Important note: Information in this article was accurate in 1995. The state of the art may have changed since the publication date.
Clinical aspects of AIDS-related lymphoma (Meeting abstract).
Proc Annu Meet Am Assoc Cancer Res; 35:660-1 1994. Unique Identifier : AIDSLINE ICDB/95606243 Levine AM; Univ. of Southern California Sch. of Medicine, Los Angeles, CA; 90033
Abstract:
Lymphoma is a relatively late manifestation of HIV infection, designated as an AIDS-defining condition in 1985. With prolonged survival in HIV disease, increasing numbers of patients with lymphoma are expected. Factors associated with lymphoma included very low CD4 cells (less than 50/dl) and elevated serum IL-6 levels. Lymphoma occurs in all risk groups for HIV infection, and appears similar in biologic, clinical and pathologic characteristics. Overall, the risk of lymphoma is increased 60- to 100-fold in the setting of HIV infection. The vast majority of AIDS lymphomas are of high-grade, B-cell type, consisting primarily of immunoblastic, diffuse large cell, or small noncleaved types. Low grade lymphomas, various T-cell lymphomas, and Ki-1-positive anaplastic lymphomas have also been described. Although polyclonal lymphomas have been reported, the vast majority are monoclonal, by genotypic and immunophenotypic analysis. Certain clinicopathologic correlates have been described. Thus, primary central nervous system (PCNS) lymphomas tend to be large cell or immunoblastic types, with uniform presence of clonal EBV, and expression of certain EBV-related latent proteins. Further, patients with these large cell lymphomas tend to have greater degrees of immunosuppression with lower CD4 cells. Systemic 'B' symptoms are seen in 80-90% of patients at diagnosis. Further, the majority of cases present with far-advanced, extranodal disease, occurring in 60-90%. Common sites of extranodal involvement include the CNS in approx 30%; bone marrow in 25%; and gastrointestinal tract in 25%. Literally any anatomic site may be involved. Prognostic indicators which correlate with survival include both HIV and lymphoma-related characteristics. Those factors associated with shorter survival include history of AIDS prior to the lymphoma; low CD4 cells (less than 200/dl); Karnofsky performance status less than 70%; and bone marrow involvement. Patients with primary CNS lymphoma seem to have the poorest prognosis, with median survival of approx 2-3 months, despite therapy. These individuals have evidence of profound HIV-associated immunodeficiency, with a history of AIDS prior to the lymphoma in 73%, and median CD4 cells of approx 30/dl. Mass lesions within the CNS are expected, occurring in any location; ring enhancement is common on CAT scan. These individuals may present with focal neurologic deficits, seizures, or altered mental status alone. Standard therapy has included radiation alone, which has resulted in significant clinical improvement in approx 75%, although survival time has not been prolonged. Use of combined chemotherapy with radiation is now being explored. Optimal therapy for patients with systemic AIDS-related lymphoma has yet to be defined. The use of various dose-intensive regimens has been associated with high rates of opportunistic infection, leading to early demise.While these regimens may be tolerable in patients with good prognostic indicators of disease, there is no evidence that this dose-intensity offers any advantage over less intensive regimens. Use of standard, or low-dose regimens of multi-agent chemotherapy, along with CNS prophylaxis has resulted in complete remission rates o approximately 50%, with median survival of approx 18 months in these responders; death is primarily due to development of: additional AIDS-related conditions. Use of low-dose chemotherapy together with antiretroviral agents (ddC) may result in fewer complicating opportunistic infections and higher response rates in patients with poor prognostic indicators. Infusional chemotherapy has been used with efficacy. Preliminary evidence of efficacy has been reported with various immunoconjugates including anti-B4 conjugated with ricin. Of interest, spontaneous regression of AIDS-related lymphoma has also been described, although rarely. (11 Refs)
Keywords: Central Nervous System Neoplasms/ETIOLOGY CD4-Positive T-Lymphocytes Human Lymphoma, AIDS-Related/*COMPLICATIONS/IMMUNOLOGY/PATHOLOGY/ THERAPY Risk Factors ABSTRACT 950430
M9541146
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Important note: Information in this article was accurate in 1995. The state of the art may have changed since the publication date.
