AIDS-associated lymphoma

Low-dose -this regimen is utilized in AIDS associated lymphomas ... 

The treatment of patients with AIDS-associated lymphomas is difficult because the immunocompromised state of these patients increases their risk of significant toxicity due to myelosuppressive therapy. Except for primary CNS lymphoma, AIDS-related lymphoma is never considered truly localized, and systemic chemotherapy is indicated. For patients with adequate immune function and without a history of an opportunistic infection, chemotherapy regimens similar to those used for aggressive lymphomas may be used. " However, many patients with AIDS-related lymphoma are treated with less intensive regimens because of the increased risk of treatment-related toxicity. In the era of highly active antiretroviral therapy (HAART), however, some clinicians believe that standard doses of chemotherapy can be safely administered to patients who achieve a virologic response to HAART. 

The Epstein-Barr virus (EBV) is a B-cell lymphotropic herpesvirus that induces a usually asymptomatic infection and is carried by more than 90% of adults. However, EBV is the causative agent for Burkitt s lymphoma and nasopharyngeal carcinoma and is involved in a number of acquired immunodeficiency syndrome (AIDS)-associated lymphomas. EBV can induce immortalization of B cells in vitro to generate lymphoblastoid cell lines (LCLs), a model for the carcinogenic potential... 

In advanced AIDS, MM is usually associated with opportunistic infections such as CMV (Said et al. 1991 RouUet et al. 1994 Kolson and Gonzalez-Scarano 2001) or is secondary to lymphoma (Fuller et al. 1993). Despite a role for other herpes viruses in AIDS-associated myelitis, no substantive evidence has been published in support of a role for other vimses in the development of HIV-associated MM, including herpes simplex 1 or 2, varicella zoster, or Epstein Barr vims (Kolson and Gonzalez-Scarano 2001). MM can occur secondary to hepatitis B and C viruses, which are common co-infections of HIV-infected patients, particularly when there is an associated cryoglobulinemia (Taillan et al. 1993 Caniatti et al. 1996). Rarely... 

The clinical presentation is similar to that observed in other immunocompromised states. Most patients with AIDS-related lymphoma present with B (constitutional) symptoms and have advanced stage (III or IV) disease at the time of diagnosis. " Involvement of extranodal sites is common. The clinical course of AIDS-related lymphoma is aggressive median survival is about 6 months and 2-year survival is only 10% to 20%. Factors associated with decreased survival include age greater than 35 years, history of injection drug use, CD4 cell count < 100/mm , a history of AIDS prior to the diagnosis of lymphoma, stage III or IV disease, and elevated LDH levels." The IPI has also been validated for use in patients with AIDS-related lymphoma. 

Almogy G, Lieberman S, Gips M, et al (2004) Clinical outcomes of surgical resections for primary liver sarcoma in adults results ftom a single centre. Eur J Surg Oncol 30 421—427 Bacchi CE, Bacchi MM, Rabenhorst SH, et al (1996) AIDS-related lymphoma in Brazil. Histopathology, immunophe-notype, and association with Epstein-Barr virus. Am J Clin Pathol 105 230 237... 

Le Lostec Z, Fegueux S et al (1994) Peripheral neuropathy associated with cryoglobuUnaemia but not related to hepatitis C virus in an HIV-infected patient. AIDS 8(9) 1351-1352 Leger JM, Henin D et al (1992) Lymphoma-induced polyradiculopathy in AIDS two cases. J Neurol 239(3) 132-134... 

Immunodeficiency has been associated with an increased incidence of viral-induced cancers, which tend to be more immunogenic than those that are chemically-induced. Cancers related to immunosuppression include leukemia and cancers of the skin (seen in transplant patients4) as well as Kaposi s sarcoma and EB V-associated B cell lymphomas (observed in HIV/AIDS patients). 

Chronic infections such as HIV result in immunosuppression as a result of induction of CD4+ Treg cells. Increased risk of Kaposi s sarcoma, non-Hodgkin s lymphoma and liver cancer is associated with long-term infections such as HIV. Immunosuppression in HIV-infected individuals occurs before the development of AIDS, which proceeds before the depletion of CD4+ T cells, and the induction of Treg cells may play a role in this process. The mechanisms are IL-10-independent and include the involvement of TGF-(3 secreted via signaling through cell-cell interaction involving CTLA-4. 

Since 1980 three types of infectious human T-cell lymphotrophic viruses (HTLVs) have been identified. HTLV-I is frequently associated with adult forms of T-cell leukemia-lymphoma, HTLV-II with hairy T-cell leukemia, and HTLV-III (now called human immunodeficiency virus HIV) with acquired immunodeficiency syndrome (AIDS). Other related retroviruses have been isolated from human and primate populations. Molecular biologists have developed a wealth of information about the biology and genetics of retroviruses, including the complete sequencing of their genomes. Despite this enormous research effort it still... 

Etoposide is used primarily in treatment of testicular tumors in combination with bleomycin and cispiatin, and in combination with cispiatin and ifosfamide for small-cell carcinoma of the lung. It also is active against non-Hodgkin s lymphomas, acute nonlymphocytic leukemia, and Kaposi s sarcoma associated with AIDS. Etoposide has a favorable toxicity profile for dose escalation in that its primary acute toxicity is myelosuppression. In combination with ifosfamide and carboplatin, it is frequently used for high-dose chemotherapy in total doses of 1500 to 2000 mg/m. ... 

Flairy-cell and chronic lymphocytic leukemias non-Flodgkin s lymphoma chronic multiple sclerosis Pneumocystis carinii pneumonia associated with AIDS Lepromatous leprosy Treahng pain in cancer Hemophiha B Multiple sclerosis Hyahne membrane disease Mulhple sclerosis... 

Uric acid nephrolithiasis calcium renal stones Malignant mesothelioma Status epilepticus Herpes simplex encephalitis Neurosyphilis Status epilepticus Cognitive dysfunction Malignant non-Hodgkin s lymphomas Treatment of PCP associated with AIDS Acanthamoeba keratitis Peripheral arterial occlusive disease Congenital or acquired protein C deficiency Respiratory distress syndrome associated with prematurity... 

Cesarman, E., Chang, Y, Moore, P.S., Said, J.W., and Knowles, D.M. (1995) Kaposi s sarcoma-associated herpesvirus-like DNA sequences in AIDS-related body-cavity-based lymphomas. The New En cmd Journal of Medicine, 332, 1186-1191. 

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