medigraphic.com
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2008, Number 5

<< Back Next >>

Rev Invest Clin 2008; 60 (5)

AIDS and Non-Hodgkin’s lymphoma. Experience at an oncological center in Mexico

Cornejo-Juárez P, Volkow-Fernández P, Avilés-Salas A, Calderón-Flores E

Language: English
References: 24
Page: 375-381
PDF size: 73.45 Kb.


ABSTRACT

Background. Non-Hodgkin lymphoma (NHL) associated with HIV became an AIDS-defining condition early in the epidemic and remains the second most common malignancy in patients with AIDS. With the advent of highly active antiretroviral therapy (HAART), the incidence and mortality of AIDSrelated opportunistic infections and Kaposi’s sarcoma has fallen dramatically, this trend is not observed so clearly for NHL. Our objective was to review the clinical spectrum of patients with AIDS-associated NHL and to analyze the impact of HAART on survival at an oncological tertiary center. Material and methods. We reviewed all medical records and histopathologic tissue of patients with HIV-associated NHL seen from January 1990 to September 2007 at the Instituto Nacional de Cancerologia in Mexico City. Survival or follow-up time was calculated from date of diagnosis to death, or to the date on which the patient was last seen. Results. Eighty seven HIV-positive patients were diagnosed with NHL (diffuse largeB-cell lymphoma n = 69; Burkitt-like n = 8; pleomorphic large cell n = 7; low-grade n = 2, and angiocentric n = 1). Twenty eight patients never received HAART, and 59 received HAART. Overall, 38 patients (43.7%) achieved complete response to NHL therapy, including only 14.3% patients in the non-HAART compared with 57.6% in the HAART group (p = 0.0001). Two patients (7.1%) in the non-HAART were alive compared with 37 (63.8%) in the HAART group (p ≤ 0.0001). Mean survival time for all patients was 11 ± 16.8 months. Survival was significantly shorter in patients not receiving HAART (4.8 ± 7.6 months) as compared with those who did (14 ± 19.2) (p = 0.01). Conclusions. Patients with NHLHIV who were able to receive treatment with HAART and were sufficiently healthy to receive optimal chemotherapy treatment showed a significantly better prognosis.


REFERENCES

  1. Knowles DM. Etiology and pathogenesis of AIDS-related non- Hodgkin’s lymphoma. Hematol Oncol Clin North Am 2003; 17: 785-820.

  2. Bertrand FE, McCubrey JA. Acquired immunodeficiency syndrome associated lymphoma. Front Biosci 2005; 1: 2972-7.

  3. Gates AE, Kaplan LD. Biology and management of AIDS-associated non-Hodgkin’s lymphoma. Hematol Oncol Clin North Am 2003; 17: 821-41.

  4. Besson C, Goubar A, Gabarre J, Rozenbaum W, Pialoux G, Chatelet FP, et al. Changes in AIDS-related lymphoma since the era of highly active antiretroviral therapy. Blood 2001; 98: 2339-44.

  5. Lim ST, Levine AM. Recent-advances in acquired immunodeficiency syndrome (AIDS)-related lymphoma. CA Cancer J Clin 2005; 55: 229-41.

  6. Levine AM, Seneviratne L, Espina BM, Rock Wohl AR, Tulpule A, Nathwani BN, et al. Evolving characteristics of AIDS-related lymphoma. Blood 2000; 96: 4084-90.

  7. Cheung TW. AIDS-related cancer in the era of highly active antiretroviral therapy (HAART): a model of the interplay of the immune system, virus, and cancer. “On the offensive- the Trojan Horse is being destroyed” -Part B: Malignant lymphoma. Cancer Invest 2004; 22: 787-98.

  8. Doweiko JP, Groopman JE. AIDS-related lymphomas: epidemiology and overview. Up to date [serial online]. April 19, 2005.

  9. Stebbing J, Marvin V, Bower M. The evidence-based treatment of AIDS-related non-Hodgkin’s lymphoma. Cancer Treat Rev 2004; 30: 249-53.

  10. Matthews GV, Bower M, Mandalia S, Powles T, Nelson MR, Gazzard BG. Changes in acquired immunodeficiency syndrome- related lymphoma since the introduction of highly active antiretroviral therapy. Blood 2000; 96: 2730-4.

  11. Bautista-Arredondo S, Mane A, Bertozzi SM. Economic impact of antiretroviral therapy prescription decision in the context of rapid scaling-up of access to treatment: lessons from México. AIDS 2006; 20: 101-9.

  12. Jaffe ES. The role of immunophenotypic markers in the classification of non-Hodgkin’s lymphomas. Semin Oncol 1990; 17: 11-19.

  13. Volkow P, Velasco SR, Mueller N, Ponce de León S, Sierra- Madero JG, Sada E, et al. Transfusion-associated HIV infection in Mexico related to paid blood donors; HIV epidemic. Int J STD AIDS 2004; 15: 337-42.

  14. Levine AM. Acquired immunodeficiency syndrome-related lymphoma: clinical aspects. Semin Oncol 2000; 27: 442-53.

  15. Doweiko JP, Groopman JE. AIDS-related lymphomas: systemic lymphoma. Up to date [serial online]. April 19, 2005.

  16. Lim ST, Karim R, Nathwani BN, Tulpule A, Espina B, Levine AM. AIDS-related Burkitt’s lymphoma versus diffuse large-cell lymphoma in the pre-highly active antiretroviral therapy (HAART) and HAART eras: Significant differences 0in survival with standard chemotherapy. J Clin Oncol 2005; 23: 4430-8.

  17. Hoffmann C, Wolf E, Fätkenheuer G, Buhk T, Stoehr A, Plettenberg A, et al. Response to highly active antiretroviral therapy strongly predicts outcome in patients with AIDS-related lymphoma. AIDS 2003; 17: 1521-9.

  18. Cheung MC, Pantanowitz L, Dezube BJ. AIDS-related malignancies: emerging challenges in the era of highly active antiretroviral therapy. Oncologists 2005; 10: 412-26.

  19. Gerard L, Galicier L, Maillard A, Boulanger E, Quint L, Matheron S, et al. Systemic non-Hodgkin lymphoma in HIV-infected patients with effective suppression of HIV replication: persistent occurrence but improved survival. JAIDS 2002; 30: 478-84.

  20. Stebbing J, Gazzard B, Mandalia S, Teague A, Waterston A, Marvin V, et al. Antiretroviral treatment regimens and immune parameters in the prevention of systemic AIDS-related non- Hodgkin’s lymphoma. J Clin Oncol 2004; 22: 2177-83.

  21. Mocroft AJ, Lundgren JD, d’Armino Monforte D, Ledergerber B, Barton SE, Vella S, et al. Survival of AIDS patients according to type of AIDS-defining event. The AIDS in Europe Study Group. Int J Epidemiol 1997; 26: 400-07.

  22. Vaccher E, Tirelli U, Spina M, Talamini R, Errante D, Simonelli C, et al. Age and serum lactate dehydrogenase level are independent prognostic factors in human immunodeficiency virus-related non-Hodgkin’s lymphomas: A single–Institute study of 96 patients. J Clin Oncol 1996; 14: 2217-23.

  23. Clayton A, Mughal T. The changing face of HIV-associated lymphoma: what can we learn about optimal therapy in the post highly active antiretroviral therapy era? Hematol Oncol 2004; 22: 111-20.

  24. Noy A. Update in HIV-associated lymphoma. Curr Opin Oncol 2004; 16: 450-4.




2020     |     www.medigraphic.com