Current Issues in Research and Treatment of AIDS-Associated Lymphoma
by Michael Marco
From the Introduction
Lymphomas are not new. They pre-date AIDS for many many years. We have known for some time that organ transplant patients and others from the general population develop lymphomas — both non-Hodgkin’s lymphoma (NHL) and Hodgkin’s disease. Never the less, in 1982 patients with HIV disease were reported to be developing NHL at an alarming rate. This is evident by the Lancet’s headline for an article which read, “Outbreak of Burkitt’s-like Lymphoma in Homosexual Men” (Ziegler 1982). It wasn’t until 1985 that the CDC caught on and added NHL to the list of AIDS-defining illnesses.
After those in the know realized that HIV caused severe immunosuppression, it became widely speculated that patients with AIDS would be likely candidates for developing NHL. Recent evidence tells us that AIDS-related malignancies — namely Kaposi’s sarcoma and NHL — are on the rise due to the fact that we have been fortunate enough to keep many patients alive with the discovery of therapies and prophylaxis for PCP, MAI, CMV, fungal infections, toxoplasmosis, etc. Indeed, in the Concorde study and in ACTG 019, 27% and 26% of the initial AIDS-defining endpoints, respectively, were AIDS-associated cancers. Moreover, 23% of the deaths in ACTG 196 were cancer related. There is no doubt that AIDS-related malignancies will continue to cause severe morbidity and mortality due to the fact that we presently have no prophylactic agents and at best only moderately effective treatments.
The initial desire for this research into all aspects of AIDS-NHL was fueled by a need to learn about this ancient neoplasm which David Scadden refers to as a “terrible scourge.” Recent review articles detail a myriad of research centered around AIDS-NHL (Karp 1992, Levine 1992 a, Scadden 1994 c). However, these scholarly accounts were not written specifically for those with AIDS-NHL and omitted the history of research on this cancer and the prospects for its cure.
Thus, a number of questions needed to be answered, including:
- What has taken place over the past 20 years in non-AIDS lymphoma research?
- How has this knowledge helped us in treating patients with AIDS who develop NHL?
- What work still needs to be confirmed or extended?
- What might we be overlooking?
- How can our present knowledge base move us quicker into the future?
In order to answer these questions, there was a need to: 1) go back 20 years (to McKelvey’s fist CHOP study) and review the NHL AIDS and non-AIDS
epidemiology, pathogenesis and treatment studies; 2) dialogue with researchers and clinicians about their findings; 3) question them regarding their views about conflicting and ambiguous data and what they feel they really know now.
Synthesizing research and querying those who have been working in the field for many years is undertaking suited for an AIDS treatment activist. There is no professional jealously involved, no financial interests from one or many pharmaceutical companies, and no fear that the most inane or outlandish question could tarnish a sterling reputation. The ability to come at this research — to actually learn cancer as well as constantly re-learning AIDS — without years of lab or clinical experience does bring a fresh perspective which might be helpful to patients and those working in the field of AIDS care and treatment. Having a knowledgeable grasp and an understanding of the many aspects of this neoplasm is one step at power for people living with AIDS.
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