scholarly journals HIV AND LYMPHOMA: FROM EPIDEMIOLOGY TO CLINICAL MANAGEMENT

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Alessandro Re ◽  
Chiara Cattaneo ◽  
Giuseppe Rossi
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Opportunistic Infections ◽  
Treatment Strategies ◽  
Infectious Complications ◽  
Hodgkin's Lymphoma ◽  
Oncogenic Viruses ◽  
Increased Risk ◽  
Systemic Symptoms ◽  
Negative Population ◽  
Hiv Negative

Patients infected with human immunodeficiency virus are at increased risk for developing both non Hodgkin’s lymphoma (NHL) and Hodgkin’s lymphoma (HL). Even if this risk has decreased for NHL after the introduction of combination antiretroviral therapy (cART), they remain the most common AIDS-related cancer in the developed world. They are almost always of B-cell origin, and some specific lymphoma types are more common than others. Some of these lymphoma types can occur in both HIV-uninfected and infected patients, while others preferentially develop in the context of AIDS. HIV-associated lymphoma differ from lymphoma in the HIV negative population in that they more often present with advanced disease, systemic symptoms, and extranodal involvement and are frequently associated with oncogenic viruses (EBV and/or HHV-8). Before the introduction of cART, most of these patients could not tolerate the treatment strategies routinely employed in the HIV-negative population. The widespread use of cART has allowed for the delivery of full-dose and dose-intensive chemotherapy regimens with improved outcomes that nowadays can be compared to those seen in non-HIV infected patients. However, a great deal of attention should be paid to opportunistic infections and other infectious complications, cART-chemotherapy interactions, and potential cumulative toxicity. In the context of relatively sparse prospective and randomized trials, the optimal treatment of AIDS-related lymphomas remains a challenge, particularly in patients with severe immunosuppression. This paper will address epidemiology, pathogenesis, and therapeutic strategies in HIV-associated NHL and HL.

Hodgkin lymphoma

2020 ◽  
pp. 5280-5287
Author(s):  
Vijaya Raj Bhatt ◽  
James O. Armitage
Keyword(s):  
B Cell ◽  
Combination Chemotherapy ◽  
Hodgkin’S Lymphoma ◽  
Treatment Strategies ◽  
Hodgkin's Lymphoma ◽  
High Dose ◽  
Advanced Stage ◽  
Stage Disease ◽  
Clinically Significant ◽  
Systemic Symptoms

Hodgkin’s lymphoma is derived from a profoundly defective B cell, with the pathobiology, histology, and clinical features being both characteristic and distinct from non-Hodgkin’s lymphomas. Its cause is unknown. Incidence is about 3 per 100 000 per year in Western countries with a bimodal age distribution meaning that it is one of the commoner lymphomas of young people. Most cases are highly responsive to combination chemotherapy, with many patients being cured of their disease. Patients with Hodgkin’s lymphoma may present with lymphadenopathy, a mediastinal (or other) mass, and systemic symptoms including weight loss, fever, and night sweats (B-symptoms). Workup requires staging with positron emission tomography (PET)-CT imaging, and biopsy. Classical Hodgkin’s lymphoma is defined by the presence of the binucleate Reed–Sternberg cell in an appropriate inflammatory histological context. These cells have a characteristic immunohistochemical phenotype, showing CD15 and CD30 positivity, but being immunonegative for classical B-cell markers such as CD20. Additional histological subtypes have been defined, with the most clinically significant being lymphocyte-predominant Hodgkin’s lymphoma. Patients with localized disease may be treated with chemotherapy with or without radiotherapy. Those with more advanced-stage disease require combination chemotherapy, with radiotherapy to sites of initial bulk disease. While relapse is uncommon in patients with early-stage disease, some 20% of patients with advanced-stage disease may need ‘salvage’ chemotherapy regimens for relapsed disease, when the aim is to attain PET negativity before embarking on high-dose therapy with stem cell rescue. Since many patients have a good outcome, it is essential to minimize the long-term sequelae of treatment. Risk stratification is a major focus of clinical trials in this area to determine optimal treatment strategies.

