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Blood, 1 January 2006, Vol. 107, No. 1, pp. 13-20.
Prepublished online as a Blood First Edition Paper on August 11, 2005; DOI 10.1182/blood-2004-11-4278.
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Submitted November 12, 2004
Accepted June 19, 2005
AIDS-related lymphoproliferative disease
Willis H Navarro and Lawrence D Kaplan*
Division of Hematology/Oncology, University of California, San Francisco, CA, USA
* Corresponding author; email: lkaplan{at}medicine.ucsf.edu.
Not long after the recognition of HIV as the causative agent of AIDS, it was evident that individuals infected with HIV developed lymphoma at a greater rate than the population at large. Approximately two-thirds of AIDS-related lymphoma (ARL) cases are categorized as diffuse large B-cell type, with Burkitt lymphomas comprising 25% and other histologies a much smaller proportion. Typically, these individuals have presented with advanced extranodal disease and CD4+ lymphocyte counts of less than 200/mm3. Recent clinical trials have demonstrated a better outcome with chemotherapy for ARL since the introduction of combination anti-retroviral treatment termed highly active antiretroviral therapy (HAART). For relapsed patients, solid evidence points to the safety and utility of hematopoietic cell transplant as a salvage modality. Co-infection with other viruses such as Epstein-Barr virus and Kaposi sarcoma-associated herpesvirus have led to the genesis of previously rare or unrecognized lymphoma subtypes such as plasmablastic and primary effusion lymphomas. The immunosuppressive impact of treatment for patients with ARL receiving chemotherapy with HAART appears transient and opportunistic infections have become less problematic than prior to HAART. There has been significant progress in the understanding and management of ARL but outcomes still remain inferior compared to those achieved in HIV-negative individuals.
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