The document discusses several AIDS-defining and non-AIDS defining cancers that are more common in HIV-positive individuals. Kaposi sarcoma, caused by HHV-8, and two types of non-Hodgkin lymphoma were originally considered AIDS-defining cancers. While antiretroviral therapy has decreased AIDS deaths and increased the population of HIV-infected individuals, it has also led to an increase in both AIDS-defining and non-AIDS defining cancers due to people living longer with HIV. The document provides details on the pathogenesis, diagnosis and treatment of several AIDS-defining cancers including Kaposi sarcoma, multicentric Castleman's disease, and plasmablastic lymphoma.
“Cancer Anorexia Cachexia (originally Cancer Cachexia) is a multifactorial syndrome defined by:
Ongoing loss of skeletal muscle mass (with or without loss of fat mass)
Cannot be fully reversed by conventional nutritional support
Leads to progressive functional impairment”.
Hodgkin’s disease was initially described as an inflammatory
disease (hence the term “disease”), but is clearly
recognized and treated as a malignant lymphoma (hence the
more accurate term Hodgkin’s lymphoma (HL) is used
synonymously with Hodgkin’s disease).
The management of Hodgkin’s lymphoma has evolved from
extended-field radiation alone as the main therapy to a
combined-modality approach with
chemotherapy and radiation, or chemotherapy alone.
Painles lymphadenopathy
Systemic symptoms- unexplained fevers, drenching night sweats, weight loss, generalize pruritus, fatigue, and alcohol-induced pain in tissues involved by HD
Mediastinal mass on a routine chest radiograph
90% of patients present with contiguous sites of involvement or Extension from adjacent lymph nodes
Hematogenous (liver or multiple bony sites) Involvement of the bones may cause blastic changes, especially in the vertebrae (creating the classic “ivory vertebra” on plain radiographs), pelvis, sternum, or ribs
Nearly all patients with hepatic or bone marrow involvement by Hodgkin lymphoma have extensive involvement of the spleen
Rare- Gut-associated lymphoid tissues such as Waldeyer ring and Peyer patches, Upper aerodigestive tract, Central nervous system, and Skin
“Cancer Anorexia Cachexia (originally Cancer Cachexia) is a multifactorial syndrome defined by:
Ongoing loss of skeletal muscle mass (with or without loss of fat mass)
Cannot be fully reversed by conventional nutritional support
Leads to progressive functional impairment”.
Hodgkin’s disease was initially described as an inflammatory
disease (hence the term “disease”), but is clearly
recognized and treated as a malignant lymphoma (hence the
more accurate term Hodgkin’s lymphoma (HL) is used
synonymously with Hodgkin’s disease).
The management of Hodgkin’s lymphoma has evolved from
extended-field radiation alone as the main therapy to a
combined-modality approach with
chemotherapy and radiation, or chemotherapy alone.
Painles lymphadenopathy
Systemic symptoms- unexplained fevers, drenching night sweats, weight loss, generalize pruritus, fatigue, and alcohol-induced pain in tissues involved by HD
Mediastinal mass on a routine chest radiograph
90% of patients present with contiguous sites of involvement or Extension from adjacent lymph nodes
Hematogenous (liver or multiple bony sites) Involvement of the bones may cause blastic changes, especially in the vertebrae (creating the classic “ivory vertebra” on plain radiographs), pelvis, sternum, or ribs
Nearly all patients with hepatic or bone marrow involvement by Hodgkin lymphoma have extensive involvement of the spleen
Rare- Gut-associated lymphoid tissues such as Waldeyer ring and Peyer patches, Upper aerodigestive tract, Central nervous system, and Skin
Lymphoproliferative disorders DR MASOUD 2022.pptxmasoud53
overview presentation about lymphoproliferative disorders for medicine students. it is with easy pattern. it covers all subjects of this disease, either malignant or benign types
Chronic Lypmhocytic leukemia/SLL/B-PLL/T-PLL/ATLL By SOLOMON SUasb by SOLOMON SUASB
the following presenation include
Introduction/Background
• Etiology of CLL
• Symptoms
• Test and Diagnosis
• Staging
• Prognosis
• Treatment
• B Cell diseases BPLL
• T cell diseases
T-PLL
ATLL
LGLL
Primary effusion lymphoma (formerly known as body cavity lymphoma), is an infrequent, aggressive B cell non-Hodgkin’s lym-phoma. The human herpes virus 8 (HHV8) or the Kaposi’s sarcoma associated herpes virus (KSHV) may be the potential determinant of the malignancy [1].
