicate that specific targeting of autophagy may provide an important new tool for treating ARLs.
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Reddy R, Gogia A, Kumar L, Sharma A, Bakhshi S, Sharma MC, Mallick S, Sahoo R. HIV-associated hematologic malignancies: Experience from a Tertiary Cancer Center in India. Indian J Med Paediatr Oncol 2016; 37:141-5. [PMID: 27688606 PMCID: PMC5027785 DOI: 10.4103/0971-5851.190355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Context and Aim: Data on HIV associated hematologic malignancies is sparse from India. This study attempts to analyze the spectrum and features of this disease at a tertiary cancer center in India. Setting and Methods: Retrospective study from case records of patients registered with a diagnosis of hematologic malignancy and HIV infection between January 2010 and June 2015. Results: Thirteen cases of HIV associated hematologic malignancies were identified, six of them pediatric. HIV diagnosis was concurrent to diagnosis of cancer in 12 and preceded it in one of them. ECOG PS at presentation was >1 in all of them. All patients, except one, had B symptoms. Six of the patients had bulky disease and six are stage 4. Predominant extranodal disease was seen in 67% of them. NHL accounted for 10 of 13 patients and DLBCL-Germinal center was the most common subtype. Mean CD4+ cell count was 235/μL (range, 32-494). HAART could be given along with chemotherapy to 11 patients. Two-thirds of patients received standard doses of therapy. Chemo-toxicity required hospitalization in 58%. CR was achieved in 45% and 36% had progressive disease with first-line therapy. At the time of last follow up, 3 patients were alive with responsive disease, 2 in CR and 1 in PR. None of the pediatric patients were long time responders. Conclusions: These malignancies were of advanced stage and higher grade. Goal of therapy, in the HAART era, is curative. Pediatric patients had dismal outcome despite good chemotherapy and HAART. There is an urgent need to improve data collection for HIV related cancers in India.
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Affiliation(s)
- Rakesh Reddy
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All Institute of Medical Sciences, New Delhi, India
| | - Ajay Gogia
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All Institute of Medical Sciences, New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All Institute of Medical Sciences, New Delhi, India
| | - Mehar C Sharma
- Department of Pathology, All Institute of Medical Sciences, New Delhi, India
| | | | - Ranjit Sahoo
- Department of Medical Oncology, Institute Rotary Cancer Hospital, All Institute of Medical Sciences, New Delhi, India
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Barta SK, Joshi J, Mounier N, Xue X, Wang D, Ribera JM, Navarro JT, Hoffmann C, Dunleavy K, Little RF, Wilson WH, Spina M, Galicier L, Noy A, Sparano JA. Central nervous system involvement in AIDS-related lymphomas. Br J Haematol 2016; 173:857-66. [PMID: 27062389 DOI: 10.1111/bjh.13998] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/03/2016] [Indexed: 11/29/2022]
Abstract
Central nervous system (CNS) involvement is reportedly more common in acquired immunodeficiency syndrome (AIDS)-related lymphomas (ARL). We describe factors and outcomes associated with CNS involvement at baseline (CNS(B) ) and relapse (CNS(R) ) in 886 patients with newly diagnosed ARL. Of 886 patients, 800 received either intrathecal (IT) therapy for CNS(B) or IT prophylaxis. CNS(B) was found in 13%. CNS(B) was not associated with reduced overall survival (OS). There was no difference in the prevalence of CNS(B) between the pre-combination antiretroviral therapy (cART) and cART eras. 5·3% of patients experienced CNS(R) at a median of 4·2 months after diagnosis (12% if CNS(B) ; 4% if not). Median OS after CNS(R) was 1·6 months. On multivariate analysis, only CNS(B) [hazard ratio (HR) 3·68, P = 0·005] and complete response to initial therapy (HR 0·14, P < 0·0001) were significantly associated with CNS(R) . When restricted to patients without CNS(B) , IT CNS prophylaxis with 3 vs. 1 agent did not significantly impact the risk of CNS(R) . Despite IT CNS prophylaxis, 5% of patients experienced CNS(R) . Our data confirms that CNS(R) in ARL occurs early and has a poor outcome. Complete response to initial therapy was associated with a reduced frequency of CNS(R) . Although CNS(B) conferred an increased risk for CNS(R) , it did not impact OS.
