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Non-Hodgkin's lymphoma, a group of cancers that originate in the lymphatic system -- the collection of lymph nodes, vessels, and organs that produces infection-fighting cells and carries them throughout the body -- is nearly 20 to 50 times more common among people infected with HIV than among those without the virus. Most cases of non-Hodgkin's lymphoma are not AIDS-related. The outcome for HIV-infected people who develop lymphoma continues to improve as doctors gain insight into its causes, and as treatment for the disease advances.
In addition to more common symptoms of non-Hodgkin's lymphoma such as swollen lymph nodes, many patients with AIDS-associated lymphomas have so-called "B symptoms" -- fever, night sweats, and weight loss. They are also more likely to develop disease outside of lymph nodes -- in the liver, bone marrow, stomach, brain, mouth, and anus -- than those without HIV infection.
The majority of non-Hodgkin's lymphomas in HIV-positive patients are aggressive large-cell lymphomas. Burkitt's 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, which develops in the brain.
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 responded well to standard chemotherapy for non-Hodgkin's lymphoma.
Patients with AIDS-related lymphoma used to receive lower doses of chemotherapy drugs than other patients, but patients taking HAART can safely receive chemotherapy drugs in doses used for those without HIV infection, likely improving their outcomes. Indeed, 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's 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 and elsewhere are assessing the best ways to use rituximab in these patients.
