HIV-associated lymphoma

Adult Lymphoma Program, University of California, San Francisco, CA 94143, USA.
Best practice & research. Clinical haematology (Impact Factor: 2.12). 03/2012; 25(1):101-17. DOI: 10.1016/j.beha.2012.01.001
Source: PubMed


The incidence of aggressive lymphoma in the setting of HIV infection is significantly increased relative to the general population. Combination antiretroviral therapy (cART) for HIV has reduced the incidence of these neoplasms and has significantly improved clinical outcome for those who do develop lymphoma and require chemotherapy. With the possible exception of those individuals with the most severe immunocompromise, patients with HIV-associated lymphoma can be treated with the same standard immuno-chemotherapy regimens used in the immunocompetent population with similar expectations for good clinical outcome. Infusional regimens like dose adjusted EPOCH-R appear to be highly effective first-line therapy and for relapsed patients high-dose chemotherapy with autologous stem cell support is well-tolerated and effective. However, it should be recognized that there are unique risks associated with management of lymphoma in this patient population. While opportunistic infections are no longer a significant cause of death, antiretroviral agents used for management of HIV infection may interact with chemotherapeutic agents and other adjunctive therapies making communication between the treating Oncologist and the patient's primary HIV treatment provider of prime importance.

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    • "This is followed by pathological evaluations, which include flow cytometry or immunohistochemical staining for immunophenotype.75 For aggressive lymphomas, this includes evaluation of proliferative fraction using Ki-67 or MIB-1 staining as a more aggressive regimen may be indicated for high growth fraction tumors.77 The expression of Ki-67 has been associated with poor outcome and survival in DLBCL patients.79,80 "
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    • "The frequency of EBV detection in these tumors ranges from 60% in BL to 100% in PCNSL (Carbone et al., 2009). Before the introduction of ART, the incidence of NHL in HIV-1 infected subjects was 100 times higher than in the general population (Goedert et al., 1998; International Collaboration on HIV and Cancer, 2000), PCNSL and high grade IBL being the most common NHL subtypes, followed by BL and intermediate grade DLBCL (Kaplan, 2012). High levels of HIV-1 plasmaviremia and low CD4 cell counts are both risk factors for the onset of NHL. "
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