HIV Related Hodgkin's Lymphoma in the HAART Era: A Comprehensive Review and Meta-Analysis of Response and Survival Rates.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1652-1652
Author(s):  
Meena Sunil ◽  
Tarisha Mixon ◽  
Erin Reid ◽  
Mary Jo Lechowicz
Keyword(s):  
Outcome Measures ◽  
Hodgkin’S Lymphoma ◽  
Meta Analysis ◽  
Survival Rates ◽  
Antiretroviral Drugs ◽  
Hodgkin's Lymphoma ◽  
Clinical Staging ◽  
Cell Counts ◽  
Increased Risk ◽  
Hiv Negative

Abstract Abstract 1652 Poster Board I-678 Introduction Hodgkin lymphoma (HL) is one of the most common non-acquired immunodeficiency syndrome (AIDS)-defining tumors in human immunodeficiency virus (HIV)-infected patients. Studies have shown that HIV infected individuals have approximately a 7.5-fold (Goedert et al 1998) to nearly 13-fold increased risk for HL compared with the general population (Biggar et al. 2006, Engels 2006). The outcomes for patients with HL and HIV (HIV-HL) were described as inferior to HIV-negative patients. The existing literature regarding response and survival data is mainly comprised of small and/or retrospective studies. We reviewed the literature for the purpose of examining a larger HIV HL cohort for response rates and survival in the HAART era. Methods We searched PUBMED, OVID & Google Scholar (1980- July 2009) and ASH (2004-2008) & ASCO (2004-2009) Annual Meeting Abstracts. Key words used were ‘Hodgkin's Lymphoma’, ‘Hodgkin's Disease',’ HIV/AIDS', HAART, therapeutic outcomes, concomitant chemotherapy & HAART/antiretroviral therapy, non AIDS malignancies. Criteria for inclusion of studies were: 1) Upfront treatment of HL HIV infected patients with chemotherapy, with or without radiotherapy, with or without antiretroviral drugs/ HAART. 2) Reported in English 3) Studies with outcome measures of treatment for HIV-HL patients such as complete response (CR) rates, and/or at least one type of survival statistic. We also examined references from above articles as well as review articles, studies on pathogenesis & histologic features of HIV-HL, and epidemiologic studies for additional references. Studies that did not clearly report on a comprehensive cohort were excluded given increased probability of reporting bias. Primary outcome measures were CR rates, and 1- and 2-year overall survival rates. The data extracted included pre-treatment patient characteristics such as median age, sex, histological diagnosis, clinical staging, site of involvement, median CD4 cell counts, treatment regimen used, use or not of antiretrovirals/HAART & prophylactic agents with chemotherapy, response to treatment, toxicity, opportunistic infections, median follow up time, relapse, disease progression, death from treatment or infections. Summary CR and OS estimates were calculated based on the assumption of fixed effects and using the Mantel-Haenszel method. Results 12 articles met inclusion criteria for meta-analysis of CR and/or OS. The overall CR rate was 72% (95% CI 67-77%) with 1- and 2-year OS of 78% (95% CI 73-82%) and 69% (95% CI 67-77%), respectively (Figure 1). Advanced stage was present in 63%, and histology other than nodular sclerosing in 76%. Mean baseline CD4 count was 212 (3-887); 59% of subject received HAART with chemotherapy. Death during treatment occurred in 7% and relapse was reported in 14%. Conclusions Adverse baseline characteristics including advanced disease and histology other than NS persist in the HAART era. Response and survival rates are improved compared to pre-HAART era but remain lower than rates found in the HIV-negative population. Further prospective trials need to be done to examine improvements in treatment for this patient population. Disclosures No relevant conflicts of interest to declare.

scholarly journals Use of pembrolizumab with or without pomalidomide in HIV-associated non-Hodgkin’s lymphoma

