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Prognostic Factors in Human Herpesvirus 8–Related Lymphoproliferative Disorders Associated With HIV Infection

Divisions of Medical Oncology A–CRO; Microbiology, Immunology and Virology–CRO; Pathology–CRO, and the Epidemiology Unit, National Cancer Institute, Aviano, Italy

Antonino Carbone

Department of Pathology, National Cancer Institute, Milan, Italy

To the Editor:

In the July 1, 2005, issue of the Journal of Clinical Oncology, Boulanger et al¹ reported that a poor Eastern Cooperative Oncology Group performance status (ECOG PS) and the absence of highly active antiretroviral therapy (HAART) before a primary effusion lymphoma (PEL) diagnosis were identified as being independently associated with impaired outcome in HIV-related PEL. The prognostic value of PS has been well established in HIV-associated non-Hodgkin’s lymphoma (NHL),² and the positive role of HAART in the outcome of HIV-related NHL has been recently reported.^2,3

Therefore, Boulanger et al demonstrated that two of the most important clinical predictors of HIV-related NHL were applicable in HIV-PEL patients, but they did not analyze specific factors such as the Human Herpesvirus–8 (HHV-8) viral load.

It should be noted that in Kaposi’s sarcoma, the HHV-8 viral load could be a predictive marker for the development of the disease and for monitoring the patient response to therapies.⁴

Our group recently reported⁵ that HHV-8 viral load was detectable in the plasma of HIV-PEL patients before and during the chemotherapy and that HHV-8 viral load showed a significant inverse correlation with CD4 count. Moreover, we studied the HHV-8 viral load at the onset of the overall HHV-8–related lymphoproliferative disorders diagnosed in The National Cancer Institute, Aviano, Italy, between April 1987 and June 2004. In all of the 25 HIV-positive patients (nine patients with Multicenter Castlemann Disease, 13 with PEL, and three with HHV-8–positive solid lymphomas) diagnosed and treated in our center, the HHV-8 viral load was measurable. We observed that patients with an HHV-8 viral load greater than 40,000 copies/mL had a shorter survival time. In the univariate analysis, we identified lymphoma diagnosis (hazard ratio [HR] for death = 3.13; 95% CI, 1.12 to 8.75; P = .03), ECOG PS more than 2 (HR for death = 4.52; 95% CI, 1.59 to 12.82; P = .005) and HHV-8 viral load of more than 40,000 copies/mL diagnosis (HR for death = 3.41; 95% CI, 1.10 to 10.57; P = .03) as predictors of an increased risk of death. The multivariate analysis confirmed lymphoma diagnosis to be an independent prognostic factor associated with a higher risk of death (HR for death = 3.68; 95% CI, 1.12 to 12.10; P = .03), whereas PS and HHV-8 viral load showed a borderline significant association (HR for death = 2.78; 95% CI, 0.92 to 8.40; P = .07; HR for death = 3.73; 95% CI, 0.92 to 15.13; P = .06, respectively). Our observation suggested that PS together with HHV-8 viral load might be an important predictor of the clinical outcome of HHV-8–related lymphoproliferative disorders associated with HIV infection. The lack of statistical power might be due to the small sample sizes, but the HHV-8 lymphoproliferative disorders are very rare diseases even in the HIV setting, therefore, we believe that cooperative studies, pooling several series, are needed to validate the role of the HHV-8 viral load as a prognostic marker.

Authors’ Disclosures of Potential Conflicts of Interest

The authors indicated no potential conflicts of interest.

REFERENCES

1. Boulanger E, Gerard L, Gabarre J, et al: Prognostic factors and outcome of human herpesvirus 8–associated primary effusion lymphoma in patients with AIDS. J Clin Oncol 23:4372-4380, 2005[Abstract/Free Full Text]

2. Vaccher E, Spina M, Talamini R, et al: Improvement of systemic human immunodeficiency virus-related non-Hodgkin’s lymphoma outcome in the era of highly active antiretroviral therapy. Clin Infect Dis 37:1556-1564, 2003[CrossRef][Medline]

3. Antinori A, Cingolani A, Alba L, et al: Better response to chemotherapy and prolonged survival in AIDS-related lymphomas responding to highly active antiretroviral therapy. AIDS 15:1483-1491, 2001[CrossRef][Medline]

4. Boivoin G, Gaudreau A, Routy JP, Evaluation of the human herpes 8 DNA load in blood and Kaposi’s sarcoma skin lesions from AIDS patients on highly active antiretroviral therapy. AIDS 14:1907-1910, 2000[CrossRef][Medline]

5. Simonelli C, Tedeschi R, Gloghini A, et al: Characterization of immunologic and virologic parameters in HIV-infected patients with primary effusion lymphoma during antiblastic therapy and highly active antiretroviral therapy. Clin Infect Dis 40:1022-1027, 2005[CrossRef][Medline]

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• In Reply:
  Emmanuelle Boulanger, Laurence Gérard, Eric Oksenhendler, and Félix Agbalika
  JCO 2006 24: 209-210 [Full Text]

This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Simonelli, C. Articles by Carbone, A. Search for Related Content PubMed PubMed Citation Articles by Simonelli, C. Articles by Carbone, A. Related Articles Related Reply Social Bookmarking                            What's this?