Objective: To clarify the incidence and clinical outcomes of non-AIDS-defining hematological malignancies (NADHMs), excluding non-Hodgkin's lymphomas, in HIV-infected patients.
Design: A nationwide epidemiological study was conducted to evaluate the incidence and clinical outcomes of NADHMs.
Methods: Questionnaires were sent to 429 regional AIDS centers and 497 educational hospitals certified by the Japanese Society of Hematology. Data from 511 institutes were obtained.
Results: From 1991 to 2010, 47 patients with NADHMs were detected (median age, 42.0 years; male, 93.6%). The median CD4-positive T-cell count was 255/μl, and the median duration from the diagnosis of HIV infection to development of hematological malignancy was 28.0 months. Most patients with acute leukemia were treated with standard induction chemotherapy. Complete remission rates and median overall survival periods for acute myeloblastic leukemia (AML) and acute lymphoblastic leukemia (ALL) were 70.0 and 85.7% and 13 and 16 months, respectively. Three of four patients with chronic-phase chronic myeloid leukemia (CML-CP) were well controlled with imatinib. Five patients (2 AML, 1 ALL, 1 accelerated-phase CML, and 1 myeloma) were treated with autologous or allogeneic stem-cell transplantation. Comparison of patients over the two periods (1991–2000 and 2001–2009) revealed a 4.5-fold increase in the incidence of hematological malignancies.
Conclusion: The incidence of NADHMs has increased in the past decade. The prognosis of these patients was similar to that of HIV-negative patients; therefore, standard chemotherapy may be a feasible treatment option for HIV-infected patients with hematological malignancies.
aDivision of Hematology, Department of Internal medicine, National Medical Center for Global Health and Medicine
bDepartment of Laboratory Medicine, Tokyo Medical University
cDepartment of Infectious Diseases and Applied Immunology, The Institute of Medical Science, The University of Tokyo
dDivision of Infectious Disease, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo
eDepartment of Infectious Diseases, National Hospital Organization OsakaNational Hospital, Osaka
fDepartment of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya
gAIDS Clinical Center, National Medical Center for Global Health and Medicine, Tokyo
hCenter for AIDS Research, Kumamoto University, Kumamoto, Japan.
Correspondence to Shotaro Hagiwara, MD, Grad Dip Clin Epid, PhD, Division of Hematology, Department of Internal Medicine, National Medical Center for Global Health and Medicine, 1–21–1 Toyama, Shinjuku, Tokyo 162–8655, Japan. Tel: +81 3 3202 7181; fax: +81 3 3207 1038; e-mail: email@example.com
Received 1 June, 2012
Revised 4 September, 2012
Accepted 12 September, 2012