IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME (IRIS)-ASSOCIATED BURKITT LYMPHOMA FOLLOWING COMBINATION ANTI-RETROVIRAL THERAPY IN HIV-INFECTED PATIENTS
Identifieur interne : 003588 ( Pmc/Curation ); précédent : 003587; suivant : 003589IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME (IRIS)-ASSOCIATED BURKITT LYMPHOMA FOLLOWING COMBINATION ANTI-RETROVIRAL THERAPY IN HIV-INFECTED PATIENTS
Auteurs : Prakash Vishnu [États-Unis] ; Russell P. Dorer [États-Unis] ; David M. Aboulafia [États-Unis]Source :
- Clinical lymphoma, myeloma & leukemia [ 2152-2650 ] ; 2014.
Abstract
HIV/AIDS-associated immune reconstitution inflammatory syndrome (IRIS) is defined as a paradoxical worsening or unmasking of infections and autoimmune diseases, following initiation of combination anti-retroviral therapy (cART). More recently, the case definition of IRIS has been broadened to include certain malignancies including Kaposi’s sarcoma, and less frequently Hodgkin’s and non-Hodgkin’s lymphoma (NHL). Here in we describe 3 patients infected with HIV who began cART and within a median of 15 weeks each achieved non-detectable HIV viral loads, and yet within 6 months presented for medical attention with fevers, night sweats, weight loss and bulky lymphadenopathy. Laboratory studies included elevated lactate dehydrogenase and β-2 microglobulin levels and well preserved CD4+ lymphocyte counts in excess of 350 cells/µL. In each patient lymph node biopsies were diagnostic of Burkitt lymphoma (BL). Patients were managed with multi-agent chemotherapy in conjunction with cART. We also survey the medical literature of other cases of IRIS-associated BL. Although the pathogenesis of IRIS-associated BL is not well elucidated, chronic antigenic stimulation coupled with immune deterioration, followed by subsequent restoration of the immune response and aberrant cytokine expression may be a pathway to lymphomagenesis. IRIS-associated BL should be suspected in patients with normal or near normal CD4+ lymphocyte counts who develop progressive lymphadenopathy post-initiation of cART.
Url:
DOI: 10.1016/j.clml.2014.09.009
PubMed: 25458079
PubMed Central: 4607473
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<front><div type="abstract" xml:lang="en"><p id="P1">HIV/AIDS-associated immune reconstitution inflammatory syndrome (IRIS) is defined as a paradoxical worsening or unmasking of infections and autoimmune diseases, following initiation of combination anti-retroviral therapy (cART). More recently, the case definition of IRIS has been broadened to include certain malignancies including Kaposi’s sarcoma, and less frequently Hodgkin’s and non-Hodgkin’s lymphoma (NHL). Here in we describe 3 patients infected with HIV who began cART and within a median of 15 weeks each achieved non-detectable HIV viral loads, and yet within 6 months presented for medical attention with fevers, night sweats, weight loss and bulky lymphadenopathy. Laboratory studies included elevated lactate dehydrogenase and β-2 microglobulin levels and well preserved CD4<sup>+</sup>
lymphocyte counts in excess of 350 cells/µL. In each patient lymph node biopsies were diagnostic of Burkitt lymphoma (BL). Patients were managed with multi-agent chemotherapy in conjunction with cART. We also survey the medical literature of other cases of IRIS-associated BL. Although the pathogenesis of IRIS-associated BL is not well elucidated, chronic antigenic stimulation coupled with immune deterioration, followed by subsequent restoration of the immune response and aberrant cytokine expression may be a pathway to lymphomagenesis. IRIS-associated BL should be suspected in patients with normal or near normal CD4<sup>+</sup>
lymphocyte counts who develop progressive lymphadenopathy post-initiation of cART.</p>
</div>
</front>
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<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
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<journal-id journal-id-type="nlm-ta">Clin Lymphoma Myeloma Leuk</journal-id>
<journal-id journal-id-type="iso-abbrev">Clin Lymphoma Myeloma Leuk</journal-id>
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<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
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<title-group><article-title>IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME (IRIS)-ASSOCIATED BURKITT LYMPHOMA FOLLOWING COMBINATION ANTI-RETROVIRAL THERAPY IN HIV-INFECTED PATIENTS</article-title>
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<contrib-group><contrib contrib-type="author"><name><surname>Vishnu</surname>
<given-names>Prakash</given-names>
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<contrib contrib-type="author"><name><surname>Aboulafia</surname>
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<aff id="A1"><label>1</label>
Floyd & Delores Jones Cancer Institute at Virginia Mason Medical Center, Seattle, WA</aff>
<aff id="A2"><label>2</label>
Department of Pathology, Virginia Mason Medical Center, Seattle, WA</aff>
<aff id="A3"><label>3</label>
Division of Hematology, University of Washington, Seattle, WA</aff>
<author-notes><corresp id="cor1"><bold>CORRESPONDING AUTHOR</bold>
. Prakash Vishnu, MD, FACP, Floyd & Delores Jones Cancer Institute at Virginia Mason Medical Center, 1100 9<sup>th</sup>
avenue, Seattle, WA 98101, Phone: (206) 223-6193; Fax: (206) 223-2382, <email>prakash.vishnu@vmmc.org</email>
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<pub-date pub-type="nihms-submitted"><day>22</day>
<month>9</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="epub"><day>02</day>
<month>10</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="ppub"><month>1</month>
<year>2015</year>
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<pub-date pub-type="pmc-release"><day>01</day>
<month>1</month>
<year>2016</year>
</pub-date>
<volume>15</volume>
<issue>1</issue>
<fpage>e23</fpage>
<lpage>e29</lpage>
<pmc-comment>elocation-id from pubmed: 10.1016/j.clml.2014.09.009</pmc-comment>
<abstract><p id="P1">HIV/AIDS-associated immune reconstitution inflammatory syndrome (IRIS) is defined as a paradoxical worsening or unmasking of infections and autoimmune diseases, following initiation of combination anti-retroviral therapy (cART). More recently, the case definition of IRIS has been broadened to include certain malignancies including Kaposi’s sarcoma, and less frequently Hodgkin’s and non-Hodgkin’s lymphoma (NHL). Here in we describe 3 patients infected with HIV who began cART and within a median of 15 weeks each achieved non-detectable HIV viral loads, and yet within 6 months presented for medical attention with fevers, night sweats, weight loss and bulky lymphadenopathy. Laboratory studies included elevated lactate dehydrogenase and β-2 microglobulin levels and well preserved CD4<sup>+</sup>
lymphocyte counts in excess of 350 cells/µL. In each patient lymph node biopsies were diagnostic of Burkitt lymphoma (BL). Patients were managed with multi-agent chemotherapy in conjunction with cART. We also survey the medical literature of other cases of IRIS-associated BL. Although the pathogenesis of IRIS-associated BL is not well elucidated, chronic antigenic stimulation coupled with immune deterioration, followed by subsequent restoration of the immune response and aberrant cytokine expression may be a pathway to lymphomagenesis. IRIS-associated BL should be suspected in patients with normal or near normal CD4<sup>+</sup>
lymphocyte counts who develop progressive lymphadenopathy post-initiation of cART.</p>
</abstract>
<kwd-group><kwd>Immune reconstitution inflammatory syndrome</kwd>
<kwd>HIV/AIDS</kwd>
<kwd>Burkitt lymphoma</kwd>
<kwd>combination anti-retroviral therapy</kwd>
<kwd>cancer</kwd>
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