Classification of AIDS‐related lymphoma cases between 1987 and 2012 in Japan based on the WHO classification of lymphomas, fourth edition

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.

In situ BCL2 expression is an independent prognostic factor in HIV‐associated DLBCL, a LYMPHOVIR cohort study

“…Previous studies included various time periods (pooling pre‐ and post‐cART lymphoma samples) and/or heterogeneous chemotherapy protocols. Such heterogeneity probably contributed to the conflicting results reported thus far in the HIV‐setting concerning the prognostic impact of COO classification, different biological markers (BCL2, TP53, Ki67) or EBER expression (Wilson et al , ; Little et al , ; Hoffmann et al , ; Wilson et al , ; Chadburn et al , ; Dunleavy et al , ; Ota et al , ). Here, in situ BCL2 expression was significantly associated with a poorer prognosis, regardless of the molecular subtype and independently of the aaIPI.…”

“…The COO has been shown to be an independent prognostic factor in HIV uninfected individuals with DLBCL when classified by immunohistochemistry (IHC) using the Hans algorithm based on CD10, BCL6 and MUM1 expression, or gene expression profiling (GEP) (Alizadeh et al , ; Coiffier, ; Rosenwald et al , ; Savage et al , ; Wright et al , ; Hans et al , ; Carbone & Gloghini, ; Wilson et al , ; Lenz et al , ). Some authors have reported an association between CD10, BCL6 and MUM1 expression and outcome in HIV‐infected DLBCL, and studies on the clinical significance of COO groups classified by the Hans algorithm on outcome have provided conflicting results (Little et al , ; Hoffmann et al , ; Chadburn et al , ; Dunleavy et al , ; Ota et al , ). Finally, in‐situ expression of other biomarkers (TP53, Ki67) or Epstein–Barr virus (EBV) has been found to be inconsistently associated with the prognosis of HIV‐associated DLBCL (Little et al , ; Chadburn et al , ; Dunleavy et al , ; Chao et al , ; Ota et al , ).…”

“…Some authors have reported an association between CD10, BCL6 and MUM1 expression and outcome in HIV‐infected DLBCL, and studies on the clinical significance of COO groups classified by the Hans algorithm on outcome have provided conflicting results (Little et al , ; Hoffmann et al , ; Chadburn et al , ; Dunleavy et al , ; Ota et al , ). Finally, in‐situ expression of other biomarkers (TP53, Ki67) or Epstein–Barr virus (EBV) has been found to be inconsistently associated with the prognosis of HIV‐associated DLBCL (Little et al , ; Chadburn et al , ; Dunleavy et al , ; Chao et al , ; Ota et al , ).…”

Approach to Peribronchovascular Disease on CT

“…13 An association of AIDS with lymphoma is known, primarily diffuse large B-cell lymphoma. 19,20 Diagnosis of primary pulmonary lymphoma is made by open surgical biopsy, and when multifocal disease is present, transthoracic needle core biopsy/ fine needle aspiration and transbronchial biopsy with CT navigation and cryobiopsy are potential methods to make diagnosis with increasing sensitivity. Molecular testing of cells obtained from bronchoalveolar lavage fluid may aid in diagnosing MALT lymphoma.…”

Current status of treatment for primary effusion lymphoma

“…Among HIV-associated lymphoma, PEL arises more frequently in the HIV-infected population. PEL accounts for approximately 4% of all HIV-associated NHL cases (11,12). PEL is described as a distinct entity and is also included in "lymphomas occurring more specifically in HIV-positive patients" among HIV-associated lymphoma in the WHO classification (13).…”