Management of AIDS-Related non-Hodgkin's lymphomas

The incidence of non-Hodgkin's lymphoma in individuals infected with HIV is approximately 60- to 100-fold increased over the general population. The m ajority of patients with AIDS-related lymphoma (ARL) present with stage III -IV disease and with B-symptoms. They often have multiple extranodal locali sations, with a high incidence of central nervous system involvement. Histo logically, most tumours are either diffuse large cell lymphomas or Burkitt lymphomas. Several factors, such as disrupted immune surveillance, Epstein- Barr virus infection, chronic antigenic stimulation, cytokine- dysregulatio n and the acquisition of genetic lesions, are thought to contribute to the pathogenesis. Patients with ARL have a poor prognosis: overall survival ranges from 1.5 t o 18 months. The most important adverse prognostic factors are poor perform ance status, a low CD4+ cell count and a history of opportunistic infection s. Results of treatment with polychemotherapy compare unfavourably to resul ts in patients without HIV infection. Since the advent of highly active antiretroviral therapy (HAART), there app ears to be a decrease in the incidence of ARL: In addition, the use of HA A RT in combination with chemotherapy and the use of new treatment modalities may improve the outcome of this disease.