Article: AIDS-Related Lymphoma Treatment


What is AIDS-related lymphoma?

AIDS-related lymphoma is a disease in which cancer (malignant) cells are found in the lymph system in patients who have AIDS (acquired immunodeficiency syndrome). AIDS is caused by the human immunodeficiency virus (HIV) which attacks and weakens the immune system. Infections and other diseases can then invade the body, and the immune system cannot fight against them.

The lymph system is made up of thin tubes that branch, like blood vessels, into all parts of the body. Lymph vessels carry lymph, a colorless, watery fluid that contains white blood cells called lymphocytes. Along the network of vessels are groups of small, bean-shaped organs called lymph nodes. Clusters of lymph nodes make and store infection-fighting cells. The spleen (an organ in the upper abdomen that makes lymphocytes and filters old blood cells from the blood), the thymus (a small organ beneath the breastbone), and the tonsils (an organ in the throat) are also part of the lymph system. Because there is lymph tissue in many parts of the body, the cancer can spread to almost any of the body's organs or tissues including the liver, bone marrow (the spongy tissue inside the large bones of the body that makes blood cells), spleen, or brain.

Lymphomas are divided into two general types, Hodgkin's lymphomas and non-Hodgkin's lymphomas, which are classified by the way their cells look under a microscope. This determination is called the histology. Histology is also used to determine the type of non-Hodgkin's lymphoma. The types of non-Hodgkin's lymphomas are classified by how quickly they spread: aggressive lymphomas grow and spread faster than indolent lymphomas.

Both major types of lymphoma, Hodgkin's lymphoma and non-Hodgkin's lymphoma, may occur in AIDS patients. Also, the aggressive types of non-Hodgkin's lymphoma are more commonly found in AIDS patients. Both types of lymphomas can also occur in adults and in children. (Refer to the PDQ summaries on Adult Hodgkin's Lymphoma Treatment; Childhood Hodgkin's Lymphoma Treatment; Adult Non-Hodgkin's Lymphoma Treatment; Childhood Non-Hodgkin's Lymphoma Treatment; and Primary CNS Lymphoma Treatment for more information.)

A doctor should be seen if any of the following symptoms persist for longer than 2 weeks: painless swelling in the lymph nodes in the neck, underarm, or groin; fever; night sweats; tiredness; weight loss without dieting; or itchy skin.

If a patient has AIDS and symptoms of lymphoma, a doctor will carefully check for swelling or lumps in the neck, underarms, and groin. If the lymph nodes don't feel normal, the doctor may need to cut out a small piece of tissue and look at it under the microscope to see if there are any cancer cells. This procedure is called a biopsy.

In general, patients with AIDS-related lymphoma respond to treatment differently than patients with lymphoma who do not have AIDS. AIDS-related lymphoma usually grows faster and spreads outside the lymph nodes and to other parts of the body more often than lymphoma that is not related to AIDS. Because therapy can damage weak immune systems even further, patients who have AIDS-related lymphoma are generally treated with lower doses of drugs than patients who do not have AIDS.

Stage Explanation

Stages of AIDS-related lymphoma

Once AIDS-related lymphoma is found, more tests will be done to find out if the cancer has spread from where it started to other parts of the body. This testing is called staging. The stage of a disease, ranging from stage I to stage IV, gives an indication of how far the disease has spread. To plan treatment, a doctor needs to know the stage of the disease.

The doctor may determine the stage of the disease by conducting a thorough examination which may include blood tests and different kinds of x-rays. This testing is called clinical staging. In some cases, the doctor may need to do an operation called a laparotomy to determine the stage of the cancer. During this operation, the doctor cuts into the abdomen and carefully looks at the organs to see if they contain cancer. The doctor will cut out (biopsy) small pieces of tissue and look at them under a microscope to see whether they contain cancer. This type of staging is called pathologic staging. Pathologic staging is usually done only when it is needed to help the doctor plan treatment.

For treatment, AIDS-related lymphomas are grouped based on where they started, as follows:

Systemic/peripheral lymphoma

Lymphoma that has started in lymph nodes or other organs of the lymph system. The lymphoma may have spread from where it started throughout the body, including to the brain or bone marrow.

Primary central nervous system lymphoma

Lymphoma that has started in the brain or spinal cord, both of which are part of the central nervous system (CNS). This type of lymphoma is called a “primary CNS lymphoma” because it starts in the CNS rather than starting somewhere else in the body and spreading to the CNS.

Treatment Option Overview

How AIDS-related lymphoma is treated

The treatment of AIDS-related lymphoma is difficult because of the problems caused by HIV infection, which weakens the immune system. The drug doses used are often lower than drug doses given to patients who do not have AIDS. Two types of treatment are used:

  • Chemotherapy (using drugs to kill cancer cells and shrink tumors)
  • Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells and shrink tumors)

Chemotherapy is the use of drugs to kill cancer cells and shrink tumors. Chemotherapy may be taken by pill, or it may be put into the body by inserting a needle into a vein or muscle. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body. Chemotherapy may be put into the fluid that surrounds the brain through a needle in the brain or back (intrathecal chemotherapy) to treat non-Hodgkin's lymphoma that has spread to the brain.

Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink tumors. Radiation for non-Hodgkin's lymphoma usually comes from a machine outside the body (external-beam radiation therapy). Radiation given to the brain is called cranial irradiation. Radiation therapy may be used alone or in addition to chemotherapy.

Additionally, clinical trials are testing the effect of giving drugs to kill the AIDS virus (antiviral therapy) in addition to treatment of lymphoma.

Treatment of AIDS-related lymphomas depends on the stage, histology, and whether the disease is indolent or aggressive, as well as the general health of the patient. A doctor must consider white blood cell count and any other diseases caused by AIDS that the patient had or currently has.

Standard treatment may be considered based on its effectiveness in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy, and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615 or the AIDS Clinical Trials Information Service at 1-800-342-AIDS (1-800-342-2437).

AIDS-Related Peripheral/Systemic Lymphoma

Treatment may be one of the following:

  1. Standard-dose or low-dose systemic chemotherapy plus intrathecal chemotherapy.
  2. A clinical trial of systemic chemotherapy plus colony-stimulating factors and antiretroviral therapy.
  3. A clinical trial of high-dose therapy and stem cell transplantation.

AIDS-Related Primary CNS Lymphoma

Treatment will probably be cranial radiation therapy. A clinical trial of new types of treatment may also be an option.

Changes to This Summary (05/19/2003)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Changes were made to this summary to match those made to the health professional version.

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PDQ also contains information on clinical trials.

Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."

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Source: National Cancer Institute
Cache Date: December 10, 2004