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Types of Lymphoma > HIV/AIDS-related Lymphomas

Last update: 06/05/2013

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Background on HIV / AIDS - related lymphomas

Here we will provide links to resources to lymphomas associated with AIDS / HIV.

"Approximately 1–6% of HIV infected patients develop lymphoma each year. "  PMC3033170/

Types of lymphoma associated with AIDS/HIV are almost exclusively of b-cell origin, and  aggressive grade.

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Burkitt-like

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Diffuse Large B-cell

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Large Cell Immunoblastic 

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Small Non-Cleaved Cell (Burkitt's / Non-Burkitt's) 

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Primary Central Nervous System which represents 
20% of all NHL cases in AIDS patients

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Hodgkin's Disease 

In the News - New Resources:

bullet Blood: How I treat HIV-associated lymphoma 

Kieron Dunleavy and Wyndham H. Wilson

“Over the past 10 years, significant progress has been made in understanding HIV-associated lymphomas and improving the prognosis of these diseases. With the advent of combination antiretroviral therapy and the development of novel therapeutic strategies, most patients with HIV-associated lymphomas are cured. The outcome for the majority of patients with HIV-associated diffuse large B-cell lymphoma and Burkitt lymphoma in particular, is excellent, with recent studies supporting the role of rituximab in these diseases.”

Incidence:  

Incidence varies by lymphoma type. 

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Non-Hodgkin lymphoma among young adults with and without AIDS in Italy.
Int J Cancer. 2001 Aug 1;93(3):430-5. PMID: 11433410  
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Epidemiology of brain lymphoma among people with or without acquired immunodeficiency syndrome. AIDS/Cancer Study Group.
J Natl Cancer Inst. 1996 May 15;88(10):675-9. PMID: 8627644 

This analysis distinguishes the separate epidemiologies of brain lymphoma incidence among persons with or without AIDS and shows brain lymphoma incidence among persons with AIDS to be several thousand-fold higher than that in the general population. The study documents the overwhelming effect of AIDS-associated brain lymphoma on the overall rate in the general population and demonstrates a significantly rising trend, although of a lesser magnitude, among persons without AIDS. IMPLICATIONS: This study emphasizes a greater need to bring health care resources to this burgeoning epidemic.
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Population-based patterns of human immunodeficiency virus-related Hodgkin lymphoma in the Greater San Francisco Bay Area, 1988-1998.
Cancer. 2003 Jul 15;98(2):300-9. PMID: 12872349 

Among males in the San Francisco Bay Area, HIV-related HL had distinctive demographic features, more aggressive clinical characteristics, stronger EBV association, and poorer survival and contributed to elevated regional HL incidence rates, particularly in young adults. Patients with HIV-related HL who were diagnosed after HAART was introduced appeared to have less aggressive disease and better survival.
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Hodgkin's disease in patients infected with human immunodeficiency virus: frequency, presentation and clinical outcome. Leuk Lymphoma. 2001 May;41(5-6):535-44. PMID: 11378571
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Changing incidence and survival in patients with aids-related non-Hodgkin's lymphomas in the era of highly active antiretroviral therapy (HAART). Leuk Lymphoma. 2001 Mar;41(1-2):105-16. PMID: 11342362
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Antiretroviral treatment regimens and immune parameters in the prevention of systemic AIDS-related non-Hodgkin's lymphoma. J Clin Oncol. 2004 Jun 1;22(11):2177-83. PMID: 15169806 

Effective HAART-induced maintenance of CD4 and CD8 counts protects from systemic AIDS-related NHL

Diagnosis

To make an accurate diagnosis of lymphoma, a biopsy must be performed by the surgical removal (resection) of a lymph node.  A fine needle aspiration may be performed if a lymph node is not accessible, but this is not considered a definitive way to determine the diagnosis.

A series of tests will then be performed to determine the characteristics of the cells.  If a malignancy is determine, these characteristics will allow your doctors to determine the appropriate treatments to use when needed. 

