CANCER IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED CHILDREN - A CASE SERIES FROM THE CHILDRENS CANCER GROUP AND THE NATIONAL-CANCER-INSTITUTE

Purpose: To describe the spectrum of malignancies in human immunodefic iency virus (HIV)-infected children and the clinical outcome of patien ts with these tumors. Methods: We retrospectively surveyed the Childre n's Cancer Group (CCG) and the National Cancer institute (NCI) for cas es of cancer that occurred between July 1982 and February 1997 in chil dren who were HIV seropositive before or at the time of cancer diagnos is, We used Kaplan-Meier survivorship curves, hazard function estimate s, and Cox proportional hazards models to evaluate survival. Results: Sixty-four children (39 boys, 25 girls) with 65 tumors were reported, Thirty-seven children (58%) acquired HN infection vertically (median a ge at cancer diagnosis, 4.3 years); 22 children (34%) acquired HIV thr ough transfusion of blood or blood products (median age at cancer diag nosis, 13.4 years). Forty-two children (65%) had non-Hodgkin's lymphom a (NHL), Eleven children (17%) had leiomyosarcomas (or leiomyomas), wh ich are otherwise exceptionally rare in children. Other malignancies i ncluded acute leukemia (five children), Kaposi's sarcoma (KS; three ch ildren), Hodgkin's disease (two children), vaginal carcinoma in situ ( one child), and tracheal neuroendocrine carcinoma (one child), Median survival after NHL diagnosis was 6 months (range, 1 day to 89 months) and after leiomyosarcoma was 12 months (range, 10 days to 19 months), The average monthly death rate after NHL diagnosis was 12% in the firs t 6 months, which decreased to about 2% thereafter In contrast, the mo nthly death rate after leiomyosarcoma diagnosis increased from 5% in t he first 6 months to about 20% thereafter. Conclusion: After NHL, leio myosarcoma is the sec and reading cancer in children with HIV infectio n, Bath cancers have high mortality rates; improved outcome for NHL, i n particular, may depend on earlier diagnosis and therapy. (C) 1998 by American Society of Clinical Oncology.