Clinical Presentation Of Aidsrelated Lymphoma

The majority of patients with systemic AIDS-related lymphomas present with advanced stage disease and B symptoms. Extranodal disease, bone marrow involvement, and leptomeningeal disease are all common features. Hepatic involvement occurs in up to 25% patients, while one in five patients has bone marrow involvement by NHL. In addition, HIV infection itself is associated with trilineage abnormalities of hematopoiesis23 24 and the poor hematologic reserves add to the myelotoxicity of cytotoxic chemotherapy. Central nervous system (CNS) involvement by systemic AIDS-associated NHL is frequent; leptomeningeal disease is present at diagnosis in 3-10% and is significantly associated with both Burkitt's lymphoma and paraspinal or paranasal involvement.25-28

In the published series from our institution (Chelsea & Westminster Hospital, London) that compared the clinical characteristics of 99 AIDS-related lymphomas presenting prior to 1996 and 55 that presented between 1996 and 1999, there were no differences in the stage at presentation, presence of B symptoms, bone marrow infiltration, or performance status between the two groups. However, the patients who developed lymphoma in the HAART era were less likely to have had a prior AIDS diagnosis, were older, and had higher CD4 cell counts at the time of lymphoma diagnosis.29 Thus, although there has been a change in the immunologic parameters of lymphoma patients, this would seem to reflect changes in the population at risk rather than any alteration of the biology of the lymphomas. A further analysis of patients who presented with lymphoma in the era of HAART compared those who were receiving HAART at the time of lymphoma diagnosis (n = 17) with those who were not (n = 34). Again there were no significant differences between the stages or disease sites at presentation but the CD4 cell counts at lymphoma diagnosis were higher in those on HAART.

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