Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

322 Abstracts 22296-22300

12th World AIDS Conference

Results: All registered cases of AIDS-NHL in the study area were included, and
cases and controls were successfully matched for degree of immune deficiency
(p for difference in CD4 count = 0.66). NHL risk was associated with indices of
prolonged immune deficiency. These included longer time since seroconversion
(p = 0.001), lower CD4 count one year prior to diagnosis (p for trend 0.003) and
a prior diagnosis of mycobacterium avium complex disease (OR 3.2, 95% CI
1.2-10). Markers of immune stimulation were also associated with risk of NHL.
These included raised serum globulin (p for trend 0.015), immunoglobulin G (p
for trend 0.026) and HIV p24 antigen positivity (OR 2.0, 95% Cl 1.3-3.3). Indices
of lytic EBV infection, including a prior diagnosis of oral hairy leukoplakia and
receipt of anti-herpesvirus therapy, were not associated with NHL risk. Total dose
of AZT received was not related to risk of NHL. The highest dosage level of ddC
was associated with a decreased risk of NHL (OR 0.38, 95% Cl 0.17-0.82).
Conclusion: Prolonged immune deficiency and immune stimulation are the
main risk factors for NHL in people with HIV. This study does not support a role of
anti-EBV therapy in NHL prophylaxis. This study suggests that effective anti-HIV
therapy may decrease the risk of NHL by decreasing immune stimulation. This
hypothesis could be further examined by analysing the effect of antiretrovirals on
serum immunoglobulins and on incidence of NHL within randomised controlled
trials.
22296 Infectious complications in patients with HIV-related
lymphoma
Tony Cheung, S. Jones, F. Wallach. Mount Sinai Medical Center, New York, New
York, USA
Background: HIV-infected persons is defective in their cellular and humoral immune system. They are susceptible to opportunistic and common bacterial and
viral infection. Our study is to evaluate the infectious and opportunistic infectious
complications of patients with HIV-related lymphoma.
Design: Retrospective chart review.
Methods: We evaluated retrospectively medical records of patients identified
to have non-Hodgkin's lymphoma (NHL) and CNS lymphoma (CNSL) from our
tumor registry and HIV (Jack-Martin fund) clinic from 1990 to 1996. Charts of 24
patients with NHL and 20 patients with CNSL were reviewed.
Results: Patients with NHL had an age range of 20-61 (median 40); male-17,
female-7; 19 Hispanic, 9 Afro-American, 5 white. Their risk factors were 9 IVDU,
7 heterosexual, 6 homosexual, and 2 hemophiliac. Mean CD4 counts were 49
~ 34 (106/L). Infectious complications (1. C.) were: 10 FUO (9 neutropenic),
3 line sepsis, 7 pneumonia, 6 sepsis (3 Acinetobactor, 2 Candida, 1 Streptococcus viridans), 1 Pneumocystis carinii pneumonia (PCP), 2 MTB, 5 Candida
pharyngitis/esophagitis, 3 Cytomegalovirus (CMV) infection (2 retinitis, 1 colitis), 2
Staphylococcus cellulitis and 1 disseminated Mycobacterium avium-intracellulare
(MAI). The frequency was 0.45 episode/patient month. Patients with CNSL had
an age range of 32-51 (median 41); male-15, female-5; 14 Hispanic, 3 White,
3 Afro-American. Mean CD4 counts were 20 ~ 10 (106/L). Risk factors were
9 IVDU, 5 heterosexual, 4 homosexual, and 2 unknown. I.C. were: 6 FUO (3
neutropenic), 2 pneumonia, 2 PCP, 2 disseminated MAI, 3 UTI, 1 CNS toxoplasmosis. The frequency was 0.30 episode/patient-month. Patients with NHL have
more I.C. (p < 0.05, chi-square). The contributing factors were chemotherapy and
neutropenia. Case-matched control study of these patients compared to other
HIV patients without lymphoma is in progress.
Conclusion: Patients with NHL appears to have more I.C. than patients with
CNSL although the latter have worse prognosis. The contributing factors are
chemotherapy and neutropenia. Immune dysfunction as manifested by lower
CD4 count appears to be less important.

