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Blood, 15 December 2000, Vol. 96, No. 13, pp. 4084-4090
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Evolving characteristics of AIDS-related lymphoma
Alexandra M. Levine,
Lasika Seneviratne,
Byron M. Espina,
Amy Rock Wohl,
Anil Tulpule,
Bharat N. Nathwani, and
Parkash S. Gill
From the Division of Hematology, Department of
Medicine, and Division of Hematopathology, Department of Pathology,
Keck School of Medicine, University of Southern California, Los
Angeles, California; and the HIV Epidemiology Program, Los Angeles
County Department of Health Services, Los Angeles, California.
Over time, the epidemiologic and demographic characteristics
of AIDS have changed in the United States, while the use of highly active antiretroviral therapy has changed the natural history of the
disease. The goal of the study was to ascertain any changes in the
epidemiologic, immunologic, pathologic, or clinical characteristics of
AIDS-related lymphoma (ARL) over the course of the AIDS epidemic. Records of 369 patients with ARL diagnosed or treated at a single institution from 1982 through 1998 were reviewed. Single institutional data were compared to population-based data from the County of Los
Angeles. Significant changes in the demographic profile of patients
with newly diagnosed ARL have occurred, with the later time intervals
associated with a higher prevalence in women (P = .25),
in Latino/Hispanic individuals (P < .0001), and in those who acquired human immunodeficiency virus (HIV) heterosexually (P = .01). These changes were similar in both countywide,
population-based analyses and in those from the single institution. The
median CD4+ lymphocyte count at lymphoma diagnosis has
decreased significantly over the years, from 177/dL in the earliest
time period (1982-1986), to 53/dL in the last time period from 1995 to
1998 (P = .0006). The pathologic spectrum of disease has
also changed, with a decrease in the prevalence of small noncleaved
lymphoma (P = .0005) and an increase in diffuse large
cell lymphoma (P < .0001). Despite changes in the use of
antiretroviral or chemotherapy regimens, the median survival has not
significantly changed.
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