Important note: Information in this article was accurate in 1993. The state of the art may have changed since the publication date.
AIDS-associated lymphoma (Meeting abstract).
Lymphoma: the next questions. April 2-4, 1992, Orlando, FL, 1992.. Unique Identifier : AIDSLINE ICDB/93690616 Straus DJ; Memorial Sloan-Kettering Cancer Center, New York, NY
Abstract:
The association of intermediate- and high-grade non-Hodgkin's lymphoma (NHL) with AIDS in the male homosexual population was established in 1984. Although the majority of patients (pts) with HIV infection and intermediate- or high-grade NHL in the United States are male homosexuals, a preponderance of iv drug abusers, another high-risk group for AIDS, was found in a large series of HIV-associated lymphomas from Italy. The unusual features of these B-cell lymphomas have been described extensively, including the involvement of extranodal sites in general and particularly the bone marrow and CNS either with meningeal metastases from systemic lymphoma or with presentation as a primary brain tumor. Recently, an alarmingly high number of high-grade NHL pts has been reported among a cohort of HIV-infected pts treated with zidovudine at the NCI between 1985 and 1987: 8 cases among 55 pts (4 large cell immunoblastic and 4 small noncleaved cell). The authors speculated that with prolonged survival due to antiretroviral treatment in the setting of profound immunosuppression, an increase in high-grade lymphomas in the HIV-infected population might be expected. The prognosis for pts with AIDS-associated NHL is poor, with median survivals of approx 6 mo in most series. This is particularly true for primary brain lymphoma, which is almost universally fatal. Death is directly due to lymphoma in approx 50% of pts and to infections, at times probably aggravated by chemotherapy in the rest. High-dose chemotherapy may increase the risk of fatal infection in these pts. However, we and others have achieved and maintained remissions and possibly even cures of the lymphoma in some pts treated with combination chemotherapy. In our series, 9/40 pts with intermediate- and high-grade NHL were rendered disease-free for more than 1 yr. Although numbers were insufficient for valid statistical analysis, it appeared that early stage and lack of prior opportunistic infections were often features of surviving pts. Kaplan and associates found CS greater than 100/mm3 to be the most important predictor of long survival. Other predictors of longer survival were absence of a prior AIDS diagnosis, Karnofsky performance status greater than 70, and absence of extranodal disease. Hodgkin's disease with manifestations somewhat different from those in pts without HIV infection has also been reported. Advanced stage, mixed cellularity histology and extranodal disease including bone marrow involvement have been seen more frequently than expected. Unlike high- and intermediate-grade B-cell NHL, it is not established that the incidence of Hodgkin's disease is increased in the age group with the highest incidence of HIV infection. As with non-Hodgkin's lymphoma, the results with chemotherapy have been poor, although long-term remission has been achieved in a minority of pts. More recently, peripheral T-cell lymphomas have also been reported in HIV-infected individuals, although these cases appear to be rare.
Keywords: Acquired Immunodeficiency Syndrome/*COMPLICATIONS Cohort Studies Hodgkin's Disease/COMPLICATIONS/EPIDEMIOLOGY Homosexuality Human Lymphoma, Non-Hodgkin's/*COMPLICATIONS/EPIDEMIOLOGY/MORTALITY/ PATHOLOGY Male Meningeal Neoplasms/SECONDARY Prognosis Retrospective Studies Survival Analysis United States/EPIDEMIOLOGY ABSTRACT 930830
M9380841
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Important note: Information in this article was accurate in 1993. The state of the art may have changed since the publication date.
