HETEROGENEITY OF ACUTE LYMPHOBLASTIC-LEUKEMIA IN HIV-SEROPOSITIVE PATIENTS

Background& As opposed to large-cell or Burkitt's-type non-Hodgkin's l ymphoma, acute lymphoblastic leukemia (ALL) is rarely observed in HIV- seropositive patients and is not a criteria of AIDS in the 1986 classi fication established by the C.D.C. Furthermore, the few cases of ALL r eported so far were B-cell ALL, Burkitt's-type. Design: We recently ob served, with unexpected frequency, ALL cases in this setting: over a 5 -year period, 5 of 25 HIV-positive patients referred to our center for hematological malignancies, had ALL. Three patients, who had previous ly been asymptomatic with regard to HIV infection, had typical Burkitt 's-type ALL. Complete remission was achieved in all cases with high-do se lymphoma-type chemotherapy regimens, but 2 patients relapsed 3 and 27 months after diagnosis. Their clinical characteristics and outcome are discussed with reference to the cases reported thus far in the lit erature. One patient had common early pre-B ALL with the Philadelphia chromosome, and one had a T-cell ALL with an unusual CD7+, CD4-, CD8- phenotype. Prognosis was very poor in both cases. Conclusion: The exac t incidence and the therapeutic management of B-cell ALL in HIV-positi ve patients warrants further evaluation. In addition, we show that the re may be a heterogeneity among ALL cases in this setting, with the fi rst description of 2 non-Burkitt's ALL with atypical features in HIV-p ositive patients.