Lymphoma in patients with HIV

Thursday, March 14, 2019

Stefan K. Barta, MD, of the University of Pennsylvania, joins David Henry, MD, to discuss the treatment and diagnosis of lymphoma in patients with HIV.

In this week's Clinical Correlation, Ilana Yurkiewicz, MD, has Part 2 of her discussion on informed consent in cancer. Dr. Yurkiewicz is a fellow in hematology and oncology at Stanford University and is also a columnist for Hematology News. More from Dr. Yurkiewicz here.

Notes, Transcripts, Links

Show notes By Emily Bryer, DO Resident in the department of internal medicine, University of Pennsylvania.

  • Immunosuppression in patients with HIV, especially with low CD4 counts, is associated with the development of lymphomas.
  • Diffuse large B-cell lymphoma is the most common lymphoma in patients with HIV followed by Burkitt lymphoma and Hodgkin lymphoma.
  • Extra-nodal manifestations of lymphoma are more common in patients with HIV, especially with lower CD4 counts.
  • Following pathologic diagnosis, staging of lymphoma should include:
    • CT scan
    • PET scan
    • Evaluation of CNS (MRI brain and LP)
    • Bone marrow biopsy
    • Evaluation for hepatitis B and C co-infection.
  • Fluorescence in situ hybridization (FISH) is a molecular technique that identifies portions of DNA and helps to identify translocations and rearrangements.
  • cMYC, BCL2, and BCL6 are all pro-proliferative genes and commonly implicated in lymphoma.
  • cMYC rearrangement pose higher risk of CNS involvement and CNS relapse.
  • cMYC rearrangement (as opposed to cMYC translocation) requires therapy that is more aggressive therapy than R-CHOP.
  • Treatment of high grade diffuse large B-cell lymphoma:
    • R-EPOCH
    • Ibrutinib plus R-EPOCH

Resources/Links:
AIDS Malignancy Consortium
Blood. 2004;103:275-82.
Blood. 2010 Apr 15; 115(15): 3008-16.

Clinical Trial: NCT03220022
Ibrutinib, Rituximab, Etoposide, Prednisone, Vincristine Sulfate, Cyclophosphamide, and Doxorubicin Hydrochloride in Treating Patients With HIV-Positive Stage II-IV Diffuse Large B-Cell Lymphomas

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Podcast Participants

David Henry, MD
David Henry, MD, FACP, is a clinical professor of medicine at the University of Pennsylvania and vice chairman of the department of medicine at Pennsylvania Hospital in Philadelphia. He received his bachelor’s degree from Princeton University and his MD from the University of Pennsylvania, then completed his internship, residency, and fellowship at the Hospital of the University of Pennsylvania. After 2 years as an attending in the U.S. Air Force, he was drawn to practicing as a hem-onc because of the close patient contact and interaction, and his belief that, win or lose with each patient, one can always make a difference in their care and lives. Follow Dr. Henry on Twitter: @davidhenrymd. Dr. Henry reported being on the advisory board for Amgen, AMAG Pharmaceuticals, and Pharmacosmos. He reported institutional funding from the National Institutes of Health and FibroGen.



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