Dev Oncol; 32:245-50 1985. Unique Identifier : AIDSLINE ICDB/87629333 Longo DL; Steis RG; Masur H; Lane HC; Preble O; Fauci AS; Gelmann EP; Medicine Branch, NCI, Bethesda, MD
Abstract:
The acquired immune deficiency syndrome (AIDS), an almost uniformly fatal, transmissible new disease characterized by profoundly depressed cellular immunity, is manifest clinically by serious, life-threatening opportunistic infections and neoplasms. There are four major risk groups: male homosexuals and bisexuals (71%), heterosexual drug abusers (17%), Haitians (5%), and hemophiliacs (1%). A large number of opportunistic pathogens which are rare in other populations cause significant morbidity and mortality in this group of patients (pts). Such pathogens include cytomegalovirus, Candida albicans, Pneumocystis carinii, Mycobacterium avium-intracellulare, Cryptococcus neoformans, Cryptosporidium, Toxoplasma gondii, and Epstein-Barr virus. Two types of malignancy occur with increased frequency in victims of AIDS: Kaposi's sarcoma (KS), and malignant lymphomas of several histologic types. The lymphoma subtypes have diverse cells of origin including B cells, T cells, and dendritic cells. Pts rarely have both KS and lymphoma. The male homosexual risk group also suffers an increased incidence of squamous cell carcinoma of the tongue and cloacagenic carcinoma of the rectum. Nearly 35% of AIDS pts have developed KS and 30% of those pts have died. Lymphoblastoid interferon, a mixture of several molecules with alpha-interferon properties purified from the Namalva cell line, was used to treat 30 pts with AIDS-associated KS. Ten pts were treated for 28 days at each of the following dose levels: 7.5 MU/m2/day, 15 MU/m2/day, and 25 MU/m2/day. The highest dose level was toxic (intolerable fatigue, weakness, depression) and dose reduction was required in 75% of the pts. There were 3 partial and 4 minor responses (response rate 11-24%). Dose level did not appear to affect response rate. Two small nonrandomized chemotherapy series have been reported using single agents (vinblastine or etoposide) and combinations (doxorubicin, bleomycin, and vinblastine). There have been no long-term disease-free survivors. In contrast to AIDS pts with KS, those who develop malignant lymphoma require aggressive management. Such lymphomas are usually rapidly progressive, unfavorable histologic subtypes that represent a major threat to life. CNS involvement is common. Ultimate success in controlling malignancies associated with AIDS probably depends on reversing the underlying immune dysfunction. (18 Refs)
Keywords: Acquired Immunodeficiency Syndrome/*COMPLICATIONS/MORTALITY Combined Modality Therapy Human Lymphoma, Non-Hodgkin's/COMPLICATIONS/THERAPY Male Neoplasms/*COMPLICATIONS Opportunistic Infections/*COMPLICATIONS Prognosis Sarcoma, Kaposi's/COMPLICATIONS/PATHOLOGY/THERAPY MEETING PAPER
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