AIDS-related lymphoma

To translate this approach into clinical scenarios, the risk-benefit assessment of chemotherapy administration in already immunocompromised patients would favor situations in which cytotoxic drugs are indicated anyhow, such as in AIDS-related lymphomas, where alkylating agents are part of the standard regimens. 

Treatment of AIDS-related lymphoma is difficult because underlying immunodeficiency increases the risk of treatment-related myelosuppression. 

A large multicenter pivotal phase II study was performed to evaluate the efficacy of rituximab in the treatment of relapsed low-grade or follicular CD20(+) B-cell NHL (171). A total of 166 patients with small lymphocytic (n= 33), follicular small cleaved (n = 67), follicular mixed (n= 53), follicular large-cell (n = 10), or low-grade variant (n = 3) NHL were enrolled at 31 centers. Patients with bulky disease (>10 cm), pleural or peritoneal involvement, CNS lymphoma, AIDS-related lymphoma, CLL or leukemic component (more than 5,000 lymphocytes/pl) were excluded. Rituximab was again administered intravenously at 375 mg/m2 weekly for four doses. The overall response rate, which was the primary study end point, was... 

The function and structure of ABC transporters along with their role and also in acquired immunodeficiency syndrome (AIDS) related lymphoma has been reviewed recently [68-72],... 

Tulpule A (2005) Multidrug resistance in AIDS-related lymphoma. Curr Opin Oncol 17 466-468... 

The risk of NHL for patients with AIDS is increased about 150- to 250-fold as compared to the general population." AIDS-related lymphoma arises as a consequence of long-term stimulation and proliferation of B lymphocytes from HIV and the reactivation of prior EBV infection due to HIV-induced immunosuppression. " AIDS-related lymphoma usually occurs late in the course of HIV infection and is the cause of death in about 15% of HIV-infected individuals. Although HIV infects T cells, more than 95% of AIDS-related lymphomas are B-cell neoplasms. About 60% of AIDS-related lymphomas are classified as Burkitt s (30%) or diffuse large B-ceU type (30%). "... 

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. 

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. 

Ansari MQ, Dawson DB, Nador R, et al. Primary body cavity-based AIDS-related lymphomas. Am Clin Pathol. 1996 105 221-229. 

M. A., Zwerski, S.L., Wood, L.V., Venzon, D.J., and Magralh, l.T. (2001) Increased level of stromal cell-derived factor-1 mRNA in peripheral blood mononuclear cells from children with AIDS-related lymphoma. Cancer Research, 61, 5028-5037. 

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... 

Liposomal encapsulation of DOX or DNR Preferred anthracycline delivery to the tumor Breast cancer, ovarian cancer, AIDS-related Kaposi s sarcoma, multiple myeloma (pegylated liposomal DOX). Breast cancer (uncoated liposomal DOX). AIDS-related Kaposi s sarcoma, acute mye-loblastic leukemia, multiple myeloma, non-Hodgkin s lymphomas (uncoated liposomal DNR)... 

Intron A interferon a-2b Schering-Plough Hairy cell leukemia, genital warts, AIDS-related Kaposi s sarcoma, hepatitis C, hepatitis B, malignant melanoma, follicular lymphoma in conjunction with chemotherapy... 

Hairy cell leukaemia Renal cell carcinoma Basal cell carcinoma Malignant melanoma AIDS-related Kaposi s sarcoma Multiple myeloma Chronic myelogenous leukaemia Non-Hodgkin s lymphoma... 

Hairy cell leukemia Genital warts AIDS-related Kaposi s sarcoma Non-A non-B hepatitis Hepatitis B Malignant melanoma Chronic viral hepatitis C Follicular lymphoma with chemotherapy June 1986 June 1988 Nov. 1988 Feb. 1991 July 1992 Dec. 1995 March 1997 Nov. 1997... 

Indications Treatment of patients with hairy-cell leukemia, malignant melanoma, follicular non-Hodgkin s lymphoma (NHL), AIDS-related Kaposi s sarcoma, chronic hepatitis C, and the skin disorder, condylomata acuminata... 

G4. Gloghini, A., De Paoli, P., Gaidano, G., Franceschi, S., and Carbone, A., High frequency of CD45RO expression in AIDS-related B-cell non-Hodgkin s lymphomas. Am. J. Clin. Pathol. 104, 680-688 (1995). 

Interferon alfa-2b Intron A (Schering-Plough) Hairy cell leukemia AIDS-related Kaposi s sarcoma chronic hepatitis, types B and C condylomata acuminata malignant melanoma follicular lymphoma non-Hodgkins lymphoma... 

Interferon alfa 2b (interferon alfa-2b [usan] Alferon Intron A Viraferon Sch 30500) is a recombinant (rbe) version, and is extensively used by injection as an anticancer agent to treat hairy cell leukaemia, condylomata acuminata, AIDS-related Kaposi s sarcoma, follicular lymphoma, chronic myelogenous leukaemia, lymph or liver metastases of carcinoid tumour, as an anticancer adjunct in malignant melanoma also, in the maintenance of remission in multiple myeloma chronic active hepatitis B, chronic hepatitis C. 

Carbone A. AIDS-related non-Hodgkin s lymphomas Ftom pathology and molecular pathogenesis to treatment. Hum Pathol. 2002 33 392-404. 

Interferon alfa-2b is an immunomodulator. It causes inhibition of virus replication in virus-infected cells, suppression of cell proliferation, and such immunomodulating activities as enhancement of the phagocytic activity of macrophages and augmentation of the specific cytotoxicity of lymphocytes for target cells. It is indicated in hairy cell leukemia condylomata acuminata AIDS-related Kaposi sarcoma chronic hepatitis B chronic non-A/non-B hepatitis (hepatitis C) and malignant melanoma and follicular non-Hodgkin s lymphoma. 

AIDS-related Kaposi s sarcoma Hepatitis B Hepatitis C Malignant melanoma Follicular lymphoma Chronic hepatitis C... 

The majority of patients infected with the human immunodeficiency virus (HIV) have abnormalities in the central nervous system. It is frequently possible to provide a specific diagnosis on the basis of abnormalities seen by MR imaging the diagnosis is difficult in the presence of focal abnormalities with mass effect, as for example the differentiation between toxoplasmosis and cerebral lymphomas. Some clinicians recommend that all patients with AIDS and brain masses should first receive antibiotics for toxoplasmosis [83]. If improvement does not occur after medication, biopsy is considered. The most accurate diagnosis could be achieved by brain biopsy, but this can lead to substantial morbidity and mortality. Any technique that allows earlier diagnosis would enable earlier commencement of appropriate therapy. This is of particular importance in the case of lymphoma because untreated mean survival is short whereas radiation therapy and steroids may improve survival. H MRS showed significantly different biochemical profiles for AIDS-related brain lesions in 26 patients, which helped in correct diagnosis [83]. HIVpositive patients (109) were found to have focal intracranial lesions [84] 56 of these... 

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. 

In 1982, an extracorporeal form of 8-MOP photochemotherapy (photopheresis) was developed by Edelson et al. for the treatment of cutaneous T-cell lymphoma, a CD4-positive T-cell malignancy. Photopheresis was also found to be effective in a number of other T-cell-mediated diseases. Clinical trials demonstrated beneficial effects in pemphigo vulgaris, severe atopic dermatitis, AIDS-related complex, rheumatoid arthritis, and systemic lupus erythematosus. ... 

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... 

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