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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3. Kaposi sarcoma was the first malignancy, which
was considered AIDS defining in young
individuals.
The CDC definition evolved later on, and since
1993, three tumors have been considered AIDS-
defining in the context of HIV: KS, certain NHL ,
and invasive cervical cancer.
Combination antiretroviral therapy (cART)
involving three or more drugs leads to preserved
CD4 lymphocyte counts, preserved immune
function, decreased immune activation,
decreased infectious complications, and
decreased mortality, transforming HIV infection
into a manageable chronic disease.
4. Decrease in deaths from AIDS since the
introduction of cART, the number of persons
living with HIV in the United States has
increased by more than 50%.
It is estimated that more than 1.1 million
people in the United States are now infected
with HIV.
With HIV-infected individuals living longer,
the population at risk for malignant
complications has increased and aged, and
this pattern may continue into the future.
5. In addition to AIDS-defining malignancies,
HIV-infected patients are at increased risk of
a number of other malignancies, including
lung cancer, liver cancer, anal cancer,
Hodgkin's lymphoma (HL), certain head and
neck cancers, and Merkel cell carcinoma.
9. Lymphomas also occurring in
immunocompetent patients
1.Burkitt lymphoma
2. Diffuse large B-cell lymphoma
Germinal center subtype
Activated B-cell subtype
3. Extranodal marginal zone B-cell lymphoma
of mucosa-associated lymphoid tissue type (MALT
lymphoma; rare, mainly in pediatric patients)
4. Classic Hodgkin's lymphoma (commonly
mixed cellularity or lymphocyte depleted forms)
10. Lymphomas occurring more specifically in
HIV+ patients
1. Primary effusion lymphoma
2. Large B-cell lymphoma arising in HHV-
8 associated multicentric Castleman
disease
3. Plasmablastic lymphoma
4. Primary diffuse large B-cell lymphoma
of the central nervous system (in patients
with AIDS, >95% EBV associated)
11. Lymphomas also occurring in other
immunodeficiency states
Polymorphic B-cell lymphoma (PTLD-
like)
12. With an estimated incidence in the
United States of 97 per 100,000 person-
years in the cART era, NHL is now the
most common malignancy in HIV-infected
individuals in the United States.
With an estimated incidence in the
United States of 62 cases per 100,000
person-years, and a broad variability in
incidence that is related to CD4 count, KS
is now the second most common tumor in
people with HIV/AIDS in the United
States.
14. Pathophysiology –
KS is characterized by inflammatory
angiogenic lesions that arise in multiple
sites. It occurs predominantly on the skin,
but can involve virtually any organ,
perhaps except the brain.
Classic KS, predominantly involves lower
extremities of elderly men, and is found
mostly in Ashkenazi Jews or in individuals
living near the Mediterranean Sea.
15.
16.
17.
18. Endemic KS, was subsequently recognized in
Africa. This form can occur earlier in life,
often in the third or fourth decades,
frequently involves the lymph nodes, and
occurs in a higher percentage of females
than classic KS. Also, it can develop in
children, causing severe morbidity.
Epidemic KS is used to describe KS arising in
HIV-infected patients. It is generally more
clinically aggressive than classic KS .
KS can also occur in transplant recipients.
KSHV is the etiologic agent for all forms of
KS.
19. KS lesions are characterized by vascular slits filled
with blood that often extravasates and accounts for
their purplish hue. Microscopically, tumors are
heterogeneous but characterized by a predominance
of KSHV-infected spindle-shaped cells with certain
markers of lymphatic endothelial cells.
Hyperproliferation of endothelial-derived spindle
cells is important in the pathogenesis of this disease.
