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Acute myeloid leukemia in patients infected with HIV-1
David M Aboulafia1, Michelle Meneses, Steven Ginsberg
1Division of Hematology/Oncology, Virginia Mason Medical Center, Seattle, Washington 98111, USA.
Objectives:
Myelodysplasia is a frequent consequence of HIV infection, but acute myeloid leukemia (AML) is rare. Clinical presentations and outcomes of patients with HIV and subsequent AML are reviewed.
Methods:
Five HIV-infected individuals who were subsequently diagnosed with AML were evaluated and treated. A further 42 cases of AML among patients with antecedent HIV infection were identified using MEDLINE, AIDSLINE, and CancerLit searches.
Results:
HIV infection was present for a median of 48 months (71-180) before AML was diagnosed and the median reported CD4 cell count was 210 x 106 cells/l. In five instances, a delay in diagnosis occurred when cytopenias were initially attributed to HIV or zidovudine-based therapy. In 45 patients, diagnosis was according to the French-American-British (FAB) leukemia classification schema and in two the FAB type was not specified. M2 (n = 15) and M4 (n = 14) subtypes represented 64% (29/45) of reported cases. Patients with a CD4 cell count < 200 x 106 cells/l (n = 11) had a median survival time of 7 weeks, while patients with a CD4 cell count >or= 200 x 106 cells/l (n = 7) had a median survival of 7 months (P = 0.005). Although long-lasting chemotherapy-induced responses were rare, the majority of treated patients did achieve complete hematologic remissions. Treatment-related morbidity did not appear to be excessive.
Conclusion:
In the absence of randomized and prospective clinical studies to guide decision making, this analysis indicates that induction chemotherapy may be a reasonable option for selected HIV-infected patients with AML and adequate immune function.
Insights
Acute myeloid leukemia (AML) is rare in HIV infection. Induction chemotherapy may benefit selected HIV-positive patients with AML and adequate immune function, offering potential remission.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Background:
- Myelodysplasia is common in HIV infection, but acute myeloid leukemia (AML) is rare.
- Understanding the clinical presentation and outcomes of HIV-associated AML is crucial.
Observation:
- This review evaluated five HIV-infected patients diagnosed with AML and identified 42 additional cases from medical literature searches.
- The median duration of HIV infection prior to AML diagnosis was 48 months, with a median CD4 cell count of 210 cells/µL.
- Delays in AML diagnosis occurred in some cases, with cytopenias initially attributed to HIV or antiretroviral therapy.
Findings:
- AML subtypes M2 and M4 were the most prevalent, accounting for 64% of diagnosed cases.
- Patients with a CD4 cell count below 200 cells/µL had a significantly shorter median survival (7 weeks) compared to those with counts of 200 cells/µL or higher (7 months).
- While durable responses to chemotherapy were uncommon, most treated patients achieved complete hematologic remission with manageable treatment-related morbidity.
Implications:
- Induction chemotherapy can be a reasonable therapeutic strategy for carefully selected HIV-infected patients with AML and adequate immune function, despite the lack of prospective studies.
- Further research is warranted to establish evidence-based guidelines for managing AML in the context of HIV infection.