2021 ◽  
Vol 9 (2) ◽  
pp. e002097
Author(s):  
Kathryn Lurain ◽  
Ramya Ramaswami ◽  
Ralph Mangusan ◽  
Anaida Widell ◽  
Irene Ekwede ◽  
...  
Keyword(s):  
B Cell ◽  
Hodgkin’S Lymphoma ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Hiv And Aids ◽  
Hodgkin's Lymphoma ◽  
People Living With Hiv ◽  
Oncogenic Viruses ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

BackgroundNon-Hodgkin’s lymphoma (NHL) is currently the most common malignancy among people living with HIV (PLWH) in the USA. NHL in PLWH is more frequently associated with oncogenic viruses than NHL in immunocompetent individuals and is generally associated with increased PD-1 expression and T cell exhaustion. An effective immune-based second-line approach that is less immunosuppressive than chemotherapy may decrease infection risk, improve immune control of oncogenic viruses, and ultimately allow for better lymphoma control.MethodsWe conducted a retrospective study of patients with HIV-associated lymphomas treated with pembrolizumab±pomalidomide in the HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute.ResultsWe identified 10 patients with stage IV relapsed and/or primary refractory HIV-associated NHL who were treated with pembrolizumab, an immune checkpoint inihibitor, with or without pomalidomide. Five patients had primary effusion lymphoma (PEL): one had germinal center B cell-like (GCB) diffuse large B cell lymphoma (DLBCL); two had non-GCB DLBCL; one had aggressive B cell lymphoma, not otherwise specified; and one had plasmablastic lymphoma. Six patients received pembrolizumab alone at 200 mg intravenously every 3 weeks, three received pembrolizumab 200 mg intravenously every 4 weeks plus pomalidomide 4 mg orally every day for days 1–21 of a 28-day cycle; and one sequentially received pembrolizumab alone and then pomalidomide alone. The response rate was 50% with particular benefit in gammaherpesvirus-associated tumors. The progression-free survival was 4.1 months (95% CI: 1.3 to 12.4) and overall survival was 14.7 months (95% CI: 2.96 to not reached). Three patients with PEL had leptomeningeal disease: one had a complete response and the other two had long-term disease control. There were four immune-related adverse events (irAEs), all CTCAEv5 grade 2–3; three of the four patients were able to continue receiving pembrolizumab. No irAEs occurred in patients receiving the combination of pembrolizumab and pomalidomide.ConclusionsTreatment of HIV-associated NHL with pembrolizumab with or without pomalidomide elicited responses in several subtypes of HIV-associated NHL. This approach is worth further study in PLWH and NHL.

scholarly journals Spectrum of lymphomas across different drug treatment groups in rheumatoid arthritis: a European registries collaborative project

2017 ◽  
Vol 76 (12) ◽  
pp. 2025-2030 ◽  
Author(s):  
Louise K Mercer ◽  
Anne C Regierer ◽  
Xavier Mariette ◽  
William G Dixon ◽  
Eva Baecklund ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
T Cell ◽  
General Population ◽  
B Cell ◽  
Hodgkin’S Lymphoma ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Treatment Groups ◽  
Increased Risk

BackgroundLymphomas comprise a heterogeneous group of malignant diseases with highly variable prognosis. Rheumatoid arthritis (RA) is associated with a twofold increased risk of both Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL). It is unknown whether treatment with biologic disease-modifying antirheumatic drugs (bDMARDs) affect the risk of specific lymphoma subtypes.MethodsPatients never exposed to (bionaïve) or ever treated with bDMARDs from 12 European biologic registers were followed prospectively for the occurrence of first ever histologically confirmed lymphoma. Patients were considered exposed to a bDMARD after having received the first dose. Lymphomas were attributed to the most recently received bDMARD.ResultsAmong 124 997 patients (mean age 59 years; 73.7% female), 533 lymphomas were reported. Of these, 9.5% were HL, 83.8% B-cell NHL and 6.8% T-cell NHL. No cases of hepatosplenic T-cell lymphoma were observed. Diffuse large B-cell lymphoma (DLBCL) was the most frequent B-cell NHL subtype (55.8% of all B-cell NHLs). The subtype distributions were similar between bionaïve patients and those treated with tumour necrosis factor inhibitors (TNFi). For other bDMARDs, the numbers of cases were too small to draw any conclusions. Patients with RA developed more DLBCLs and less chronic lymphocytic leukaemia compared with the general population.ConclusionThis large collaborative analysis of European registries has successfully collated subtype information on 533 lymphomas. While the subtype distribution differs between RA and the general population, there was no evidence of any modification of the distribution of lymphoma subtypes in patients with RA treated with TNFi compared with bionaïve patients.