Most of this hyperproliferation appears to be directly
or indirectly induced by KSHV.
a viral homologue to human IL-6 and three
homologues of macrophage inhibitory protein that
have been shown to have angiogenic activity
20. ORF74 of KSHV encodes for a constitutively
active G-protein–coupled receptor (KSHV-GPCR)
that induces production of vascular endothelial
growth factor and other angiogenic factors.
KSHV can be induced to undergo lytic replication
by hypoxia, and it is possible that the tendency
of KS to arise in the feet, which are relatively
hypoxic, is partly the result of hypoxia-induced
KSHV reactivation.
KSHV transmission can occur by both sexual and
nonsexual routes. Saliva of infected individuals
has greater KSHV shedding than other body
fluids.
21. The most widely used staging system for KS, devised
prior to available cART, is the AIDS Clinical Trials
Group Oncology Committee TIS staging system.
Patients are scored based on extent of tumor
involvement (T), immune status (I), and systemic
illness (S).
Risk is assigned as good or poor, depending on the
presence or absence of localized tumor versus more
extensive tumor with associated edema, ulceration,
visceral disease, or extensive oral KS; CD4 more or
less than 150 cells/mm3; and the presence or absence
of antecedent opportunistic infections, constitutional
symptoms, other HIV-related illness, and Karnofsky
performance status.
22. Good risk is designated with a subscript 0, and
poor risk by subscript 1, the summary taking the
form T0 or T1, I0 or I1, or S0 or S1a good risk (T0S0,
T1S0, or T0S1) and a poor risk (T1S1).
Criteria for a partial response include 50%
decrease in the total number of lesions, 50%
decrease in the area of measured cutaneous
lesions, or flattening of 50% of nodular lesions in
the absence of progressive disease.
23. Stage
Good Risk (0) (All of the
Following)
Poor Risk (1) (Any of the
Following)
Tumor (T) Confined to skin and/or lymph
nodes and/or non-nodular oral
disease confined to the palate
Tumor-associated edema or
ulceration
Extensive oral KS
Gastrointestinal KS
KS in other nonnodal viscera
Immune system (I) (not
included if HIV-sensitive to
cART)
CD4 cells ≥150/mcL CD4 cells <150/mcL
Systemic illness No history of opportunistic
infection or thrush
History of opportunistic
infections and/or thrush; “B”
symptoms present
No B symptoms (unexplained
fever, night sweats, >10%
involuntary weight loss, or
diarrhea) persisting more than
2 weeks
Performance status ≥70
Performance status <70
Other HIV-related illness
(e.g., neurologic disease,
lymphoma)
24. Therapy Type Response Rates (Ref.)
Commonly used standard therapy
cART Variable; should be optimized in
combination with other
therapies
Liposomal doxorubicin 59%–76% (80,188)
Paclitaxel 59%–71% (84,189)
25. Alternative therapies
Interferon-α Variable, CD4 cell-dependent
Adriamycin/bleomycin/vinc
a alkaloids
24%–88% (higher response
rates with higher doxorubicin
doses, but greater toxicity)
Vincristine/vinblastine 45%
Bleomycin/vinca alkaloids 23%
26. Several forms are: unicentric hyaline-vascular form, a
multicentric plasma cell form, and a multicentric
form associated with KSHV.
Nearly all Castleman disease arising in the setting of
HIV infection is KSHV-associated MCD (KSHV-MCD).
KSHV-MCD is characterized by intermittent flares of
inflammatory symptoms, including fevers, fatigue,
and cachexia, and edema, together with
lymphadenopathy and/or splenomegaly.
Gastrointestinal symptoms and cough are also
common. Flares can be severe and often fatal; they
are primarily caused by cytokine overproduction
related to the highly lytic state of the KSHV in MCD.
In particular, a KSHV-encoded analogue of
interleukin-6 (vIL-6) and/or overproduction of
cellular IL-6 are believed to cause many of the
symptoms of KSHV-MCD.
27. Diagnosis of KSHV-MCD generally requires
excisional lymph node biopsy and demonstration
of KSHV-infected plasmablasts.
Laboratory abnormalities include anemia,
thrombocytopenia, hypoalbuminemia,
hyponatremia, and elevated C-reactive protein.
