Profile and management of AIDS related lymphoma.

Abstract

Worldwide, HIV-associated lymphoma (HAL) is a common HIV-related malignancy. Most are aggressive, high-grade B cell malignancies and are classified as AIDS Related Lymphomas (ARL). ARL include Diffuse large B cell lymphoma (DLBCL), Burkitt lymphoma (BL), and less commonly, plasmablastic lymphoma (PBL), primary effusion lymphomas (PEL) and primary central nervous system lymphoma (PCNSL). Prior to antiretroviral therapy (ART), the incidence of lymphoma was 60-200 fold higher than that seen in HIV-negative subjects, but this has decreased to 11-25 fold with the widespread use of ART. The prevalence of HIV in South Africa (SA) is estimated at 13.5% (8 million people), with the province of KwaZulu-Natal (KZN) leading other provinces at a seroprevalence rate of 18%. Most patients in SA access medical care through government health facilities. King Edward Vlll Hospital (KEH) is a government-funded, tertiary health care centre affiliated with the academic hospital of the Nelson R. Mandela School of Medicine of the University of KwaZulu located in Durban, KZN. Most ARL in the indigent population, other than BL, are treated at KEH. The aim of this original research was to describe the profile, outcome and prognostic variables of ARL treated in a government hospital at the epicentre of the HIV/AIDS pandemic in KZN, and compare this to data described elsewhere in South Africa and internationally. There is limited data from South Africa on ARL, and no data from KZN. Globally, conventional chemotherapy for ARL has been supplemented by rituximab, which is a monoclonal antibody targeting CD20. A shift in treatment midway through this study period, to include the use of rituximab locally for CD20-positive ARL, provided an opportunity to compare outcomes with and without rituximab. Plasmablastic lymphoma is a challenging ARL, in terms of diagnosis and management. As this is an unusual lymphoma, with a prevalence of 0.004% of all lymphomas, there viii are no large, prospective trials. We describe our experience with the profile and outcome of this cohort of ARL patients, treated with combination chemotherapy. Outcome in lymphoma is guided by prognostic scoring systems, the international prognostic index (IPI) or the age-adjusted IPI (aaIPI). As these prognostic scoring systems have not been validated in the local population in KZN, the utility of these scoring systems was assessed in this research.