Lymphomas Overview
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Background on HIV / AIDS -
related lymphomas
Here
we will provide links to resources to lymphomas associated
with AIDS / HIV.
Types of lymphoma associated
with AIDS/HIV are almost exclusively of b-cell origin,
and aggressive grade.
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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
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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
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Common signs
and symptoms
 | fatigue |
 |
sweats (night sweats) |
 | loss of appetite |
 | feeling of fullness or discomfort due to enlarged
liver or spleen |
 | 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.
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Resources
 | 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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Treatment Resources
Treatment Options for AIDS-Related
Lymphoma from Cancer.gov
Treatments for Refractory lymphomas
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Clinical Trials
Lymphoma-specific clinical trials by:
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References and Related articles
 | 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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