Patients with MCD should undergo computed
tomography (CT) of neck, chest, abdomen, and
pelvis.
There is no standard therapy for KSHV-MCD.
HIV-infected patients should receive cART,
although intolerance to a number of drugs,
including antiretrovirals, may occur until MCD is
controlled.
28. CD20 monoclonal antibody rituximab,
Rituximab combined with liposomal
doxorubicin,
Ganciclovir, IFN-α, and high-dose
zidovudine combined with ganciclovir,
Splenectomy has sometimes been used to
manage severe cytopenias in KSHV-MCD.
29. Plasmablastic lymphoma (PBL) is an EBV-
associated B-cell NHL proposed as a new
entity in 1997.
Although most common in the setting of HIV,
PBL also occurs in organ transplantation
patients and elderly individuals.
It often presents with disease within the oral
cavity, but may occur at other extranodal or
nodal sites.
HIV-associated PBL usually presents as either
stage I or stage IV disease and has a 7:1 male
predominance.
30. PBL is characterized by a high proliferative
index and aggressive clinical course.
Historically, the prognosis has been poor,
with median survival less than 2 years.
PEL is a rare KSHV-associated aggressive
mature B-cell lymphoma that usually
presents as a lymphomatous effusion in
serous body cavities; patients are at risk for
other concomitant KSHV-associated
malignancies. Many cases are pleural, but
peritoneal, pericardial, and leptomeningeal
presentations are seen.
31. Diagnosis of PEL depends on the
demonstration of KSHV infection of tumor
cells. In more than 70% of cases, tumor cells
are coinfected with EBV. Common B-cell
surface markers (CD19, CD20, CD79a) are
absent, while activation markers (CD30,
CD38, CD71, CD138) are often present.
Doxorubicin-based regimens report initial
complete response rates as high as 40%, but
the clinical course is characterized by rapid
relapse, with a median survival of less than 6
months.
32. Small noncleaved-cell lymphoma
Burkitt’s lymphoma and Burkitt-like lymphoma
Immunoblastic lymphoma (primary CNS)
Diffuse large-cell lymphoma (90% CD20+)
Large noncleaved-cell lymphoma
CD30+ anaplastic large B-cell lymphoma
Plasmablastic lymphoma
Advanced stage (>75% III or IV)
Extranodal involvement
Central nervous system, liver, bone marrow, gastrointestinal
Tirelli U, et al. AIDS. 2000;14:1675-1688.
33. Outgrowth of lymphoma treatment in general
Multiple agent, non-cross resistant chemotherapy
Increase dose intensity (infusional therapy, high dose or
multiple drugs)
Central nervous system treatment or prophylaxis
Supportive antibiotics and hematopoietic growth factors
Importance of HAART
Use of monoclonal antibodies (rituximab) AMC 010
and 034
High dose chemotherapy with ASCT
34. CHOP +
Rituximab
CHOP
Alone
Number of patients 99 51
Complete
response (%)
58 48
Median time to
response (weeks)
11.0 10.5
Median event-free
survival (weeks)
52 51
Death due to
infection
13* 1
Median overall
survival (weeks)
139 110
• Phase II trial
– 149 patients
– Median CD4 count: 133
cells/mm3
• Regimens
– Rituximab (day 1) +
CHOP (day 3)
– CHOP
• Patients restaged every
2 cycles
• Median F/U 137 wk
*P=0.035 vs CHOP alone.
Kaplan LD, et al. Blood 2005;106:1538-1543
35. Dose-adjusted EPOCH chemotherapy
Etoposide 200 mg/m2 (96-hour infusion)
Vincristine 1.6 mg/m2 (96-hour infusion)
Doxorubicin 40 mg/m2 (96-hour infusion)
Prednisone 60 mg po on days 1–5
Cyclophosphamide IV on day 5
CD4 <100 cells/mm3: 187 mg/m2
CD4 >100 cells/mm3: 375 mg/m2
Dose adjusted in cycles 2 through 6 to a maximum of 750
mg/m2
Little RF, et al. Blood. 2003;101:4653-4659.
