Chemotherapy for Hiv-Associated Non-Hodgkin Lymphoma (Hiv-Nhl) in Combination With Highly Active Antiretroviral Therapy (Haart) Is Not Associated With Excessive Toxicity.

Ratner, Lee; Redden, David; Hamzeh, Fayez M.; Levine, A; Harrington, William J.; Scadden, David T.; Kaplan, Lawrence D.; Ambinder, R. F.; Grochow, Louise B.; Flexner, Charles; Tan, Bruce K.; Dj, Straus

doi:10.1097/00126334-199905010-00112

Cited by 16 publications

(11 citation statements)

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“…22 A recent small trial that looked at low-dose and then standard-dose CHOP in patients with ARL has also failed to demonstrate a difference between low-dose and standard-dose CHOP, and its results appear consistent with previous published data on survival after low-dose or standard-dose mBACOD. 42 In another retrospective analysis of 369 patients with ARL, treated between 1982 and 1998 in one institution, no difference in survival was apparent when patients treated for various time intervals were compared. 43 While the current study is retrospective and employed with variable treatment regimens, there still are no published data to suggest that any of the major regimens we employed was significantly different from the others in terms of outcome.…”

Section: Discussionmentioning

confidence: 95%

Clinical, immunologic, and pathologic correlates of bone marrow involvement in 291 patients with acquired immunodeficiency syndrome–related lymphoma

Seneviratne

Espina

Nathwani

et al. 2001

Blood

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Bone marrow involvement is reported in approximately 25% of patients with newly diagnosed acquired immunodeficiency syndrome-related lymphoma (ARL). Studied were 291 patients with ARL, diagnosed and treated at one medical center between 1984 and 1998. Clinical, immunologic, and pathologic characteristics of patients with bone marrow involvement were compared with those of patients without marrow involvement. Bone marrow involvement was present in 55 patients (19%). Small noncleaved lymphoma was diagnosed in 38% of the entire group and was the most common pathologic subtype in patients with bone marrow involvement (55% versus 34%; P ‫؍‬ .008). Analysis of complete blood counts revealed a median hemoglobin level of 10.6 g/dL in both marrow-positive and marrownegative groups. In contrast, a platelet count lower than 100 000/L was more common in patients with bone marrow involvement (27% versus 11%; P ‫؍‬ .02). Patients with marrow involvement were more likely to have leptomeningeal (cerebrospinal fluid [CSF]) lymphoma than patients whose marrows were uninvolved (24% versus 7%; P < .001) and were also more likely to have high lactate dehydrogenase (LDH) (P ‫؍‬ .002), bone involvement (P < .001), and/or systemic B symptoms including fever, night sweats, and/or weight loss (P ‫؍‬ .05). Median survival did not differ between marrow-positive and marrow-negative groups. On multivariate analysis, factors associated with decreased survival of marrow-positive patients included greater than 50% involvement (P ‫؍‬ .002), systemic B symptoms (P ‫؍‬ .008), and high-grade histologic type (P ‫؍‬ .035). Marrow involvement in ARL correlates with small noncleaved pathology, thrombocytopenia lower than 100 000 mm 3 , high LDH, and lymphomatous involvement of the CSF. Survival is statistically shorter in patients with greater than 50% marrow involvement, high-grade pathology, and/or systemic B symptoms. (Blood. 2001;98:2358-2363)

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Section: Discussionmentioning

confidence: 95%

Clinical, immunologic, and pathologic correlates of bone marrow involvement in 291 patients with acquired immunodeficiency syndrome–related lymphoma

Seneviratne

Espina

Nathwani

et al. 2001

Blood

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“…The recent advent of HAART has resulted in notable improvement on survival and has dramatically reduced the incidence of opportunistic infections in HIV-infected individuals (5)(6)(7)17). Although the prognosis of patients with AIDS-related lymphoma remains poor, some subgroups of patients have a signi cantly better outcome (18 -22).…”

