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Development of Non-Hodgkin Lymphoma in a Cohort of Patients with Severe Human Immunodeficiency Virus (HIV) Infection on Long-Term Antiretroviral Therapy
- James M. Pluda, MD;
- Robert Yarchoan, MD;
- Elaine S. Jaffe, MD;
- Irwin M. Feuerstein, MD;
- Diane Solomon, MD;
- Seth M. Steinberg, PhD;
- Kathleen M. Wyvill, RN;
- Andrew Raubitschek, MD;
- David Katz, MD; and
- Samuel Broder, MD
Abstract
Objective: To describe the incidence of non-Hodgkin lymphoma in a group of patients with symptomatic human immunodeficiency virus (HIV) infection receiving long-term dideoxynucleoside antiretroviral therapy.
Design: We examined the records of all patients with the acquired immunodeficiency syndrome (AIDS) or severe AIDS-related complex who were entered into three long-term phase I trials of zidovudine (azidothymidine, AZT) or zidovudine-containing regimens at the National Cancer Institute between 1985 and 1987.
Setting: The Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland.
Participants: Fifty-five HIV-infected patients with AIDS or severe AIDS-related complex.
Measurements and Main Results: Eight of fifty-five patients (14.5%; 95% CI, 6.5% to 26.7%) developed a high-grade non-Hodgkin lymphoma of B-cell type, a median of 23.8 months (range, 13 to 35 months) after starting antiretroviral treatment. Using the method of Kaplan and Meier, the estimated probability of developing lymphoma by 30 months of therapy was 28.6% (CI, 13.7% to 50.3%) and by 36 months, 46.4% (CI, 19.6% to 75.5%). The patients who developed lymphoma had less than 100 T4 cells/mm3 for a median of 17.8 months (range, 7 to 35 months) and less than 50 T4 cells/mm3 for a median of 15.3 months (range, 5.5 to 35 months) before the diagnosis. All patients presented with non-Hodgkin lymphoma in extranodal sites, and two developed primary brain involvement in the setting of Toxoplasma infection.
Conclusion: Patients with symptomatic HIV infection who survive for up to 3 years on antiretroviral therapy may have a relatively high probability of developing non-Hodgkin lymphoma. Prolonged survival in the setting of profound immunosuppression with substantial T4-cell depletion is probably an important factor in the development of these lymphomas. However, a direct role of therapy itself cannot be totally discounted. As improved therapies for the treatment of HIV infection and its complications result in prolonged survival, non-Hodgkin lymphoma may become an increasingly significant problem.
Article and Author Information
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From National Cancer Institute, National Institute of Neurological Disorders and Stroke, and National Institutes of Health, Bethesda, Maryland; and Georgetown University, Washington, D.C. For current author addresses, see end of text.
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Requests for Reprints: James M. Pluda, MD, National Institutes of Health, Building 10, Room 13N248 Bethesda, MD 20892.
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Current Author Addresses: Drs. Pluda and Yarchoan: National Institutes of Health, Building 10, Room 13N248, Bethesda, MD 20892.
Dr. Jaffe: National Institutes of Health, Building 10, Room 2N202, Bethesda, MD 20892.
Dr. Feuerstein: National Institutes of Health, Building 10, Room 1C660, Bethesda, MD 20892.
Dr. Solomon: National Institutes of Health, Building 10, Room 2A19, Bethesda, MD 20892.
Dr. Steinberg: National Institutes of Health, Building 10, Room 13C 103, Bethesda, MD 20892.
Ms. Wyvill: National Institutes of Health, Building 10, Room 12N226, Bethesda, MD 20892.
Dr. Raubitschek: National Institutes of Health, Building 10, Room B3B69, Bethesda, MD 20892.
Dr. Katz: National Institutes of Health, Building 10, Room 2N212, Bethesda, MD 20892.
Dr. Broder: National Institutes of Health, Building 31, Room 11A48, Bethesda, MD 20892.
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