Open questions on new treatment strategies of lymphomas in individuals infected by HIV
| Questions . | Comments . |
|---|---|
| 1. Should rituximab be included within the regimen in CD20+ HIV-NHL? | The combination of rituximab and chemotherapy results in significant clinical benefit for all CD20+ HIV-NHL patients compared with chemotherapy alone (higher CR rates and better PFS and OS), as in the general population. There is need to maximize opportunistic infection prophylaxis in patients with CD4 count ≤50/µL, according to current guidelines on HIV management. |
| 2. What is the best chemotherapy regimen (infusional vs bolus chemotherapy)? | In the cART era, the standard treatments of HIV-associated lymphomas (infusional or bolus chemotherapy) mirror that of HIV-negative patients, but controversy remains regarding the optimal chemotherapy regimen. |
| 3. Are there subtypes of lymphomatous disease that should be treated differently from others? | The best therapy for HIV-associated BL still remains unclear, but CHOP chemotherapy backbone is not recommended. HIV-infected patients with PBL or PEL continue to be characterized by a dismal prognosis and should be included in clinical trials. HD methothrexate-based chemotherapy is recommended for selected† HIV-positive patients with PCNSL, based on general consensus. For patients inelegible for chemotherapy, WBRT remains a useful palliative treatment. |
| 4. Should antiretroviral therapy be suspended during chemotherapy? | All HIV-infected patients with cancer must be mainteined on cART during antineoplastic treatment. Ritonavir or cobicistat-based antiretroviral regimens must be avoided because of drug-drug interactions. |
| 5. Is the approach with intensive chemotherapy and peripheral stem cell rescue feasible? | HIV infection should not preclude lymphoma patients from undergoing HDC-ASCT, according to the same eligibility criteria adopted for the general population. |
| Questions . | Comments . |
|---|---|
| 1. Should rituximab be included within the regimen in CD20+ HIV-NHL? | The combination of rituximab and chemotherapy results in significant clinical benefit for all CD20+ HIV-NHL patients compared with chemotherapy alone (higher CR rates and better PFS and OS), as in the general population. There is need to maximize opportunistic infection prophylaxis in patients with CD4 count ≤50/µL, according to current guidelines on HIV management. |
| 2. What is the best chemotherapy regimen (infusional vs bolus chemotherapy)? | In the cART era, the standard treatments of HIV-associated lymphomas (infusional or bolus chemotherapy) mirror that of HIV-negative patients, but controversy remains regarding the optimal chemotherapy regimen. |
| 3. Are there subtypes of lymphomatous disease that should be treated differently from others? | The best therapy for HIV-associated BL still remains unclear, but CHOP chemotherapy backbone is not recommended. HIV-infected patients with PBL or PEL continue to be characterized by a dismal prognosis and should be included in clinical trials. HD methothrexate-based chemotherapy is recommended for selected† HIV-positive patients with PCNSL, based on general consensus. For patients inelegible for chemotherapy, WBRT remains a useful palliative treatment. |
| 4. Should antiretroviral therapy be suspended during chemotherapy? | All HIV-infected patients with cancer must be mainteined on cART during antineoplastic treatment. Ritonavir or cobicistat-based antiretroviral regimens must be avoided because of drug-drug interactions. |
| 5. Is the approach with intensive chemotherapy and peripheral stem cell rescue feasible? | HIV infection should not preclude lymphoma patients from undergoing HDC-ASCT, according to the same eligibility criteria adopted for the general population. |
HDC-ASCT, high-dose chemotherapy-autologous stem cell transplantation.
Patients responsive to cART, with good performance status and without opportunistic infections.