Section: Discussionmentioning

confidence: 99%

“…Therapy for HIV has improved in the past 10 years because of different combinations of drugs, particularly those including a protease inhibitor. The widespread use of the so-called HAART (highly active antiretroviral therapy) since 1996-1997 has resulted in a greater reduction in HIV viral load, fewer opportunistic infections, and reduced mortality compared with nucleoside analog therapy alone (5,(7)(8)(9)(10). The US Centers for Disease Control and Prevention (CDC) reported that AIDS-related deaths decreased for the rst time in 1996 (11).…”

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confidence: 99%

Impact of Highly Active Antiretroviral Therapy in the Treatment of HIV–Infected Patients with Systemic Non-Hodgkin‘s Lymphoma

et al. 2002

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Twenty cases of systemic non-Hodgkin's lymphoma (NHL) in HIV-infected patients were reviewed over a 10-year-period, divided into Group A, including 13 NHL cases treated before the highly active antiretroviral therapy (HAART) era, and Group B, including 7 patients who received HAART. A Kaplan-Meier survival curve was performed and log-rank was applied to assess statistical differences between the groups. In group A, the median CD4 count was 36 cells/mm3. No complete remission was found. In group B, the median CD4 count was 137 cells/mm3. Four patients (57.0%) are still alive and in complete remission. Group A had a median survival of 5 months and group B 31 months (p = 0.0032). Our results are in agreement with recent reports in that a higher CD4 count and better immune status achieved with HAART is predictive of a better outcome. We found that HAART in combination with chemotherapy improves overall survival of NHL patients without increasing adverse effects.

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“…However, it is unclear whether HAART is fully effective at reversing the B-cell stimulation that is associated with HIV-1 infection, and represents a risk factor for NHL. Ratner et al [101] showed that concomitant use of standard chemotherapy and HAART in HIV-1-infected patients with NHL was effective and safe. In addition, the incidence of all subtypes of NHL has decreased significantly, especially for primary brain lymphoma and immunoblastic lymphoma, in the era of HAART [84].…”

Section: Lymphoproliferative Manifestationsmentioning

confidence: 99%

Impact of highly active antiretroviral therapy on organ‐specific manifestations of HIV‐1 infection

2005

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In the last 10 years, interesting results have been reported concerning the impact of highly active antiretroviral therapy (HAART) on the changing pattern of organ-specific manifestations of HIV-1 infection. There has been a clear step-wise reduction in the incidence of several opportunistic infections (OIs), particularly Pneumocystis carinii pneumonia, whereas a nonsignificant reduction in incidence has been observed for other organ-specific diseases, including invasive cervical cancer and Hodgkin disease. In addition, several organ-specific manifestations, including HIV-associated nephropathy, wasting syndrome and cardiomiopathy, are a direct consequence of damage by HIV-1, and so HAART may have a therapeutic effect in improving or preventing these manifestations. Finally, the introduction of HAART has seen the emergence of several complications, termed immune reconstitution inflammatory syndrome, which includes OIs such as cytomegalovirus vitritis, Mycobacterium avium complex lymphadenitis, paradoxical responses to treatment for tuberculosis, and exacerbation of cryptococcosis. Because not all HIV-1 organ-specific manifestations are decreasing in the HAART era, this review will analyse the influence of HAART on several organ-specific manifestations, and in particular OIs related to several organs, cerebral disorders and HIV-1-related neoplasia.

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Chemotherapy for Hiv-Associated Non-Hodgkin Lymphoma (Hiv-Nhl) in Combination With Highly Active Antiretroviral Therapy (Haart) Is Not Associated With Excessive Toxicity.

Cited by 16 publications

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Clinical, immunologic, and pathologic correlates of bone marrow involvement in 291 patients with acquired immunodeficiency syndrome–related lymphoma

Clinical, immunologic, and pathologic correlates of bone marrow involvement in 291 patients with acquired immunodeficiency syndrome–related lymphoma

Impact of Highly Active Antiretroviral Therapy in the Treatment of HIV–Infected Patients with Systemic Non-Hodgkin‘s Lymphoma

Impact of highly active antiretroviral therapy on organ‐specific manifestations of HIV‐1 infection

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