respectively. No toxic death was observed. One pt (6%) had a CR (duration of
7 months) and 4 pts (22%) obtained a PR (median duration of 3 months). Four
responding pts had previously received C and D. Thirteen pts experienced disease progression. Eighteen of 24 pts (75%) died, all but one of NHL progression.
Median survival from study entry was 2 months (<1-13).
Conclusions: Our results confirm those of Sparano et al in resistant NHL of
the general population treated with this regimen, with some of our pts benefitting
from this approach. However, the outcome of the majority of the pts in this setting
is still poor and new treatment approaches are needed.
Supported by AIRC and ISS grants.
22298 NHL: 17 years follow-up in a Greek cohort of 158 (HIV+)
haemophilia patients
Anastasia Karafoulidou1, Olga Katsarou1, E. Patsouris2,
Nikolaos Moschopoulos1, G. Touloumi3, V. Kapsimali4, S. Tsourakakis4,
C. Panagiotopoulou1, T. Mandalaki1. 12nd Reg. BTC-Haemophilia Cetre-Laikon
Hos. of Athens, Agioy, Thomas Str. - 11527 Athens; 2Pathology Dept. Univ. of
Athens-Laikon Hos., Athens; 3Dept. of Hygiene Athens Univ. Athens;
4Evangelismos Hosp. - Athens; 5Surg. Dept. Univ of Athens - Laikon Hosp.
Athens, Greece
Background: The aim of this study is to describe the Non-Hodgkin lymphomas
(NHL) in a Greek hemophila cohort and to compare the after first AIDS diagnosis
survival of NHL with other AIDS conditions.
Methods: 158 HIV-1 positive Haemophilia patients with well known seroconversion dates have been followed for up to 16 years after infection. 12 NHL have
been diagnosed, 10 as first AIDS diagnosis, while 59 have developed with other
first AIDS conditions. Cox proportional hazards models have been applied to
evaluate the independent effects of several prognostic factors.
Results: The majority of NHL were high grade in advanced stage. 5 out of 12
were extranodal and 1 was Waldestrom's macroglobulinemia. They were treated
with chemotherapy (CHOP-standard doses) and radiotherapy. 7 out of 12 pts
(0.58%) had complete/partial response. The median duration of response was 21
months. Median survival of responders was 29 months while of non-responders
5.5 months. The median time from seroconversion to first AIDS diagnosis was
10.38 years (range: 4.45-14.07) in NHL and 9 years (range: 3.14-14.64) in
other AIDS cases. Median CD4 count at AIDS diagnosis was significant higher
in NHL (median: 150 cells/p1m 3) than in other AIDS (median: 24 cells///m3, P =
0.0026). The after AIDS survival was similar in NHL (median: 0.5 years) and in
other AIDS (median: 0.8 years). CD4 count at first AIDS diagnosis was the only
significant prognostic factor of after AIDS survival (p = 0.003), while time of first
AIDS diagnosis was marginaly significant (p = 0.050).
Conlusions: 1. The incidence of NHL in this haemophilia cohort is similar to
other HIV positive groups. 2. The response to standart therapy is quite similar
to HIV negative groups of NHL, with well managed toxicity, and depends on the
histological type of the NHL.3. The survival after AIDS do not differ significantlly
between NHL and other AIDS conditions.
22299 1Primary central nervous system lymphoma with negative
SPECT in a patient with AIDS
Marcelo Corti, K. Corbera, N. Trione, M. Villafane, R. Schtirbu, C. Vivas,
R. Masini. Hospital FJ. Muniz, Rivadavia 8326, 1407 Buenos Aires, Argentina
Background: Primary central nervous system lymphomas constitute the second
cause of occupant mass in AIDS patients. The differential diagnosis between this
and infectious cause is ussually difficult. The SPECT represent a non invasive
method that allows us to get a closer diagnosis of this neoplasias.
Methods: By case presentation of a patient with occupant cerebral mass
syndrome with a diagnosis of primary CNS lymphoma with a negative SPECT
Results: Through the clinical characteristics and the cerebral TC scan the
diagnosis was deduced. The SPECT didn't demonstrated enhacement of the
lesion. The evolution of the patient was unfavorable, leading to his death, so a
necropsy was performed.
The histopathology of the brain lesion demonstrated that it was a centroblastic,
polimorfic, B cel lymphoma of high grade, with meningeal compromise.
Conclusion: Although the SPECT seems to be a non invasive, sensitive and
specific method for differential diagnosis of occupant mass in AIDS, its negativity
does not discard the diagnosis of primary CNS lymphoma.
S22300 Malignancies in children with HIV infection
Mariana Mardarescu, M. Luminos, S. Petrea, I. Darasteanu. Colentina Hospital
for Infectious Diseases Bucharest, Romania
This study included 15 cases of malignancies in children with HIV infection out of
280, admitted in our hospital between 1994-1996. Ten patients were diagnosed
in the stage of AIDS.
The outstanding age group affected was 8-9 years, accounting for 9 cases,

followed by the group of 6-7 years (6 cases).
This 15 reported cases included the following malignancies: Kaposi's sarcoma
(6 cases), CNS lymphoma (4 cases), leiomyosarcoma (5 cases). The routes of
HIV aquisition were: transfusions (5 cases), parenteral (9 cases) and perinatal (1
case).
13 of these patients deceased some of them being too ill of AIDS to benefit of
cancer treatment.

122297

Second-line chemotherapy (CT) with CDE
(cyclophosphamide, doxorubicin, etoposide) in patients
(pts) with resistant human immunodeficiency
virus-related non-Hodgkin's lymphoma (HIV-NHL)

Domenico Errante, E. Vaccher, M. Tavio, G. Nasti, S. Sandri, O. Schioppa,
U. Tirelli. 'Division Medical Oncology and AIDS-CRO Via Pedemontana
12-33081 Aviano (PN), Italy
Objective: Approximately half of pts with HIV-NHL may achieve complete remission (CR) after first-line CT. No combination regimen has yet been shown to
be efficacious in pts with resistant HIV-NHL. Sparano et al reported encouraging results with the infusional CDE regimen (a 96-hour continuous intravenous
infusion of cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2, and etoposide
240 mg/m2) as first-line CT in pts with HIV-NHL (Blood, 1993; 10:2810-5) and as
second-line CT in relapsed and resistant pts with NHL of the general population
(JCO; 1993, 11: 1071-9).
Methods: Our study was designed to assess the safety and potential efficacy
of CDE in pts with resistant HIV-NHL (i.e., pts with PR and progression <3 months
after completion of CT and pts progressing under first-line CT), a group with a
very poor prognosis.
Results: Twenty-four pts received CDE at the same Sparano's et al schedule
every 28 days. High-grade lymphoma was diagnosed in 21 pts (87%). Eightyseven percent of pts had previously received C and D, and none had received
E. Eighteen pts are currently evaluable for response. Median age was 34 yrs
(16-52). Twenty were males, 4 females. Systemic "B" symptoms were found in
50% of pts. Median PS was 2 (1-3). Median CD4+ cells at CDE entry was 52
(1-150). A median of 2 cycles (1-4) of CDE have been administered so far. Grade
4 leukopenia and thrombocytopenia occurred in 14 (58%) pts and 8 (33%) pts