Persons with the human immunodeficiency virus (HIV) have a much higher incidence of Non-Hodgkin’s lymphoma (NHL) compared to persons without the virus. Because HIV weakens the immune (infection fighting) system of the body, NHL treatment has not been aggressive and is associated with a poor prognosis. Recently, however, researchers have reported that the use of intensive anti-viral therapy allows higher doses of chemotherapy to be tolerated in persons with HIV related NHL, which may increase survival rates.
Non-Hodgkin’s lymphoma is a cancer of the lymph tissue, which is part of the immune system in the body. Lymph tissue is present in lymph nodes, lymph vessels and bone marrow, which exist throughout the body. It is also present in organs such as the thymus, tonsils and spleen. The main cells in the lymph system are lymphocytes, of which there are two types: B and T-cells. Each of these cells has a very specific function in aiding the body to fight infection. The large majority of NHL cases involve cancer of the B-lymphocytes, characterized by the excessive multiplication of these atypical cells. These cancerous cells can crowd lymph tissue causing suppression of normal formation and function of other cells normally found in this tissue. Because lymphocytes can travel virtually anywhere in the body through blood or lymph fluid, lymphomas can occur in sites other than lymph tissue, such as the gastrointestinal tract or the brain. Patients with HIV related NHL often have fast growing, or high-grade lymphomas that tend to develop outside of the lymph system.
Chemotherapy, the standard treatment for NHL, targets and kills rapidly dividing cells, such as cancer cells. Although chemotherapy is effective at killing cancer cells, treatment does not differentiate between cancer cells and healthy cells. Higher doses of chemotherapy kill more cancer cells than lower doses. Unfortunately, higher doses of chemotherapy also kill more normal cells. Because patients with HIV already have a compromised immune system and often have other medical complications, aggressive treatment with standard or high-dose chemotherapy can cause potentially lethal side effects. Therefore, lower dose chemotherapy has historically been used for treatment against HIV related NHL. However, standard or high-dose chemotherapy is needed in order to obtain the most effective results.
Researchers from Mexico recently reported that the use of higher doses of chemotherapy for treatment of patients with HIV related NHL, result in an increased survival rate. Prior to chemotherapy, these patients received intensive anti-viral treatment consisting of multiple agents. Chemotherapy treatment consisted of cyclophosphamide, vincristine, mitoxantrone and bleomycin, followed by Neupogen (a drug that restores immune cell levels). Seventy two percent of the patients in this study showed a complete response following treatment. Three years after treatment, 62% of patients had survived. Not one patient died from side effects of the chemotherapy treatment.
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From these findings, doctors concluded that modern anti-viral therapy allowed these patients to tolerate standard, higher doses of chemotherapy for the treatment of HIV related NHL. Overall response rates were high and survival time improved in these patients. Clinical trials are currently ongoing to further evaluate intensive treatments including stem cell transplantation to provide the most effective treatment strategy for persons with HIV related NHL. Patients with HIV related NHL may wish to talk to their physicians about the risks and benefits of participating in ongoing clinical trials utilizing this type of treatment or other promising treatments. Two sources of information on ongoing clinical trials that can be discussed with a doctor include comprehensive, easy to use clinical listing services provided by the National Institutes of Health (cancer.gov) and eCancerTrials.com. eCancerTrials.com also performs personalized clinical trial searches on behalf of patients. (Cancer Biotherapy and Radiopharmacy, Vol 14, No 5, pp 349-352,1999 )
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