Non-Hodgkin lymphoma (NHL) is a group of cancers that originate in the lymphatic system, a collection of lymph nodes, vessels, and organs that produces the immune system's infection-fighting cells and carries them throughout the body. NHL is 20 to 50 times more common among people infected with HIV than among those without the virus. Most cases of NHL are not AIDS related. The outcome for HIV-infected people who develop lymphoma is improving as doctors gain insight into its causes, and as treatment for both HIV and lymphoma advances. Controlling the HIV virus after treatment for lymphoma will reduce the risk that the cancer will recur.
In addition to common symptoms of non-Hodgkin lymphoma, such as swollen lymph nodes, many patients with AIDS-associated lymphomas have so-called B symptoms, such as fever, night sweats, and weight loss.
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The majority of NHLs in HIV-positive patients are aggressive, large-cell lymphomas. Burkitt lymphoma, a very fast-growing type of lymphoma, is also common among HIV-positive patients. People with HIV may also develop unusual HIV-associated lymphomas, including primary effusion lymphoma, which usually arises in the lung cavity; plasmablastic lymphoma, which often develops in the jaws and mouth; and primary central nervous system lymphoma (PCNSL), which develops in the brain. PCNSL is very rare in people who have CD4 counts above 50. (CD4 cells are the primary target of the HIV virus, commonly thought of as Helper T cells. Very low CD4 counts are one definition of AIDS, as they signal severe immunocompromise.)
Treatment for AIDS-associated lymphomas almost always includes chemotherapy or, less often, radiation therapy. New research indicates that patients with immune systems supported by highly active antiretroviral therapy (HAART) tolerate and respond well to standard chemotherapy for non-Hodgkin lymphoma.
In the past, patients with AIDS-related lymphoma received lower doses of chemotherapy drugs than other lymphoma patients. However, patients taking HAART can safely receive chemotherapy drugs in similar doses as those used for cancer patients without HIV infection, likely improving their outcomes. Several studies, including one run by the AIDS Malignancy Consortium and conducted at Memorial Sloan Kettering, show that even patients with lymphomas that relapse, or that do not initially respond to therapy, can receive high-dose therapy with stem cell support (also known as an autologous transplant). (For more information about Transplantation, visit that section of our Web site.) We are also studying intensive treatment approaches (without transplantation) in patients with AIDS-related Burkitt lymphoma.
Rituximab, one of a class of drugs called monoclonal antibodies, targets lymphomas and improves the outcome in patients without HIV infection. Recent studies have shown rituximab may also help treat AIDS-related lymphoma. Current studies at Memorial Sloan Kettering are assessing the best ways to use rituximab in these patients.
Hodgkin lymphoma is another kind of lymphoma that is common in HIV patients. As with NHL, many patients with Hodgkin lymphoma respond well to standard chemotherapy if they are taking HAART. Studies are underway to further improve the outcome for these patients.
Our Team of Experts
At Memorial Sloan Kettering Cancer Center, individuals with AIDS-related lymphoma are treated by a group of doctors who work together to diagnose and treat each patient.
Select from the list below to learn more about our AIDS-related lymphoma specialists, their education, training, board certifications, current publications, and specific areas of clinical expertise.