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infected with human immunodeficiency virus (HIV) 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
acquired immune deficiency syndrome (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 differs 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 (Epstein-Barr virus and/or human
herpesvirus-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.
|Table 1. Lymphomas associated with HIV infection (according to WHO classification of tumours of haematopoietic and lymphoid tissues, 2008) * (Ref.4).|
|Table 2. HIV-associated lymphomas and oncogenic viruses.|
|Table 3. Main reported series of front line therapy for HIV-associated aggressive B cell lymphoma in the cART era.|
|Table 4. Main reported series of front line therapy for HIV-associated Burkitt lymphoma in the cART era.|
|Table 5. Main reported series of front line therapy for HIV-associated Hodgkin lymphoma in the cART era.|
|Table 6. Main reported series of ASCT as salvage treatment in HIV-positive patients with lymphoma.|
Figure 1a*. Overall survival and progression-free survival of 27 patients with HIV-related lymphoma after ASCT (Ref. 138).
Figure 1b*. Overall survival and progression-free survival of the entire series of 50 patients with HIV-related lymphoma eligible for the study (Ref. 138).
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