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Advances in the management of HIV-related non-Hodgkin lymphoma

Behler, Caroline M; Kaplan, Lawrence D

doi: 10.1097/01.cco.0000239881.16216.05
Lymphoma
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Purpose of review Human immunodeficiency virus infection is associated with an increased risk of non-Hodgkin lymphoma. Even with a decrease in AIDS-defining illnesses after the advent of highly active antiretroviral therapy, HIV-associated non-Hodgkin lymphoma remains an important problem.

Recent findings Low CD4+ T-lymphocyte count, disease stage, performance status, serum lactate dehydrogenase, and number of extranodal sites of disease are all important prognostic factors for HIV-non-Hodgkin lymphoma. Recent studies have examined the role of infusional chemotherapy, as well as immunotherapy, in the treatment of aggressive HIV-non-Hodgkin lymphoma, and autologous stem cell transplantation for relapsed or refractory HIV-non-Hodgkin lymphoma. New developments in the association of viral infection and pathogenesis of certain subtypes of HIV-non-Hodgkin lymphoma have also recently been reported.

Summary Outcomes of HIV-non-Hodgkin lymphoma are improving with the routine use of highly active antiretroviral therapy and combination chemotherapy. For aggressive HIV-non-Hodgkin lymphoma, infusional chemotherapy regimens are well tolerated and lead to complete response in about 50–75% of cases and a 2–3 years overall survival of 40–60%. The potential benefit of adding rituximab to combination chemotherapy may be offset by infectious complications in severely immunosuppressed patients. HIV-associated Burkitt lymphoma should be treated with an intensive regimen rather than standard cyclophosphamide, doxorubicin, vincristine, prednisone-like chemotherapy. Autologous stem cell transplantation should be considered for selected patients with relapsed or refractory HIV-non-Hodgkin lymphoma.

Division of Hematology and Oncology, University of California, San Francisco, USA

Correspondence to Caroline M. Behler, 505 Parnassus M1286, Box 1270, University of California, San Francisco, San Francisco, CA 94143-1270, USA Tel: +1 415 353 2421; e-mail: caroline.behler@ucsf.edu

© 2006 Lippincott Williams & Wilkins, Inc.