Combined chemotherapy including high-dose methotrexate in KSHV/HHV8-associated primary effusion lymphoma.
Primary effusion lymphoma (PEL) is a rare KSHV/HHV8-associated high-grade non-Hodgkin's lymphoma (NHL) of B-cell origin, characterized by serous effusions in body cavities. Most patients are HIV-infected homosexual men with severe immunosuppression and other KSHV/HHV8-associated diseases such as Kaposi's sarcoma (KS). The prognosis is poor with a median survival of less than 6 months in most cohorts. The achievement of a sustained complete remission is rare. High-dose chemotherapy regimens are warranted to improve complete remission rate and survival. Seven patients with AIDS-associated PEL were treated with a combined chemotherapy including high-dose methotrexate followed by leucovorin rescue. In all cases, KSHV/HHV8 sequences were detected in the effusion samples using quantitative PCR assays. Five patients had a pre-existing KS, associated in three cases with multicentric Castleman's disease (MCD). Upon diagnosis, 6 patients received antiretroviral therapy, which was maintained during chemotherapy in 5 of them. At time of analysis, 3 out of 7 patients were in complete remission 18, 26, and 78 months after PEL diagnosis. Three patients died with a progressive PEL at 22, 67, and 153 days after diagnosis, and 1 patient died 9 months after PEL diagnosis with a MCD-associated plasmablastic NHL. Complete remission was obtained in 3 out of 7 patients treated for AIDS-associated PEL with combined chemotherapy containing high-dose methotrexate.
Boulanger
Emmanuelle
E
Department of Clinical Immunopathology, Hôpital Saint-Louis, AP-HP, Paris, France. eric.oksenhendler@sls.ap-hop-paris.fr
Daniel
Marie-Thérèse
MT
Agbalika
Félix
F
Oksenhendler
Eric
E
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy; D000328:Adult; D015703:Antigens, CD / Q000097:blood; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D004279:DNA, Viral / Q000302:isolation & purification; D005602:France; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D006566:Herpesviridae Infections / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D019288:Herpesvirus 8, Human / Q000302:isolation & purification; D018451:Homosexuality, Male; D006801:Humans; D016130:Immunophenotyping; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D010996:Pleural Effusion / Q000473:pathology; D011379:Prognosis; D012367:RNA, Viral / Q000097:blood; D012514:Sarcoma, Kaposi / Q000097:blood / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality / Q000473:pathology; D016896:Treatment Outcome; D019562:Viral Load; D044465:White People
D015703:Antigens, CD; D004279:DNA, Viral; D012367:RNA, Viral; D008727:Methotrexate