- 130: Journal of Clinical Oncology, Vol 24, No 1 (January 1), 2006: pp. 209
CORRESPONDENCE
Prognostic Factors in Human Herpesvirus 8–Related Lymphoproliferative Disorders Associated With HIV Infection
Cecilia Simonelli, Rosamaria Tedeschi, Annunziata Gloghini, Michele Spina, Renato Talamini, Paolo De Paoli, Umberto Tirelli
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
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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]