AIDS-related lymphoma

AIDS (acquired immunodeficiency syndrome) is a disease caused by the human immunodeficiency virus (HIV). This virus attacks and weakens the immune system so the body can’t fight infections or diseases.

People with AIDS have a greater risk of developing certain cancers. Non-Hodgkin lymphoma (NHL) is the most common type of lymphoma that affects people with AIDS. Fewer people develop AIDS-related lymphoma now that highly active antiretroviral therapy (HAART) drugs are used to treat HIV infection.

AIDS-related lymphoma often grows and spreads quickly (is aggressive). It is often diagnosed at an advanced stage.

AIDS-related lymphomas are usually B-cell lymphomas. The main types of NHL that develop in people with AIDS include:

• diffuse large B-cell lymphoma (DLBCL)
• Burkitt lymphoma
• primary central nervous system (CNS) lymphoma
• primary effusion lymphoma (PEL)

AIDS-related lymphomas often affect the bone marrow, brain and spinal cord (called the central nervous system, or CNS), lungs, liver and gastrointestinal (GI) tract. People with NHL related to AIDS often have tumours in the chest that are at least one-third as wide as the chest or tumours in other areas that are 10 cm or more across (called bulky disease) and B symptoms (unexplained fever, drenching night sweats and unexplained weight loss).

You may be offered the following treatments for AIDS-related lymphoma.

HAART slows down how quickly AIDS progresses. It may allow some people with AIDS-related lymphoma to safely receive combinations of chemotherapy drugs in standard or even higher doses.

Chemotherapy is the main treatment for AIDS-related lymphoma.

A common combination of chemotherapy drugs used to treat AIDS-related lymphoma is CHOP:

• cyclophosphamide (Cytoxan, Procytox)
• doxorubicin (Adriamycin)
• vincristine (Oncovin)
• prednisone

Targeted therapy uses drugs to target specific molecules (such as proteins) on the surface of cancer cells. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells while limiting harm to normal cells.

Rituximab (Rituxan) is the most common targeted therapy used to treat NHL. Some people with AIDS-related lymphoma may be given rituximab combined with chemotherapy.

R-CHOP may also be given for AIDS-related lymphoma. It is the CHOP combination of drugs with rituximab, which is a type of targeted therapy.

The central nervous system (CNS) is the brain and spinal cord. There is a risk that AIDS-related lymphoma will spread to the CNS. CNS prophylaxis is used to try to prevent lymphoma cells from entering the tissue covering the brain and spinal cord.

CNS prophylaxis may be given as intrathecal chemotherapy. This means that the chemotherapy drugs are injected into the cerebrospinal fluid (CSF). A common drug used in CNS prophylaxis is methotrexate.

Sometimes an AIDS-related lymphoma starts in the brain or spinal cord. This is called AIDS-related primary CNS lymphoma. It is treated either with chemotherapy or with external beam radiation therapy to the whole brain.