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Affiliation(s)
| | - Jitesh Joshi
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | | | - Xiaonan Xue
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Dan Wang
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Josep-Maria Ribera
- Hospital Universitari Germans Trias i Pujol, Josep Carreras Research Institute Badalona, Badalona, Spain
| | - Jose-Tomas Navarro
- Hospital Universitari Germans Trias i Pujol, Josep Carreras Research Institute Badalona, Badalona, Spain
| | - Christian Hoffmann
- IPM Study Centre, Hamburg, Germany.,University of Schleswig-Holstein, Kiel, Germany
| | - Kieron Dunleavy
- National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA
| | - Richard F Little
- National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA
| | - Wyndham H Wilson
- National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA
| | - Michele Spina
- Division of Medical Oncology A, National Cancer Institute, Aviano, Italy
| | - Lionel Galicier
- Department of Clinical Immunology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris and Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Ariela Noy
- Memorial Sloan-Kettering Cancer Center & Weill Cornell New York, New York, NY, USA
| | - Joseph A Sparano
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
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11
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Abstract
People living with human immunodeficiency virus (HIV) are living longer since the advent of effective combined antiretroviral therapy (cART). While cART substantially decreases the risk of developing some cancers, HIV-infected individuals remain at high risk for Kaposi sarcoma, lymphoma, and several solid tumors. Currently HIV-infected patients represent an aging group, and malignancies have become a leading cause of morbidity and mortality. Tailored cancer-prevention strategies are needed for this population. In this review we describe the etiologic agents and pathogenesis of common malignancies in the setting of HIV, as well as current evidence for cancer prevention strategies and screening programs.
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Affiliation(s)
- Priscila H Goncalves
- HIV & AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jairo M Montezuma-Rusca
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Robert Yarchoan
- HIV & AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Thomas S Uldrick
- HIV & AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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12
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Boons E, Vanstreels E, Jacquemyn M, Nogueira TC, Neggers JE, Vercruysse T, van den Oord J, Tamir S, Shacham S, Landesman Y, Snoeck R, Pannecouque C, Andrei G, Daelemans D. Human Exportin-1 is a Target for Combined Therapy of HIV and AIDS Related Lymphoma. EBioMedicine 2015; 2:1102-13. [PMID: 26501108 PMCID: PMC4588406 DOI: 10.1016/j.ebiom.2015.07.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/29/2015] [Accepted: 07/29/2015] [Indexed: 11/12/2022] Open
Abstract
Infection with HIV ultimately leads to advanced immunodeficiency resulting in an increased incidence of cancer. For example primary effusion lymphoma (PEL) is an aggressive non-Hodgkin lymphoma with very poor prognosis that typically affects HIV infected individuals in advanced stages of immunodeficiency. Here we report on the dual anti-HIV and anti-PEL effect of targeting a single process common in both diseases. Inhibition of the exportin-1 (XPO1) mediated nuclear transport by clinical stage orally bioavailable small molecule inhibitors (SINE) prevented the nuclear export of the late intron-containing HIV RNA species and consequently potently suppressed viral replication. In contrast, in CRISPR-Cas9 genome edited cells expressing mutant C528S XPO1, viral replication was unaffected upon treatment, clearly demonstrating the anti-XPO1 mechanism of action. At the same time, SINE caused the nuclear accumulation of p53 tumor suppressor protein as well as inhibition of NF-κB activity in PEL cells resulting in cell cycle arrest and effective apoptosis induction. In vivo, oral administration arrested PEL tumor growth in engrafted mice. Our findings provide strong rationale for inhibiting XPO1 as an innovative strategy for the combined anti-retroviral and anti-neoplastic treatment of HIV and PEL and offer perspectives for the treatment of other AIDS-associated cancers and potentially other virus-related malignancies.