AIDS-Related Malignancies: State of the Art and Therapeutic Challenges

2008 ◽  
Vol 26 (29) ◽  
pp. 4834-4842 ◽  
Author(s):  
Jean-Philippe Spano ◽  
Dominique Costagliola ◽  
Christine Katlama ◽  
Nicolas Mounier ◽  
Eric Oksenhendler ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Hodgkin’S Lymphoma ◽  
Advanced Disease ◽  
State Of The Art ◽  
Hodgkin's Lymphoma ◽  
Increased Risk ◽  
Therapeutic Recommendations ◽  
The Subject ◽  
The Impact ◽  
Related Mortality

Despite the impact of combination antiretroviral therapy (cART) on HIV-related mortality, malignancy remains an important cause of death in the current era. Although the advent of cART has resulted in reductions in the incidence of Kaposi's sarcoma and non-Hodgkin's lymphoma, non–AIDS-defining malignancies present an increased risk for HIV-infected patients, characterized by some common clinical features, generally with a more aggressive behavior and a more advanced disease at diagnosis, which is responsible for poorer patient outcomes. Specific therapeutic recommendations are lacking for these new nonopportunistic malignancies, such as Hodgkin's lymphoma, anal cancer, lung cancer, hepatocarcinoma, and many others. Antiretroviral agents have a propensity for causing drug interactions as a result of their ability to either inhibit or induce the cytochrome P450 (CYP) enzyme system. Because many antineoplastic drugs are also metabolized by the CYP system, coadministration with cART could result in either drug accumulation with increased toxicity, or decreased efficacy of one or both classes of drugs. Further research delineating the combined safety and pharmacokinetics of antiretrovirals and antineoplastic therapy is necessary. Special considerations of these AIDS-related and non–AIDS-related malignancies and their clinical and therapeutic aspects constitute the subject of this review.

Hepatocellular Carcinoma and Non-Hodgkin's Lymphoma: The Roles of HIV, Hepatitis C Infection, and Alcohol Abuse

2006 ◽  
Vol 24 (31) ◽  
pp. 5005-5009 ◽  
Author(s):  
Kathleen A. McGinnis ◽  
Shawn L. Fultz ◽  
Melissa Skanderson ◽  
Joseph Conigliaro ◽  
Kendall Bryant ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatitis C ◽  
Alcohol Abuse ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Hiv Positive ◽  
Hepatitis C Infection ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma ◽  
Hiv Negative

