Linfomas asociados a infección por VIH en pacientes del Hospital Clínico San Borja Arriarán / Fundación Arriarán2001-2008 / Lymphomas associated with HIV infection in patients at the Hospital San Borja Arriarán /Fundación Arriarán 2001-2008, Santiago, Chile

Introduction: Hodgkin lymphomas (HL) and non Hodgkin lymphomas (NHL) are frequently associated to acquired immunodeficiency syndrome in adults. Objective: To systematize the clinical features and histological characteristics of lymphomas in AIDS patients, its treatment and outcomes in our institution. Patients and Methods: Retrospective analysis of patients with HIV-associated lymphoma between January 2001 and December 2008 at the San Borja Arriarán Hospital complex. Results: Information was obtained from 30 patients with NHL and 7 with HL, with a median of 40 years. The majority of tumors were Burkitt lymphoma (47%), diffuse large cell lymphoma B-cell (37%) and NHL of T lineage (10%). There was no CNS or cavities lymphoma. Almost all patients (86.7%) with NHL were treated with CHOP chemotherapy, 57% of those receiving treatment had progression or relapse from complete remission. A rescue chemotherapy was indicated in 4 patients. 73% of patients receiving CHOP, complete 5 to 6 cycles of chemotherapy. The use of CHOP chemotherapy for the subgroup of patients with Burkitt lymphoma achieved low rates of complete remission and frequent relapse and disease progression, showing that CHOP was ineffective in improving survival, especially in high risk patients. We found statistically significant differences in survival according to IPIae (International prognostic Index age-adjusted). Conclusion: Non-Hodgkin lymphoma in HIV patients treated with chemotherapy protocols PAlNDA persists in our environment as a disease with a poor prognosis compared with findings in the international literature. The incorporation of new drugs of proven utility as rituximab and specific schemes chemotherapy could improve these results. The establishment of prognostic groups established by IPIae can guide clinical work for the use of chemotherapy tailored to their specific risk and optimized according to histological type.

Introducción: Los linfomas de Hodgkin (LH) y no Hodgkin (LNH) se asocian con alta frecuencia al síndrome de inmunodeficiencia humana en adultos. Objetivo: Sistematizar los aspectos clínicos e histológicos de los linfoma que afectan a pacientes con SIDA, su tratamiento y resultados globales en nuestra institución. Pacientes y Métodos: Análisis retrospectivo de pacientes con linfoma asociado a VIH entre enero de 2001 y diciembre de 2008 en el complejo hospitalario San Borja Arriarán. Resultados: Se obtuvo información de 30 pacientes con LNH y 7 LH, con una mediana de 40 años. Los tipos histológicos predominantes fueron linfoma de Burkitt (47 %), linfoma difuso de células grandes de estirpe B (37 %) y LNH de estirpe T (10%). No se diagnosticaron LNH del SNC ni linfoma de cavidades. Casi la totalidad de los pacientes (86,7%) con LNH se trataron con esquema CHOP, 57% de quienes recibieron tratamiento presentaron progresión o recaída desde remisión completa, ofreciéndoles una quimioterapia de rescate a cuatro pacientes. El 73% de los pacientes que recibieron CHOP lograron completar entre cinco y seis ciclos de quimioterapia. El uso de quimioterapia CHOP para el subgrupo de pacientes con linfoma de Burkitt alcanzó bajos porcentajes de remisión completa y mayoritariamente progresó la enfermedad, siendo esta quimioterapia, inefectiva para mejorar la sobrevida, especialmente en los pacientes de riesgo alto. Se encontraron diferencias estadísticamente significativas en sobrevida según el IPIae (índice internacional pronóstico ajustado por edad) al ingreso. Conclusión: El LNH en los pacientes con VIH tratados con los protocolos de quimioterapia PANDA persiste en nuestro medio como una enfermedad de muy mal pronóstico comparado con los resultados en la literatura internacional. La incorporación de nuevos fármacos de demostrada utilidad como rituximab y esquemas específicos de quimioterapia podrían mejorar estos resultados. El establecimiento de grupos pronósticos establecidos por IPIae puede orientar el trabajo clínico para el uso de quimioterapia ajustada a su riesgo específico y optimizado según tipo histológico.

