Author Affiliations: HIV and AIDS Malignancy Branch, Division of Clinical Sciences (Dr Little), Medicine Branch (Drs Gutierrez and Wilson), and Laboratory of Pathology, Center for Cancer Research (Dr Jaffe), National Cancer Institute, Bethesda, Md; and Pharmacy Department (Dr Pau) and Clinical Pathology Department (Dr Horne), Clinical Center, National Institutes of Health, Bethesda, Md.
Grand Rounds at the Clinical Center of the National
Institutes of Health Section Editors: John I. Gallin, MD, the Clinical
Center of the National Institutes of Health, Bethesda, Md; David S. Cooper,
MD, Contributing Editor, JAMA.
Patients with acquired immunodeficiency syndrome (AIDS)–associated
non-Hodgkin lymphoma often present with multiple poor prognostic features,
including significant tumor burden, advanced immunosuppression, and other
concurrent morbidities. Strategies to manage such complex multiple-disease
cases have often incorporated the assumption that prospects for long-term
survival are poor and that intensive therapy cannot be tolerated and so is
not justified. Since the advent of highly active antiretroviral therapy for
human immunodeficiency virus infection, life expectancy has improved substantially
for patients in whom the virus can be successfully suppressed. Thus, for complicated
cases involving AIDS-associated malignancy, a reassessment of treatment strategies
and the potential for long-term survival is warranted. Here, we present the
case of a patient with poor prognosis due to AIDS-associated lymphoma with
leptomeningeal involvement, advanced immunosuppression, and deep venous thrombosis.
The management of this case illustrates that a multidisciplinary approach
to complex AIDS cases involving malignancy and concurrent morbidity can result
in a return to functional health in affected patients. Successful strategies
for achieving favorable outcomes currently exist with available therapies.
Little RF, Gutierrez M, Jaffe ES, Pau A, Horne M, Wilson W. HIV-Associated Non-Hodgkin LymphomaIncidence, Presentation, and Prognosis. JAMA. 2001;285(14):1880-1885. doi:10.1001/jama.285.14.1880