Purpose To explore the relationship of HIV, hepatitis C (HCV), and alcohol abuse/dependence to risk for hepatocellular carcinoma and non-Hodgkin's lymphoma (NHL). Patients and Methods Male veterans (n = 14,018) with a first HIV diagnosis in the Veterans Affairs Healthcare System from October 1997 to September 2004; and 28,036 age-, race-, sex-, and location-matched HIV-negative veterans were identified. We examined the incidence of hepatocellular carcinoma and NHL and presence of HCV and alcohol abuse/dependence using International Classification of Diseases, ninth revision (ICD-9-CM) codes. HIV-positive to HIV-negative incident rate ratios (IRRs) and 95% CIs for the occurrence of hepatocellular carcinoma and NHL were calculated using Poisson regression models. Results HIV-positive veterans were at greater risk for hepatocellular carcinoma than HIV-negative veterans (IRR = 1.68; 95% CI, 1.02 to 2.77). After adjusting for HCV infection and alcohol abuse/dependence, HIV status was not independently associated with hepatocellular cancer (IRR = 0.96; 95% CI, 0.56 to 1.63). HIV-positive veterans had 9.71 times (95% CI, 6.99 to 13.49) greater risk of NHL than HIV-negative veterans. After adjusting for HCV and alcohol abuse/dependence, the IRR for NHL comparing HIV-positive with HIV-negative veterans is similar (IRR = 10.03, 95% CI, 7.19 to 13.97). Conclusion HIV-positive veterans have a higher relative incidence of hepatocellular carcinoma and NHL than HIV-negative veterans. For hepatocellular carcinoma, this association appears to be largely explained by the higher prevalence of HCV and alcohol abuse/dependence. Efforts to decrease hepatocellular carcinoma among persons with HIV should focus primarily on detecting and treating HCV and reducing heavy alcohol use.

Increased Risk of Second Lung Cancer in Hodgkin’s Lymphoma Survivors: A Meta-analysis

Lung ◽  
2012 ◽  
Vol 191 (1) ◽  
pp. 117-134 ◽  
Author(s):  
Ezzeldin M. Ibrahim ◽  
Ghieth A. Kazkaz ◽  
Khaled M. Abouelkhair ◽  
Mubarak M. Al-Mansour ◽  
Turki M. Al-Fayea ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Hodgkin’S Lymphoma ◽  
Meta Analysis ◽  
Hodgkin's Lymphoma ◽  
Increased Risk ◽  
Lymphoma Survivors

Methylenetetrahydrofolate Reductase and Methionine Synthase Polymorphism and Risk of Non-Hodgkin’s Lymphoma.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4691-4691
Author(s):  
Hee Nam ◽  
Yeo-Kyeoung Kim ◽  
Il-Kwon Lee ◽  
Deok-Hwan Yang ◽  
Kyeong-Soo Park ◽  
...  
Keyword(s):  
B Cell ◽  
Hodgkin’S Lymphoma ◽  
Methylenetetrahydrofolate Reductase ◽  
Methionine Synthase ◽  
Hodgkin's Lymphoma ◽  
B Cell Lymphomas ◽  
Mthfr Polymorphism ◽  
Non Hodgkin’S Lymphoma ◽  
Increased Risk ◽  
Non Hodgkin's Lymphoma

Abstract Methylenetetrahydrofolate reductase (MTHFR) and methionine synthase (MTR) are key enzymes in folate metabolism, which is essential for DNA methylation and synthesis. It is known that polymorphisms in its genes have been associated with some forms of cancer including lymphoma. Previous studies have shown MTHFR 677TT was associated with decreased risk of non-Hodgkin’s lymphoma(NHL). However, recent two reports have shown MTHFR 677TT was associated with increased risk. To evaluate the association between the MTHFR C677T and MTR A2756G polymorphisms and risk of non-Hodgkin’s lymphoma, large-scale population-based case-control study was conducted in Chonnam University Hwasun Hospital between March 1997 and June 2005. Three hundreds sixty-five patients with histologically comfirmed lymphoma and 1,162 controls were evaluated. Genotyping was done using PCR-RFLP. The cases consisted of 203 diffuse large B-cell lymphomas(DLBCL), 77 T-cell lymphomas, 62 other B-cell lymphomas, and 23 unclassifiable lymphomas. The MTHFR 677CT and 677TT genotypes were inversely associated with NHL and DLBCL, respectively. Using subjects with the MTHFR 677CC as reference group, the odds ratio of MTHFR 677CT and 677TT were (0.70, 95% CI 0.54–0.90) and (0.46, 95% CI 0.32–0.68) for NHL. The association was more evident for DLBCL (OR 0.56, 95% CI 0.40–0.78 for 677CT; OR 0.40, 95% CI 0.24–0.65 for 677TT). Dose-response effect was evident for the MTHFR T-allele (p < 0.01). There was no significant association of MTR A2756G with NHL. These results suggest that the MTHFR polymorphism may play an important role in the pathogenesis of NHL, particularly DLBCL.