36. CD4
(cells/mm3)
<100 >100 Total
Number of patients 16 23 39
Complete
response (%)
56 87 79
Relapse 2 0 2
Progression-free
survival (%)
73 93 87
Overall survival (%) 36 87 60
• Median follow-up
– 53 months
• Median CD4
– 190 cells/mm3
• Not prognostic
– Tumor proliferation
– p53 overexpression
Little RF, et al. Blood. 2003;101:4653-4659.
37. Incidence: <5% of AIDS patients. Now very rare
Diagnostic approaches
Cranial CT or MRI scan
Most important differential diagnosis: toxoplasmosis
Stereotatic brain biopsy essential for diagnosis
When biopsy not possible, EBV-PCR of CSF is useful, 100% sensitive, 80%
specific
Therapeutic approaches
Traditional: radiation (4000-5000 cGy)- 10% 1yr survival
High-dose methotrexate based chemotherapy
Non-AIDS patients: shows promise
High-dose ZDV + GCV +/- IL-2 may have benefit (JAIDS
1999;15:713-19)
38. B-cell non-Hodgkin’s lymphoma
Most cases are dually infected with HHV8 and EBV
Median survival: 6 months
Traditional treatment: CHOP
High-dose methotrexate plus CHOP
Retrospective series of 7 patients treated:
3 in complete remission 18, 26, and 78 months after diagnosis
3 died with progressive PEL
1 achieved complete remission, but died with plasmablastic non-
Hodgkin’s lymphoma at 9 months
Boulanger E, et al. Am J Hematol. 2003;73:143-148.
39. Patients with HIV-associated HL generally
present at a younger age, with higher-
stage disease, less frequent mediastinal
involvement, more frequent involvement
of extranodal sites of disease, and more
frequent “B” symptoms as compared with
the general population.
Mixed cellularity or lymphocyte-depleted
histology is most commonly seen.
40. In general, complete response rates in HIV-
associated HL are relatively high with
systemic chemotherapy (50% to >80%), but
relapse is common.
For patients successfully treated for HL,
long-term control of HIV appears to improve
overall survival.
41. HIV-infected patients have an increased
incidence of several cancers caused by HPV,
including cancer of the cervix, anus, penis,
vulva, oral pharynx, and tonsil.
42. HPV infection induces type-specific immune
responses
Promising vaccine candidate:
Virus-like particles (VLP) are recombinant viral capsids
that induce type-specific neutralizing antibodies
VLPs are nontoxic and highly immunogenic
Both bivalent (HPV 16,18) and quadravalent (HPV
6,11,16,18) vaccines available.
43. Pap smear at initial evaluation
Repeat Pap smear 6 months later
If both negative, can do annual Pap
Low threshold for colposcopy
Role of HPV testing
Screening for women over 18
44. Cryoablation
Laser therapy
Cone biopsy
Loop electrosurgical excision
procedure (LEEP)
Topical 5-FU
Trans-retinoic acid
Podophyllin cream
Imiquimod cream
Antiretroviral Therapy (?)
Surgery (stage I)
Radiation therapy
Cisplatin or carboplatin
Local Disease HSIL Invasive Disease1,2
1Mitsuyasu RT, et al. Cancer Management. 2006:609-632.
2Martin F, et al. Sex Transm Infect. 2001;77:327-331.
45. Routine periodic cytologic examination of
the anal mucosa should also be considered in
high-risk individuals, and programs to screen
HIV-infected women and men for anal
intraepithelial neoplasia and to treat high-
grade lesions are being considered.
Current options for high-grade anal
intraepithelial neoplasia include local
treatment with topical immune modulators
(e.g., imiquimod) or antiviral agents (e.g.,
cidofovir), electrocautery, laser or infrared
coagulation, and surgery.
46. The standard of care for stages I–III anal
cancer is concurrent chemoradiation, and
patients with HIV should receive standard
regimens.
Given concern of hematologic toxicity
associated with mitomycin-C–based
chemoradiation in patients with HIV,
cisplatin-based regimens have been
advocated by some.
The alternative to chemoradiation is surgical
abdominoperineal resection, leaving patients
with a permanent colostomy.