Linfoma relacionado a infección por virus de la inmunodeficiencia humana en un hospital público de Santiago, Chile / HIV-related lymphoma in a public hospital in Chile. Analysis of 55 cases

Background: Cancer is the third cause of death in patients infected with human immunodeficiency virus (HIV) and lymphoma is the most common type. Aim: To describe the clinical characteristics, histology, risk factors and prognosis of these patients, in a Chilean public hospital in Chile. Material and Methods: Records of 55 patients (45 males) aged between 23 and 67years with lymphoma and HIV positive serology, diagnosed between 1992-2008, were reviewed. Results: Six patients (11%) had Hodgkin lymphoma (HL) and the rest, non-Hodgkin lymphoma (NHL). B-cell phenotype constituted 83.7% of NHL cases. The most common subtypes of all the lymphoma were diffuse large B cell lymphoma in 24 cases (43.6%), Burkitt lym-phoma in 12 cases (21.8%), andplasmablastic lymphoma in 5 cases (9.1%). Thirty five patients (64%) underwent curative intended chemotherapy (CT) concomitantly with highly active antiretroviral therapy (HAART). Three year survival of the whole cohort was 27%. By multivariate analysis, the most important prognostic factors for long term survival, were complete responses to CT, (p < 0.01) and a low international prognostic index (IPI) score for NHL, (p = 0.01). HAART, histologic subtype and CD4 lymphocyte count at diagnosis, did not influence survival. Conclusions: The most important prognostic factors for HIV patients with lymphoma, were achieving CR with CT and low IPI score. Prognosis remains poor, even with HAART therapy.

HIV-associated non-Hodgkin's lymphoma: Experience from a regional cancer center.

Aims : To analyze clinical features and survival in HIV-associated non-Hodgkin lymphoma (NHL) cases registered at Dr BRA Institute Rotary Cancer Hospital of AIIMS, New Delhi. Materials and Methods : We have retrospectively reviewed records of NHL patients registered, from January 2003 to July 2007 to analyze HIV-associated NHL. Results : Seven cases of HIV-associated NHL cases were identified. Age range was 14-56 years. Five were males. Baseline performance status (ECOG-PS) was >I in 6. Mean LDH was 409 U/L. Mean hemoglobin was 10.5 g% and mean CD4 count was 243/mm3 (range 18- 454). Three cases had nodal lymphoma and four had extra nodal lymphoma. No primary CNS (PCNSL) lymphoma was seen. All patients were of advanced stages and of intermediate to high-risk group based on international prognostic index (IPI). Six cases had high-grade NHL. None had CNS involvement. Five had B symptoms. HIV infection was diagnosed as part of NHL work-up in five patients. All patients received HAART. All were planned for chemotherapy with CNS prophylaxis. Protocols used were CVP, CHOP, R-CHOP or MCP-842. One patient received IFRT. Response : One patient achieved complete response (CR) and continues to be disease free, with 4.5 years of follow-up. Three cases achieved partial response (PR) and 2 had progressive disease (PD). Currently, three patients are on follow-up. Conclusions : These NHL are of higher grade and advanced stage. Response and tolerance to chemotherapy is poor. Appropriate supportive care and CNS prophylaxis might improve outcome. We need to improve epidemiological data collection system in this part of world. With HAART, the goal of therapy is durable CR rather than palliation.

Clinical, endoscopic and prognostic aspects of primary gastric non-hodgkin's lymphoma associated with acquired immunodeficiency syndrome

Primary gastric non-Hodgkin's lymphoma (NHL) is a co-morbidity that can be observed during the clinical course of acquired immunodeficiency syndrome (AIDS). We evaluated the prevalence, clinical-evolutive aspects and form of endoscopic presentation of primary gastric NHL associated with AIDS. Two hundred and forty-three HIV patients were submitted to upper digestive endoscopy, with evaluation of clinical, endoscopic and histological data. A CD4 count was made by flow cytometry and viral load was determined in a branched-DNA assay. Six cases (five men; mean age: 37 years; range: 29-46 years) of primary gastric NHL were detected. The median CD4 count was 140 cells/mm³ and the median viral load was 40,313 copies/mL. Upper digestive endoscopy revealed polypoid (in four patients) ulcero-infiltrative (two patients) and ulcerated (two patients) lesions and combined polypoid and ulcerated lesions (two patients). Histology of the gastric lesions demonstrated B cell NHL (four patients) and T cell NHL (two patients). Five of the six patients died of complications related to gastric NHL. We concluded that primary gastric NHL is an important cause of mortality associated with AIDS.