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MESH Headings
- Acrylates/chemistry
- Acrylates/pharmacology
- Acrylates/therapeutic use
- Active Transport, Cell Nucleus/drug effects
- Animals
- Apoptosis/drug effects
- Base Sequence
- CRISPR-Cas Systems/genetics
- Cell Cycle Checkpoints/drug effects
- Cell Line
- Cell Nucleus/drug effects
- Cell Nucleus/metabolism
- Female
- HIV/drug effects
- HIV/isolation & purification
- Humans
- Karyopherins/antagonists & inhibitors
- Karyopherins/metabolism
- Lymphoma, AIDS-Related/drug therapy
- Mice, Nude
- Molecular Sequence Data
- Molecular Targeted Therapy
- NF-kappa B/metabolism
- Protein Binding/drug effects
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- RNA, Viral/metabolism
- Receptors, Cytoplasmic and Nuclear/antagonists & inhibitors
- Receptors, Cytoplasmic and Nuclear/metabolism
- Reproducibility of Results
- Triazoles/chemistry
- Triazoles/pharmacology
- Triazoles/therapeutic use
- Tumor Suppressor Protein p53/metabolism
- Virus Replication/drug effects
- Xenograft Model Antitumor Assays
- rev Gene Products, Human Immunodeficiency Virus/genetics
- rev Gene Products, Human Immunodeficiency Virus/metabolism
- Exportin 1 Protein
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Affiliation(s)
- Eline Boons
- KU Leuven, Department of Microbiology and Immunology, Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, B-3000 Leuven, Belgium
| | - Els Vanstreels
- KU Leuven, Department of Microbiology and Immunology, Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, B-3000 Leuven, Belgium
| | - Maarten Jacquemyn
- KU Leuven, Department of Microbiology and Immunology, Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, B-3000 Leuven, Belgium
| | - Tatiane C. Nogueira
- KU Leuven, Department of Microbiology and Immunology, Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, B-3000 Leuven, Belgium
| | - Jasper E. Neggers
- KU Leuven, Department of Microbiology and Immunology, Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, B-3000 Leuven, Belgium
| | - Thomas Vercruysse
- KU Leuven, Department of Microbiology and Immunology, Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, B-3000 Leuven, Belgium
| | - Joost van den Oord
- KU Leuven, Department of Imaging and Pathology, Translational Cell & Tissue Research, B-3000 Leuven, Belgium
| | | | | | | | - Robert Snoeck
- KU Leuven, Department of Microbiology and Immunology, Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, B-3000 Leuven, Belgium
| | - Christophe Pannecouque
- KU Leuven, Department of Microbiology and Immunology, Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, B-3000 Leuven, Belgium
| | - Graciela Andrei
- KU Leuven, Department of Microbiology and Immunology, Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, B-3000 Leuven, Belgium
| | - Dirk Daelemans
- KU Leuven, Department of Microbiology and Immunology, Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, B-3000 Leuven, Belgium
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13
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Choi H, Lee HW, Ann HW, Kim JK, Kang HP, Kim SW, Ku NS, Han SH, Kim JM, Choi JY. A Case of Rectal Squamous Cell Carcinoma with Metachronous Diffuse Large B Cell Lymphoma in an HIV-Infected Patient. Infect Chemother 2014; 46:257-60. [PMID: 25566406 PMCID: PMC4285004 DOI: 10.3947/ic.2014.46.4.257] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/17/2013] [Accepted: 10/16/2013] [Indexed: 12/27/2022] Open
Abstract
Diffuse large B cell lymphoma (DLBCL) is one of the most common acquired immune deficiency syndrome (AIDS)-defining malignancies among human immunodeficiency virus-infected patients, and rectal cancer has recently emerged as a prevalent non-AIDS-defining malignancy. We report a case of rectal squamous cell carcinoma that was metachronous with DLBCL in an HIV-infected patient who was receiving highly active antiretroviral therapy. The patient was diagnosed with DLBCL and showed complete remission after chemotherapy. Follow-up imaging showed increased uptake at the rectum, previously treated as lymphoma. Repeated biopsy was performed and squamous cell carcinoma of the rectum was reported. After concurrent chemoradiation therapy, curative resection was performed.
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Affiliation(s)
- Heun Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Won Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hea Won Ann
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hua Pyong Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Wook Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Su Ku
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. ; AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hoon Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. ; AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - June Myung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. ; AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. ; AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
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14
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Hoffmann C, Hentrich M, Gillor D, Behrens G, Jensen B, Stoehr A, Esser S, van Lunzen J, Krznaric I, Müller M, Oette M, Hensel M, Thoden J, Fätkenheuer G, Wyen C. Hodgkin lymphoma is as common as non-Hodgkin lymphoma in HIV-positive patients with sustained viral suppression and limited immune deficiency: a prospective cohort study. HIV Med 2014; 16:261-4. [PMID: 25252101 DOI: 10.1111/hiv.12200] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The incidence of HIV-related non-Hodgkin lymphoma (NHL) but not that of Hodgkin lymphoma (HL) has been declining. The aim of the study was to compare HIV-infected patients with NHL and HL with respect to antiretroviral therapy (ART) exposure at the time of lymphoma diagnosis. METHODS HIV-infected patients with NHL and HL included in a prospective multicentre cohort study since January 2005 were compared with respect to ART exposure and viral load at the time of lymphoma diagnosis. RESULTS As of 31 December 2012, data for 329 patients with NHL and 86 patients with HL from 31 participating centres were available. Patients with HL were more likely to be on ART (73.5% vs. 39.1%, respectively; P < 0.001) and more frequently had a viral load below the detection limit (57.3% vs. 27.9%, respectively; P < 0.001) than patients with NHL. The proportion of patients with HL was 8.0% in ART-naïve patients, 34.8% in patients with current HIV RNA < 50 HIV-1 RNA copies/mL, and 50.0% in patients with both HIV RNA < 50 copies/mL for > 12 months and a CD4 cell count of > 200 cells/μL. Of note, 45.8% of all patients with NHL were not currently on ART and had a CD4 count of < 350 cells/μL. CONCLUSIONS This prospective cohort study shows that HL was as common as NHL in patients with sustained viral suppression and limited immune deficiency. In contrast to NHL, the majority of patients with HL were on effective ART, suggesting that ART provides insufficient protection from developing HL. The high proportion of untreated patients with NHL suggests missed opportunities for earlier initiation of ART.
