Acquired immunodeficiency syndrome-related lymphoma: clinical aspects

While the widespread use of highly active antiretroviral therapy (HAART) has led to substantial decreases in the incidence of opportunistic infections and Kaposi's sarcoma, a major decrease in lymphoma has not yet occurred. Patients with acquired immunodeficiency syndrome (AIDS)-related lymphoma present with widespread, extranodal disease, often in the presence of systemic "B" symptoms. Factors associated with decreased survival include age greater than 35 years, history of injection drug use, poor performance status, CD4 cell count less than 100/dL, a history of AIDS prior to the diagnosis of lymphoma, stage III or IV disease, and/or elevated lactate dehydrogenase (LDH) levels. Low-dose combination chemotherapy has been associated with complete remission (CR) rates of 41% to 46%, with an overall median survival time of 8.7 months, similar to results achieved with standard-dose therapy, which is associated with greater toxicity. Infusional regimens have been associated with CR rates as high as 94%, and further evaluation is justified. Combination chemotherapy may be given safely with HAART. Treatment of relapsed AIDS-related lymphoma remains problematic.