See Diagnostic Tests


Common symptoms

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fatigue

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sweats (night sweats)

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loss of appetite

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feeling of fullness or discomfort due to enlarged liver or spleen

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enlarged lymph nodes - painless swelling in the neck, armpit or groin - often in more than one group

Other symptoms may include night sweats, unexplained high temperatures and weight loss. These are known as B symptoms.

Resources

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General information from Cancer.gov  Patient | Professional
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Management of HIV-related lymphoma - Treating Aggressive Non-Hodgkin's Lymphoma - John D. Hainsworth, MD  Medscape  2003 (free login req.) 
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Mediterr J Hematol Infect Dis. 2009;
Michele Bibas and Andrea Antinori

EBV and HIV-Related Lymphoma http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3033170/

Approximately 1–6% of HIV infected patients develop lymphoma each year. In 2006 the World Health Organization estimated 39.5 million people were living with HIV and that during that year there were 4.3 million new infections with 65% of these occurring in sub-Saharan Africa.

Classification of HIV-associated lymphomas
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3033170/table/t1-mjhid-1-2-e2009032/

1. Lymphoma also occurring in immunocompetent patients:
  a. Burkitt and Burkitt-like Lymphoma
  b. Diffuse large B-cell lymphoma
    i. Centroblastic
    ii. Immunoblastic (including primary CNS lymphoma)
  c. Extranodal marginal zone lymphoma of Malt type
  d. Peripheral T-cell lymphoma
  e. Classical Hodgkin Lymphoma
2. Lymphoma occurring more specifically in Hiv positive patients
  a. Primary effusion Lymphoma
  b. Plasmablastic lymphoma of the oral cavity type
3. Lymphoma also occurring in other immunodeficiency states
  a. Polymorphic B-cell lymphoma (PTLD-like)

The increased risk for lymphoma among HIV-infected individuals appears related to multiple factors, including duration and degree of immunosuppression, induction of cytokines leading to B-cell proliferation, and opportunistic infections with oncogenic herpesviruses such as EBV and HHV8

HIV-associated malignancies are commonly considered to be the result of diminished immune surveillance against viruses and virus-infected tumor cells. The beneficial effects of HAART on these tumors have therefore been interpreted as the result of drug-mediated HIV suppression and immune reconstitution.

 

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Immunol Res. 2013 May 1.
Marta Epeldegui, Elena Vendrame, and Otoniel Martínez-Mazacorresponding author

HIV-associated immune dysfunction and viral infection: role in the pathogenesis of AIDS-related lymphoma http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3640300/

 

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Related articles: http://www.ncbi.nlm.nih.gov

 

Treatment Resources

Treatment Options for AIDS-Related Lymphoma from Cancer.gov
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AIDS-Related Peripheral/Systemic Lymphoma
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AIDS-Related Primary Central Nervous System Lymphoma
Treatments for Refractory lymphomas


Clinical Trials

Lymphoma-specific clinical trials by:
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All
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Newly diagnosed or previously untreated
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Recurrent

References and Related articles

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HIV-associated Hodgkin's lymphoma (HIV-HL): Results of a prospective multicenter trial http://bit.ly/bpJmKE

"Conclusions:
In pts with HIV-HL risk-adapted CT and concomitant HAART is feasible and effective. However, pts must closely be monitored for neutropenic infections. These data suggest that the prognosis of HIV-HD may approach results achieved in the HIV-negative population with HL."  (Which is very good indeed.)
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OUTCOMES: Presentation and outcomes of systemic non-Hodgkin's lymphoma: A comparison between patients with acquired immunodeficiency syndrome (AIDS) treated with highly active antiretroviral therapy and patients without AIDS. Leuk Lymphoma. 2006 Sep;47(9):1822-9. PMID: 17064995 
 