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Affiliation(s)
- C Hoffmann
- IPM Study Center, Hamburg, Germany; University of Schleswig Holstein, Campus Kiel, Kiel, Germany
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15
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Ota Y, Hishima T, Mochizuki M, Kodama Y, Moritani S, Oyaizu N, Mine S, Ajisawa A, Tanuma J, Uehira T, Hagiwara S, Yajima K, Koizumi Y, Shirasaka T, Kojima Y, Nagai H, Yokomaku Y, Shiozawa Y, Koibuchi T, Iwamoto A, Oka S, Hasegawa H, Okada S, Katano H. Classification of AIDS-related lymphoma cases between 1987 and 2012 in Japan based on the WHO classification of lymphomas, fourth edition. Cancer Med 2014; 3:143-53. [PMID: 24407967 PMCID: PMC3930399 DOI: 10.1002/cam4.178] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 11/06/2013] [Accepted: 11/18/2013] [Indexed: 11/17/2022] Open
Abstract
The introduction of combined antiretroviral therapy (ART) has reduced the mortality of patients with human immunodeficiency virus-1 infection worldwide. However, malignant lymphoma is a severe and frequent complication seen in patients with acquired immunodeficiency syndrome (AIDS). The diagnostic criteria for some categories of AIDS-related lymphoma were revised in the World Health Organization International Classification of Lymphoma, fourth edition. The purpose of this study was to assess the clinicopathological characteristics of Japanese patients with AIDS-related lymphoma according to the revised classification. In this retrospective study, 207 AIDS-related lymphoma cases diagnosed between 1987 and 2012 in Japan were subjected to histological subtyping and clinicopathological analyses. Diffuse large B-cell lymphoma (DLBCL) was the predominant histological subtype throughout the study period (n = 104, 50%). Among the DLBCL cases, 24% were of the germinal center (GC) type and 76% were of the non-GC type. Non-GC-type cases showed a significantly lower 1-year survival rate (43%) than the GC-type cases (82%). Cases of Burkitt lymphoma (n = 57, 28%), plasmablastic lymphoma (n = 16, 8%), primary effusion lymphoma (n = 9, 4%), Hodgkin lymphoma (n = 8, 4%), and large B-cell lymphoma arising in Kaposi sarcoma-associated herpesvirus-associated multicentric Castleman disease (n = 2, 1%) were also observed. Hodgkin lymphoma was more common in patients receiving ART (11.1%) than in ART-naïve patients (1.4%). Statistical analyses identified CD10 negativity, BCL-6 negativity, Epstein–Barr virus positivity, and Kaposi sarcoma-associated herpesvirus positivity as risk factors for poor prognosis. This information will help in the early diagnosis of lymphoma in patients with AIDS.
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Affiliation(s)
- Yasunori Ota
- Department of Pathology and Laboratory Medicine, Institute of Medical Science, The University of Tokyo, Shirokanedai 4-6-1, Minato-ku, Tokyo, 108-8639, Japan
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16
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Abstract
Immune Reconstitution syndrome following antiretroviral therapy is common in HIV/AIDS patients due to boosting of immunity. A case is reported here wherein AIDS-related Non-Hodgkin‘s lymphoma patient received CHOP regimen and antiretroviral therapy. Patient developed tubercular lymphadenopathy paradoxically as a manifestation of IRIS.
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Affiliation(s)
- Uday A Phatak
- Department of Medicine, Shri Siddhivinayak Ganapati Cancer Hospital, Miraj, India
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