High-Dose Therapy and Autologous Peripheral-Blood Stem-Cell Transplantation As Salvage Treatment for HIV-Associated Lymphoma in Patients Receiving Highly Active Antiretroviral Therapy

Re, Alessandro; Cattaneo, Chiara; Michieli, Mariagrazia; Casari, Salvatore; Spina, Michele; Rupolo, Maurizio; Allione, Bernardino; Nosari, Annamaria; Schiantarelli, Clara; Viganó, Mariagrazia; Izzi, Immacolata; Ferremi, P.; Lanfranchi, Arnalda; Mazzuccato, Maurizio; Carosi, G.; Tirelli, Umberto; Rossi, Giuseppe

doi:10.1200/jco.2003.06.039

Cited by 117 publications

(77 citation statements)

References 17 publications

(15 reference statements)

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“…Although there may be no role for rituximab in CD20-negative PBL, it may have potential in those PBL cases with weak CD20 expression. Autologous stem cell transplantation (SCT) in the management of HIV-associated lymphomas has shown to be feasible and effective [45,46], but its role in HIV-associated PBL is unclear. In fact, DLBCL with plasmablastic differentiation have shown to be resistant to standard chemotherapy and even SCT [43].…”

Section: Discussionmentioning

confidence: 99%

HIV‐associated plasmablastic lymphoma: Lessons learned from 112 published cases

2008

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Plasmablastic lymphoma (PBL) is a distinct subtype of non-Hodgkin B-cell lymphoma, originally described with a strong predilection to the oral cavity of human immunodeficiency virus (HIV)-infected individuals. Data regarding patient age and gender, HIV status, initiation of and response to highly active antiretroviral therapy (HAART), tumor extent, pathology, treatment, and outcome were extracted from 112 cases of PBL identified in the literature. The median age at presentation was 38 years with a male predominance of 7:1, and the median CD41 count was 178 cells/mm 3 . PBL presented on average 5 years after diagnosis of HIV. Common primary sites of presentation included the oral cavity, gastrointestinal tract, and lymph nodes. Most cases presented with either stage I or stage IV disease. There was a variable expression of B-cell markers in tumor cells, but plasma cell markers were expressed in all cases. EBV was detected in 74%. Chemotherapy was used to treat 55% patients and was combined with radiotherapy in 21% cases. Complete response was obtained in 66% of treated cases; the majority of these responses were seen after CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone). The refractory/relapsed disease rate was 54%. Death occurred in 53% of patients, with a median overall survival of 15 months. Sex, CD41 count, viral load, clinical stage, EBV status, primary site of involvement, and use of CHOP failed to show an association with survival. PBL is an aggressive B-cell lymphoma that presents in both oral and extra-oral sites of chronically HIV-infected immunosuppressed young men. Am. J. Hematol. 83:804-809, 2008. V

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Section: Discussionmentioning

confidence: 99%

HIV‐associated plasmablastic lymphoma: Lessons learned from 112 published cases

2008

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“…It is possible that delayed recovery of humoral immunity could contribute to this increased risk of life-threatening bacterial infections in HIV-infected patients. There have been several reports on the feasibility and efficacy of high dose chemotherapy and autologous stem cell transplant for ARL [23,24]. It is reasonable to assume that patients with well controlled HIV and good performance status should be considered candidates for this therapy.…”

Section: Therapy Of Aids Nhlmentioning

confidence: 99%

AIDS and associated malignancies

Wood

Harrington

2005

Cell Res

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AIDS associated malignancies (ARL) is a major complication associated with AIDS patients upon immunosuppression. Chronically immunocompromised patients have a markedly increased risk of developing lymphoproliferative disease. In the era of potent antiretrovirals therapy (ARV), the malignant complications due to HIV-1 infection have decreased in developed nations where ARV is administered, but still poses a major problem in developing countries where HIV-1 incidence is high and ARV is still not yet widely available. Even in ARV treated individuals there is a concern that the prolonged survival of many HIV-1 carriers is likely to eventually result in an increased number of malignancies diagnosed. Malignancies that were found to have high incidence in HIV-infected individuals are Kaposi's sarcoma (KS), Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL). The incidence of NHL has increased nearly 200 fold in HIV-positive patients, and accounts for a greater percentage of AIDS defining illness in the US and Europe since the advent of HAART therapy. These AIDS related lymphomas are distinct from their counterparts seen in HIV-1 seronegative patients. For example nearly half of all cases of ARL are associated with the presence of a gamma herpesvirus, Epstein Barr virus (EBV) or human herpesvirus-8 (HHV-8)/ Kaposi's sarcoma associated herpesvirus (KSHV). The pathogenesis of ARLs is complex. B-cell proliferation driven by chronic antigenemia resulting in the induction of polyclonal and ultimately monoclonal lymphoproliferation may occur in the setting of severe immunosuppression.

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“…High-dose chemotherapy with autologous stem cell transplant (ASCT) has been reported in only two individual case reports of PEL [59,60], and currently, there is no evidence to support using ASCT as consolidation therapy in first remission. However, extrapolating from other studies in ARL [61], it can be considered for chemotherapy-responsive relapsed disease in patients who maintain a good performance status.…”

Section: Treatmentmentioning

confidence: 99%