[Lymphomas in the acquired human immunodeficiency syndrome. Clinical, histological, immunological, and developmental...

To assess in a retrospective fashion the appearance of lymphoid malignancies in subjects infected by the human immunodeficiency virus, or included in any risk-group, between January 1984 and June 1991.

Twenty-six patients with AIDS-related lymphoma (23 non-Hodgkin's lymphoma (NHL) and 3 Hodgkin's disease (HD) cases) were entered in the study. Of them, 25 were males, with a mean age of 27 years. Eleven were intravenous drug abusers, eight were homosexuals, five were haemophiliacs and two were heterosexuals.

The NHL histologic subtypes found were: small, non cleaved cell (Burkitt's), 14 cases; immunoblastic, 2 cases; diffuse, large cell, 1 case; anaplastic, 1 case; extramedullary plasmacytoma, 1 case, and high grade, unclassifiable, 4 cases. The malignant cell immunophenotype was B in 95% of the cases. The pathological stage at diagnosis was IV-B in 16 cases, IV-A in 3, III-B in 1 and I-E in 3. Extranodal involvement was seen in 95% of the patients, mainly extended to the bone marrow (53%), liver (48%) central nervous system (35%) and digestive tract (22%). The three HD patients (2 with lymphocytic depletion and 1 with mixed cellularity) were in stage IV-B at diagnosis, with bone marrow involvement. Twenty-three patients received chemotherapy, 7 were treated with radiotherapy, and 4 underwent surgery. Complete remission (CR) was attained in 35% of the cases and partial response in 55%. The median survival of the series is 7 months, and that of the CR patients is 20 months (p less than 0.001). The series mortality was 77%, mostly related to disease progression or opportunistic infection.

The general characteristics of AIDS-related lymphoma were confirmed here: aggressive clinical course, poor response to therapy and high risk of opportunistic infections. The possibility of achieving CR may justify the use of combination chemotherapy in patients with good functional status.