Human immunodeficiency virus-related non-Hodgkin's lymphoma

Abstract

F e r r a t a S t o r t i F o u n d a t i o n © F e r r a t a S t o r t i F o u n d a t i o nEditorialsaccount. The results of the combination of full dose chemotherapeutic regimens and HAART have improved the response rate and the survival of patients with HIV-related lymphomas ( Figure 1). In two comparative studies, the prognosis of patients with HIVrelated lymphomas was similar to that observed in non-immunosuppressed patients with non-Hodgkin's lymphoma of the same histological type. 11,12 The main prognostic factors for these patients were the IPI score and the CD4 lymphocyte count at the time of diagnosis. 13 In addition, it is of note that chemotherapy and concomitant HAART do not cause prolonged suppression of lymphocyte subsets 14 and, most importantly, that the immmunological response to HAART has a positive effect on the survival of these patients. 15 Treatment of patients with HIV-related BL has evolved from reduced-dose or CHOP-like chemotherapy regimens with resultant poor clinical outcomes to more Burkitt-oriented short, intensive multiagent chemotherapy including fractionated cyclophosphamide, high-dose methotrexate and cytarabine. The widespread use of HAART has overcome much of the reluctance to pursue intensive regimens in AIDS-related BL. Specific therapies for these patients have includ- Although these regimens have been associated with significant toxicity in HIV-related BL, they have resulted in an improvement in the response rate and in the survival probability of up to 50%. In the ALL3/97 study, no significant differences were observed in the survival of patients with HIV-related or unrelated BL. 18Again, patients with an immunological response to HAART had a better prognosis than those who did not take or did not respond to HAART.Mimicking non-Hodgkin's lymphoma in nonimmunosuppressed patients, the next step was to use immunochemotherapy for both AIDS-related DLBCL and BL. Three phase II trials with chemotherapy (CHOP in two trials 19,20 and CDE in one 21) and rituximab have shown that immunochemotherapy with concomitant administration of HAART is feasible, safe and effective, with complete responses in more than 70% of patients and survival probabilities ranging from 65% to 75%. However, from the data of these phase II trials it is difficult to determine the contribution of rituximab to the overall efficacy. The only comparative trial published to date, the AMC-10 trial, 22 which compared the CHOP regimen with or without rituximab, showed a not statistically significant trend for a better response rate (57.6% vs. 47%) in the rituximab-CHOP (R-CHOP) arm, which did not translate into better survival, at least in part because of the excess number of infectious deaths in that arm (14% vs. 2%). Nevertheless, even in moderately immunosuppressed patients (i.e., those with a CD4 lymphocyte count over 100/µL) no significant benefits in terms of survival were observed in the R-CHOP arm. The inclusion of a high number of severely immunosuppressed patients in that trial could explain the inferio...

Prognostic factors in patients with HIV‐associated peripheral T‐cell lymphoma: A multicenter study

“…The use of HAART has not only been associated with a decrease in the incidence, but also an improvement in survival in HIV‐associated lymphomas [39]. Furthermore, studies have shown that an immunological response to HAART could be the main reason for this survival benefit [40].…”

HIV-infection impact on clinical–biological features and outcome of diffuse large B-cell lymphoma treated with R-CHOP in the combination antiretroviral therapy era

“…The prognosis of HIV-related lymphomas has substantially improved with the introduction of cART, mostly because cART has reduced the risk of infectious complications preventing patient death from AIDS-related diseases other than lymphoma [5]. Additionally, the use of the granulocyte colony-stimulating factor has decreased the frequency of neutropenic-related infections and has contributed to timely administration of adequate systemic treatment [6].…”

Linfomas asociados a infección por Virus de Inmunodeficiencia Humana: Experiencia de un centro hospitalario de la V región, Chile

“…No obstante, destaca el hecho que todos los pacientes sobrevivientes a la fecha, hayan recibido TARGA asociada a quimioterapia intravenosa, y más aún, que cinco de ellos se encuentren en RC a la fecha de redacción de este informe. Dicha observación concuerda con algunos reportes que han demostrado la viabilidad del uso concomitante de quimioterapia y TARGA [22][23]25,29 . Considerando el grado de compromiso clí-nico e inmunológico, los tipos histológicos más frecuentes y el bajo número de pacientes que se encontraba recibiendo TARGA al momento del diagnóstico de linfoma, se sugiere que el comportamiento de esta serie respecto a la asociación diagnóstica Linfoma/VIH se asemeja al observado durante la era pre-TARGA, con predominio de aquellos tipos histológicos defi nitorios de SIDA y bajos porcentajes de remisión completa.…”