AIDS-related Burkitt lymphoma in the United States: What do age and CD4 lymphocyte patterns tell us about etiology and/or biology?

Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
Blood (Impact Factor: 10.45). 12/2010; 116(25):5600-4. DOI: 10.1182/blood-2010-03-275917
Source: PubMed


Trimodal or bimodal age-specific incidence rates for Burkitt lymphoma (BL) were observed in the United States general population, but the role of immunosuppression could not be excluded. Incidence rates, rate ratios, and 95% confidence intervals for BL and other non-Hodgkin lymphoma (NHL), by age and CD4 lymphocyte count categories, were estimated using Poisson regression models using data from the United States HIV/AIDS Cancer Match study (1980-2005). BL incidence was 22 cases per 100 000 person-years and 586 for non-BL NHL. Adjusted BL incidence rate ratio among males was 1.6× that among females and among non-Hispanic blacks, 0.4× that among non-Hispanic whites, but unrelated to HIV-transmission category. Non-BL NHL incidence increased from childhood to adulthood; in contrast, 2 age-specific incidence peaks during the pediatric and adult/geriatric years were observed for BL. Non-BL NHL incidence rose steadily with decreasing CD4 lymphocyte counts; in contrast, BL incidence was lowest among people with ≤ 50 CD4 lymphocytes/μL versus those with ≥ 250 CD4 lymphocytes/μL (incidence rate ratio 0.3 [95% confidence interval = 0.2-0.6]). The bimodal peaks for BL, in contrast to non-BL NHL, suggest effects of noncumulative risk factors at different ages. Underascertainment or biological reasons may account for BL deficit at low CD4 lymphocyte counts.

14 Reads
  • Source
    • "It has an estimated incidence of 1200 patients per year in the United States [2]. Immunodeficiency associated BL is more commonly seen with human immunodeficiency virus (HIV) infection than other forms of immunodeficiency [3] though its incidence is lowest in patients with a CD4 count <50 cells/mL [4]. NHL accounts for approximately one third of AIDS-related malignancies and the frequency of BL is 2.4– 20% of HIV-associated NHL [5]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background. The outcome of HIV-associated non-Hodgkin lymphoma (NHL) has improved substantially in the highly active antiretroviral therapy (HAART) era. However, HIV-Burkitt lymphoma (BL), which accounts for up to 20% of HIV-NHL, has poor outcome with standard chemotherapy. Patients and Methods. We retrospectively reviewed HIV-BL treated in the HAART era with the Magrath regimen (CODOX-M/IVAC±R) at four Canadian centres. Results. Fourteen patients with HIV-BL received at least one CODOX-M/IVAC±R treatment. Median age at BL diagnosis was 45.5 years, CD4 count 375 cells/mL and HIV viral load (VL) <50 copies/mL. Patients received PCP prophylaxis and G-CSF, 13 received HAART with chemotherapy and 10 rituximab. There were 63 episodes of toxicity, none fatal, including: bacterial infection, n = 20; grade 3-4 hematologic toxicity, n = 14; febrile neutropenia, n = 7; oral thrush; and ifosfamide neurological toxicity, n = 1 each. At a median followup of 11.7 months, 12 (86%) patients are alive and in remission. All 10 patients who received HAART, chemotherapy, and rituximab are alive. CD4 counts and HIV VL 6 months following BL therapy completion (n = 5 patients) were >250 cells/mL and undetectable, respectively, in 4. Conclusion. Intensive chemotherapy with CODOX-M/IVAC±R yielded acceptable toxicity and good survival rates in patients with HIV-associated Burkitt lymphoma receiving HAART.
    Advances in Hematology 01/2012; 2012(21):735392. DOI:10.1155/2012/735392
  • Source
    • "Opportunistic infections may be sometimes observed in patients presenting with CD4+ T cell counts well above the critical range usually referred to for a given infection, as is the case for PML, TB[32-34], lymphoma[35] or Kaposi sarcoma patients who may unexpectedly present with relatively high CD4+ T cell numbers in the 300-400/μl range[36]. Conversely, at any given CD4+ cell count stratum, a fraction of patients have chances to develop PML, TB, lymphoma or KS, but CD4+ cell counts alone do not help us to further narrow down our attention on those who will actually develop disease. "
    [Show abstract] [Hide abstract]
    ABSTRACT: ABSTRACT: One of the most neglected areas of everyday clinical practice for HIV physicians is unexpectedly represented by CD4 T cell counts when used as an aid to clinical decisions. All who care for HIV patients believe that CD4+ T cell counts are a reliable method to evaluate a patient immune status. There is however a fatalistic acceptance that besides its general usefulness, CD4+ T cell counts have relevant clinical and immunological limits. Shortcomings of CD4 counts appear in certain clinical scenarios including identification of immunological nonresponders, subsequent development of cancer on antiretroviral treatment, failure on treatment simplification. Historical and recently described parameters might be better suited to advise management of patients at certain times during their disease history. Immunogenotypic parameters and innate immune parameters that define progression as well as immune parameters associated with immune recovery are available and have not been introduced into validation processes in larger trials. The scientific and clinical community needs an effort in stimulating clinical evolution of immunological tests beyond "CD4saurus Rex" introducing new parameters in the clinical arena after appropriate validation.
    Journal of Translational Medicine 06/2011; 9(1):93. DOI:10.1186/1479-5876-9-93 · 3.93 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In connection with the weak, low frequency, signal instability, randomness strong and vulnerable to interference and other major features of the ECG signal, designed a multi-polar amplification, filtering, high input impedance, high signal to noise ratio of the acquisition circuit. Analyzed the system characteristics distribution of the circuit in the electronic components within the tolerance range, and proved the system reliability from the theoretical point of view and practical point of view, and provided the reliability of technical support of system from theoretical analysis to practical realization.
    01/2010; DOI:10.1109/ICBBE.2010.5514786
Show more