Patterns and Timing of Initial Relapse in Patients with Hodgkin’s and Non-Hodgkin’s Lymphoma.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3673-3673 ◽  
Author(s):  
Sughosh Dhakal ◽  
Tithi Biswas ◽  
Sheema Chawla ◽  
Nikhil Uppal ◽  
Christopher Beck ◽  
...  
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Early Stage ◽  
Treatment Strategies ◽  
Autologous Stem Cell Transplant ◽  
Hodgkin's Lymphoma ◽  
Cell Transplant ◽  
Local Recurrences ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma ◽  
Aggressive Histology

Abstract Purpose/Objective: To evaluate patterns of recurrence in patients with Hodgkin’s (HL) and non-Hodgkin’s lymphoma (NHL) who subsequently undergo autologous stem cell transplant (ASCT). In this population that has declared itself as high risk, we evaluated time to and sites of relapse relative to initial sites of disease and radiation therapy (RT). This information might enhance understanding of the natural history of these diseases in the setting of modern therapy, influence treatment strategies, and assist in screening decisions. Materials/Method: We analyzed the records of all 281 consecutive patients with refractory or recurrent HL and NHL (indolent and aggressive, as defined at initial diagnosis) who underwent ASCT in our center between 5/92–7/03. Patients were initially diagnosed between 1979–2003 at a median age of 44 years (8–70). 25 patients were unevaluable due to insufficient data, and 68 patients were excluded from analysis because their disease was refractory to initial and salvage therapy. HL patients were segregated according to initial staging (I/II vs. III/IV). Results: Early stage HL patients relapsed at a median of 2.0 years (0.5–10.3) with 87% relapsing in initial disease site(s); 13% (95% CI 3.8–30.1%) relapsed only in new sites. Advanced stage HL patients relapsed at a median of 1.4 years (0.6–10.5) with 96% relapsing in initial site(s); 4% (95% CI 0.1–21.9%) relapsed only in new sites. Indolent histology NHL patients relapsed at a median of 2.1 years (0.5–14.9) with 83% relapsing in initial site(s); 17% (95% CI 7.3–32.8%) relapsed only in new sites. Aggressive histology NHL patients relapsed at a median of 1.0 year (0.3–8.0) with 64% relapsing in initial site(s); 36% (95% CI 26.2–46.2%) relapsed only in new sites. For early stage HD patients, recurrences were predominantly local, and uniformly so in those unirradiated. For all other groups, fewer patients were irradiated than unirradiated and local recurrences predominated regardless of therapy. Conclusions: Almost all patients with HL who relapse and subsequently undergo ASCT initially recur in previous disease sites. Although patients with aggressive histology NHL are more likely to relapse in new sites than patients with indolent NHL, local recurrences predominate in both groups. The median time to recurrence is brief (1–2.1 years). In a population defined by recurrent disease, it is expected that relapses will occur in irradiated sites. Relative protection by RT of local recurrence cannot be determined until all patients, regardless of relapse status, are analyzed. However, these data support an emphasis on local control and suggest that the frequency of screening be most rapid in the early post-therapy years. Comparison of Site(s) of Relapse to Site(s) of Initial Presentation HL NHL Early (n=30) Adv. (n=23) Ind. (n=40) Agg. (n=95) Characteristic % % % % New Site(s) 13 4 18 36 Previous site(s) only 63 61 60 44 Previous site(s) + new site(s) 23 35 23 20 Characteristic n n n n Radiated patients relapsing in previous site(s) 15/19 6/6 5/7 20/34 Unradiated patients relapsing in previous site(s) 11/11 16/17 26/33 42/61

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