Linfomas del tubo digestivo y glándulas anexas en pacientes con SIDA: serie de casos / Non-Hodgkin's lymphomas of the digestive tract and anexal glands in AIDS patients

Introducción: el linfoma no Hodgkin (LNH) es la segunda neoplasia más frecuente en pacientes con SIDA. Una de las principales características de los LNH asociados con el SIDA es la alta frecuencia de compromiso extranodal, incluyendo el tracto astrointestinal, como manifestación inicial de la neoplasia. Métodos: se analizaron de manera retrospectiva las características epidemiológicas, clínicas, virológicas, inmunológicas e histopatológicas de 8 pacientes con diagnóstico de linfomas del tracto gastrointestinal y glándulas anexas (hígado y parótida) asistidos en la División de VIH- /SIDA del Hospital de Enfermedades Infecciosas F J Muñiz de Buenos Aires, Argentina, entre enero de 1997 y diciembre de 2004. Todos los pacientes fueron evaluados por tomografía computarizada y examen de la médula ósea, además de los exámenes endoscópicosde diagnóstico. Resultados: todos los pacientes fueron varones; 4 eran heterosexuales, 2 homosexuales, uno hemofílico y uno adicto a drogas endovenosas. Tres pacientes presentaron coinfección por el virus de la hepatitis C. La mediana de edad fue de 42 años y la mediana de linfocitos T CD4 + fue de 87 células/uL al momento del diagnóstico de la neoplasia. Ningún paciente recibía TARGA al momento del diagnóstico del linfoma. La incidencia global de linfomas (primarios del sistema nervioso central, no Hodgkin sistémicos y de Hodgkin) durante el período de estudio fue de 2,9% (54 casos); 17 pacientes (32%) tuvieron diagnóstico de LNH sistémicos; 10 (58,8%) de ellos tuvieron presentación extranodal al momento del inicio de las mani manifestaciones clínicas y 8 (80%) comprometieron el tubo digestivo y las glándulas anexas (parótida, cavum, esófago, estómago, duodeno, colon derecho en 2 casos e hígado en el restante), como LNH primarios, de alto grado y de fenotipo "B". Todos los pacientes presentaronsíntomas "B" al momento del diagnóstico. De acuerdo con los criterios de estadificación de Lugano, 4 se encontraban en el estadio...

Background: Non-Hodgkin's lymphoma (NHL) is the second most common neoplasm among patients with AIDS. One of the major clinical characteristics of AIDS-associated NHL is the high frequency of extranodal involvement, including the gastrointestinaltract, at initial presentation. Methods: From January 1997 to December 2004, 8 cases of NHL of the digestive tract and anexal glands (liver and parotid gland) were observed at the HIV/AIDS division of the Infectious Diseases F J Muñiz Hospital from Buenos Aires,Argentina. All patients were staged by computed tomography scanning and bone marrow examination, in addition to the endoscopic evaluation. Results: All patients were males; 4 were heterosexual, 2 homosexual, and 1 were a hemophilic and an intravenous drug abuser. The median age was 42 years and the median CD4 T cell count was 87 cells/uL at the time of the diagnosis of neoplasm. No patient was receiving highly active antiretroviral therapy (HAART) at lymphoma diagnosis. The global incidence of AIDS-associated lymphomas (central nervous system lymphomas, non-Hodgkin lymphomas and Hodgkin lymphoma) during the time of study was 2,9% (54 cases); 17 patients(32%) had diagnosis of systemic NHL; 10 (58,8%) of them were extranodal at the onset of clinical symptoms and 8 (80%) involvement the digestive tract and anexal glands (parotid gland, cavum, esophagus, stomach, duodenum, the right colon in 2 patients and the liver), as primary NHL of high grade and "B" phenotype. All patients presented "B" symptoms at the time of diagnosis. Primary duodenal lymphoma was the only Burkittlymphoma of this serie and we detected the Epstein-Barr virus genome in the biopsy smears of this tumor and in the hepatic lymphoma. Four patients were treated with systemic chemotherapy with granulocytic growth factor support plus highly active antiretroviral therapy (HAART); 2 of them (cavum and one of the colon) had a prolonged survival with immune reconstitution during 5 and 6...