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Incidence, Presentation, and Prognosis

Richard F. Little, MD; Martin Gutierrez, MD; Elaine S. Jaffe, MD; Alice Pau, PharmD; McDonald Horne, MD; Wyndham Wilson, MD,PhD

JAMA. 2001;285:1880-1885.

ABSTRACT
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.

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.

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