Guidelines on Diagnosis and Treatment of Malignant Lymphomas

of cases and EBV in about 50%, but no association with
KSHV/HHV8 has been found. Markers of plasmacytic
differentiation such as CD138 are positive.
Staging
Staging of HIV-related lymphomas uses the classification used in
other settings such as the Ann Arbor classification and that used
for BL.
Recommended Investigations:
Generic: see page 2
Specific:
Full history and examination with particular
reference to AIDS status and HAART therapy
CD4 count
Potential Pitfalls
a. Failure to recognise HIV-positive status
b. Inappropriate nihilism in face of better treatment outcomes
c. Failure to consider drug interactions in the context of HAART
d. Failure to use appropriate prophylaxis against
opportunistic infections
Treatment
Patients need to be managed in a multidisciplinary setting with
joint management by an infectious disease team and a team
skilled in the management of lymphoma.
Comorbidities and the status of HIV will determine the intensity
of treatment possible.
HL and BL are treated using standard therapy and continuing
HAART. The outcome of patients with DLBCL treated with
dose adjusted R-EPOCH appears particularly encouraging.
Favourable prognostic factors include good performance status,
low IPI, preserved CD4 count and no history of IV drug abuse.
Patients with BL are usually treated with standard Burkitt
regimens, though good results have also been obtained with
DA-R-EPOCH and both DFS and OS at 5 years
of about 50% can be achieved.
PEL and primary CNS lymphoma remain almost uniformly fatal
with a median survival of 6 months.
Relapse Evaluation and Follow Up
Response evaluation and follow up should be the same as for
immune competent patients. Patients with HIV-related lymphomas
will also be on lifetime follow up by the infectious disease service.
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