Advances and future challenges in non-Hodgkin's lymphoma

The mortality and morbidity burden of Non-Hodgkin's lymphoma (NHL) is increasing within the human immunodeficiency virus- (HIV-) infected population. Recent improvements in HIV management has meant overall reductions in deaths, especially those due to opportunistic infections, and while the outcome of HIV-related NHL may now be somewhat less grim, the incidence remains high and outcome poor. The median survival of those with HIV-related NHL is only approximately 7 months, although those with high CD4 lymphocyte counts seem to do somewhat better. Improved management of the underlying HIV infection, more effective infusional chemotherapy regimens, moderately effective second line regimens, and new investigational approaches all offer promising hope that improvements will soon be seen for the treatment of HIV-related systemic NHL. Immunotherapy, monoclonal antibodies, and adoptive immunotherapy targeting Epstein Barr virus (EBV) all represent novel experimental treatment approaches that are becoming possible based on our increased understanding of the pathogenesis of HIV-related lymphoma. Primary central nervous system lymphoma (PCNSL) in HIV patients has declined in incidence and there now is a rapid, less invasive diagnostic test. The presence of EBV DNA in the cerebral spinal fluid of HIV patients with focal brain lesions strongly suggests a diagnosis of PCNSL. Unfortunately, this disease remains difficult to treat in such an immunocompromised patient population. Further work is needed in order to prevent and effectively manage these diseases.