Heterogeneity of acute lymphoblastic leukemia in HIV-seropositive patients.
BACKGROUND
As opposed to large-cell or Burkitt's-type non-Hodgkin's lymphoma, acute lymphoblastic leukemia (ALL) is rarely observed in HIV-seropositive patients and is not a criteria of AIDS in the 1986 classification established by the C.D.C. Furthermore, the few cases of ALL reported so far were B-cell ALL, Burkitt's-type.


METHODS
We recently observed, with unexpected frequency, ALL cases in this setting: over a 5-year period, 5 of 25 HIV-positive patients referred to our center for hematological malignancies, had ALL. Three patients, who had previously been asymptomatic with regard to HIV infection, had typical Burkitt's-type ALL. Complete remission was achieved in all cases with high-dose lymphoma-type chemotherapy regimens, but 2 patients relapsed 3 and 27 months after diagnosis. Their clinical characteristics and outcome are discussed with reference to the cases reported thus far in the literature. One patient had common early pre-B ALL with the Philadelphia chromosome, and one had a T-cell ALL with an unusual CD7+, CD4-, CD8- phenotype. Prognosis was very poor in both cases.


CONCLUSIONS
The exact incidence and the therapeutic management of B-cell ALL in HIV-positive patients warrants further evaluation. In addition, we show that there may be a heterogeneity among ALL cases in this setting, with the first description of 2 non-Burkitt's ALL with atypical features in HIV-positive patients.
Gérinière
L
L
Service d'Hématologie, Centre Hospitalier Lyon-Sud, Pierre Bénite, France.
Bastion
Y
Y
Dumontet
C
C
Salles
G
G
Espinouse
D
D
Coiffier
B
B
D000328:Adult; D015703:Antigens, CD / Q000032:analysis; D019011:Antigens, CD7; D000945:Antigens, Differentiation, T-Lymphocyte / Q000032:analysis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D006679:HIV Seropositivity / Q000150:complications*; D006801:Humans; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000150:complications / Q000276:immunology; D008297:Male; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy; D011379:Prognosis
D015703:Antigens, CD; D019011:Antigens, CD7; D000945:Antigens, Differentiation, T-Lymphocyte