Non-Hodgkin's Lymphoma in Patients With Advanced HIV Infection Treated With Zidovudine FREE

Richard D. Moore, MD, MHSc; Harold Kessler, MD; Douglas D. Richman, MD; Charles Flexner, MD; Richard E. Chaisson, MD

[+] Author Affiliations

Reprint requests to Johns Hopkins Hospital, 1830 E Monument St, Room 8059, Baltimore, MD 21205 (Dr Moore).

JAMA. 1991;265(17):2208-2211. doi:10.1001/jama.1991.03460170062034

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ABSTRACT

ABSTRACT | REFERENCES

We wished to determine the incidence of human immunodeficiency virus—related high-grade non-Hodgkin's lymphoma (NHL) and identify factors associated with the development of NHL in patients receiving zidovudine. Data are from a 2-year prospective, observational, multisite study of 1030 patients with the acquired immunodeficiency syndrome (AIDS) and advanced AIDS-related complex who received zidovudine. Non-Hodgkin's lymphoma developed in 24 (2.3%) of 1030 patients who received zidovudine during 1463 person-years of follow-up (rate, 1.6 per 100 person-years of therapy). The relative hazard for development of NHL was stable throughout 2 years of therapy, with the risk of developing NHL 0.8% for each additional 6 months of therapy. Factors associated with development of NHL were a prior diagnosis of Kaposi's sarcoma, herpes simplex virus infection, or lower mean neutrophil count. Less strongly associated was a prior diagnosis of oral hairy leukoplakia or homosexual transmission of HIV. By Cox proportional hazards analysis, a prior diagnosis of Kaposi's sarcoma, cytomegalovirus disease, or oral hairy leukoplakia was most strongly associated with development of NHL. Our study demonstrates a relatively high incidence of NHL in patients with advanced human immunodeficiency virus disease who are undergoing antiretroviral therapy and suggests possible risk factors for development of NHL.

(JAMA. 1991;265:2208-2211)

REFERENCES

ABSTRACT | REFERENCES

Ziegler JL, Beckstead JA, Volberding PA, et al. Non-Hodgkin's lymphoma in 90 homosexual men: relation to generalized lymphadenopathy and the acquired immunodeficiency syndrome . N Engl J Med. 1984;;311:565-570.

Kaplan LD, Abrams DI, Feigal E, et al. AIDS-associated non-Hodgkin's lymphoma in San Francisco . JAMA. 1989;;261:719-724.

Harnly ME, Swan SH, Holly EA, et al. Temporal trends in the incidence of non-Hodgkin's lymphoma and selected malignancies in a population with a high incidence of acquired immunodeficiency syndrome (AIDS) . Am J Epidemiol. 1988;;128:261-267.

Bernstein L, Levin D, Mench H, Ross RK. AIDS-related secular trends in cancer in Los Angeles County men: a comparison by marital status . Cancer Res. 1989;;49:466-470.

Centers for Disease Control. Revision of the case definition of acquired immunodeficiency syndrome for national reporting—United States . MMWR. 1985;;34:373-375.

Pluda JM, Yarchoan R, Jaffe ES, et al. Development of non-Hodgkin's lymphoma in a cohort of patients with severe human immunodeficiency virus (HIV) infection on long-term antiretroviral therapy . Ann Intern Med. 1990;;113:276-282.

Physicians' Desk Reference. 45th ed. Oradell, NJ: Medical Economics Co Inc; 1991;:790.

Lifetime bioassay studies . In: Comprehensive Information for Investigators, RETROVIR . Research Triangle Park, NC: Burroughs Wellcome Co; 1990;:48.

Moore RD, Keruly JC, Link GA, et al. Long-term safety and efficacy of zidovudine in patients with advanced HIV-disease . Arch Intern Med. In press.

Fischl MA, Richman DD, Hansen N, et al. The safety and efficacy of zidovudine (AZT) in the treatment of subjects with mildly symptomatic human immunodeficiency virus type 1 (HIV) infection . Ann Intern Med. 1990;;112:727-737.

Volberding PA, Lagakos SW, Koch MA, et al. Zidovudine in asymptomatic human immunodeficiency virus infection . N Engl J Med. 1990;;322:941-949.

Rabkin CS, Goedert JJ. Risk of non-Hodgkin lymphoma and Kaposi's sarcoma in homosexual men . Lancet. 1990;;336:248-249.

Safai B, Mike V, Giraldo G, Beth E, Good RA. Association of Kaposi's sarcoma with second primary malignancies . Cancer. 1980;;45:1472-1479.

Rutherford GW, Schwarcz SK, Lemp GF, et al. The epidemiology of AIDS-related Kaposi's sarcoma in San Francisco . J Infect Dis. 1989;;159:569-572.

Lemp GF, Payne SF, Neal D, Temelso T, Rutherford GW. Survival trends for patients with AIDS . JAMA. 1990;;263:402-406.

Murray RS, Rosenberg NL, DeMasters BK, Jones J. Relationship between primary central nervous system lymphoma and Epstein-Barr virus in acquired immunodeficiency syndrome: in-situ hybridization studies . Ann Neurol. 1987;;22:155. Abstract.

Bashir RM, Harris NL, Hochberg FH, Singer RM. Detection of Epstein-Barr virus in CNS lymphomas by in-situ hybridization . Neurology. 1989;;39:813-817.

Greenspan JS, Greenspan D, Lennette ET, et al. Replication of Epstein-Barr virus within the epithelial cells of oral 'hairy' leukoplakia, an AIDS-associated lesion . N Engl J Med. 1985;;313:1564-1571.

Beral V, Peterman TA, Berkelman R, Jaffe WW. Kaposi's sarcoma among persons with AIDS: a sexually transmitted infection ? Lancet. 1990;;335:123-128.

Drew WL, Mills J, Hauer LB, Miner RC, Rutherford GW. Declining prevalence of Kaposi's sarcoma in homosexual AIDS patients paralleled by fall in cytomegalovirus transmission . Lancet. 1988;;1:66.

Holmberg S, Gerber AR, Steward JA. Herpes virus as co-factors in AIDS . Lancet . 1988;;2:746-747.

Krueger GR, Manak M, Bourgeois N, et al. Persistent active herpes virus infection associated with atypical polyclonal lymphoproliferation (APL) and malignant lymphoma . Anticancer Res. 1989;;9:1457-1476.

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