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.

Keywords
Acquired immune deficiency syndrome, human immunodeficiency virus, non-Hodgkin lymphoma