"Patients with AIDS-related NHL who received HAART had high grade histology and baseline cytopenia and received reduced-dose chemotherapy more often than patients without AIDS. However, AIDS patients who received HAART and chemotherapy had survival similar to NHL patients without AIDS, an improvement from the pre-HAART era. Appropriate hematologic support, through growth factors, transfusions, and avoidance of drugs with hematologic toxicity, might allow full dosing of chemotherapy, and perhaps would further improve outcomes among patients with AIDS and NHL."
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OUTCOMES: AIDS-associated Burkitt or Burkitt-like lymphoma: Short intensive polychemotherapy is feasible and effective. Leuk Lymphoma. 2006 Sep;47(9):1872-80. PMID: 17065000 | Related articles 

In conclusion, the short and intensive GMALL protocol for B-ALL/NHL is feasible in patients with AIDS-BL/BLL. Outcome may be improved compared to patients treated with CHOP-based regimens. In the era of HAART, more intensive chemotherapy regimens should be considered in patients with highly aggressive lymphomas.
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OUTCOMES:  A prospective, non-randomized phase 1-2 trial of VACOP-B with filgrastim support for HIV-related non-Hodgkin's lymphoma. Biotechnol Annu Rev. 2005;11:381-9. PMID: 16216784
 
Forty-seven patients were enrolled, most with diffuse large-cell or immunoblastic NHL. Protocol-defined maximum tolerated dose was not reached and the limits of dose-limiting toxicity were not exceeded, even in patients receiving ART. Thirty-two cycles (4.9%) were delayed >6 days because of toxicity; 30 patients (64%) completed all 12 weeks of treatment. After completion of therapy, 14 patients had a complete response (30%), and 4 had a partial response (8%). Median time to progression was 9 months. At 42 months, progression-free survival was 25% and overall survival was 28%.
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OUTCOMES:  Acquired immunodeficiency syndrome-related malignancies in the era of highly active antiretroviral therapy. Int J Hematol. 2006 Jul;84(1):3-11. Review. PMID: 16867895 

This feasibility study demonstrates acceptable tolerance and excellent clinical activity of oral combination chemotherapy in patients with AIDS-associated Hodgkin's disease. Improved survival is observed in combination with HAART therapy. Dose-modification of this regimen would be suitable to evaluate in the resource constrained setting and larger confirmatory studies are encouraged.
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OUTCOMES: Rituximab does not improve clinical outcome in a randomized phase III trial of CHOP with or without rituximab in patients with HIV-associated non-Hodgkin's lymphoma: AIDS-malignancies consortium trial 010. Blood. 2005 May 24; PMID: 15914552  
 
... benefits may be offset by an increase in infectious deaths, particularly in those individuals with CD4+ lymphocyte counts < 50/mm(3)."
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Changing incidence and prognostic factors of survival in AIDS-related non-Hodgkin's lymphoma in the era of highly active antiretroviral therapy (HAART). Leuk Lymphoma. 2005 Feb;46(2):207-15. PMID: 15621803
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OUTCOMES: Improved survival in HIV-related Hodgkin's lymphoma since the introduction of highly active antiretroviral therapy. AIDS. 2003 Jan 3;17(1):81-7. PMID: 12478072  PubMed | Related abstracts
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Improved survival in HIV-related Hodgkin's lymphoma since the introduction of highly active antiretroviral therapy. AIDS. 2003 Jan 3;17(1):81-7. PMID: 12478072  PubMed | Related abstracts
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OUTCOMES: Long-term survival of patients with HIV-related systemic non-Hodgkin's lymphomas. Hematol Oncol. 1996 Mar;14(1):7-15.  PMID: 8613137
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PROGNOSIS: 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 Aug;14(8):2217-23.  PMID: 8708710  
 
"Our study shows that in addition to HIV-related prognostic factors, ie, CD4 cell count less than 100/microL, classical prognostic factors such as age and serum LDH level are independent prognostic factors and should be included in the design of future clinical trials of HIV-related NHL."
 
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For all medical concerns,  you should always consult your doctor. 
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